title: Strong predictive value of mannose-binding lectin levels for cardiovascular risk of hemodialysis patients.
abstract: Hemodialysis patients have higher rates of cardiovascular morbidity and mortality compared to the general population. Mannose-binding lectin (MBL) plays an important role in the development of cardiovascular disease. In addition, hemodialysis alters MBL concentration and functional activity. The present study determines the predictive value of MBL levels for future cardiac events (C-event), cardiovascular events (CV-event) and all-cause mortality in HD patients.
  
  
  
  We conducted a prospective study of 107 patients on maintenance hemodialysis. Plasma MBL, properdin, C3d and sC5b-9 was measured before and after one dialysis session. The association with future C-events, CV-events, and all-cause mortality was evaluated using Cox regression models.
  
  
  
  During median follow-up of 27 months, 36 participants developed 21 C-events and 36 CV-events, whereas 37 patients died. The incidence of C-events and CV-events was significantly higher in patients with low MBL levels (<319 ng/mL, lower quartile). In fully adjusted models, low MBL level was independently associated with increased CV-events (hazard ratio 3.98; 95 % CI 1.88-8.24; P < 0.001) and C-events (hazard ratio 3.96; 95 % CI 1.49-10.54; P = 0.006). No association was found between low MBL levels and all-cause mortality. Furthermore, MBL substantially improved risk prediction for CV-events beyond currently used clinical markers.
  
  
  
  Low MBL levels are associated with a higher risk for future C-events and CV-events. Therefore, MBL levels may help to identify hemodialysis patients who are at risk to develop cardiovascular disease.
authors: Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. f.poppelaars@student.rug.nl.
authors: Felix
authors: 0000-0002-5173-8078
authors: F
authors: Poppelaars
authors: Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors: Mariana
authors: M
authors: Gaya da Costa
authors: Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors: Stefan P
authors: SP
authors: Berger
authors: Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors: Solmaz
authors: S
authors: Assa
authors: Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors: Anita H
authors: AH
authors: Meter-Arkema
authors: Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.|Department of Nephrology, Leiden University Medical Center, University of Leiden, Leiden, The Netherlands.
authors: Mohamed R
authors: MR
authors: Daha
authors: Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors: Willem J
authors: WJ
authors: van Son
authors: Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors: Casper F M
authors: CF
authors: Franssen
authors: Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors: Marc A J
authors: MA
authors: Seelen
mesh_terms: D002318:Cardiovascular Diseases / Q000097:blood* / Q000209:etiology* / Q000401:mortality; D002423:Cause of Death; D015933:Complement C3d / Q000378:metabolism; D015938:Complement Membrane Attack Complex / Q000378:metabolism; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D037601:Mannose-Binding Lectin / Q000097:blood*; D008875:Middle Aged; D011237:Predictive Value of Tests; D011414:Properdin / Q000378:metabolism; D006435:Renal Dialysis / Q000009:adverse effects*; D012307:Risk Factors
chemical_list: D015938:Complement Membrane Attack Complex; D037601:Mannose-Binding Lectin; D011414:Properdin; D015933:Complement C3d
keywords: Cardiovascular; Complement; Hemodialysis; MBL; Risk