Pentraxin-3 in hemodialysis patients: Relationship to comorbidities

Hemodialysis (HD), despite being the most common treatment modality for endstage renal disease (ESRD), still carries a mortality rate higher than 20-50%/year resulting from various comorbidities. The aim of this study was to measure the plasma level of pentraxin-3 (PTX-3) in patients on maintenance HD and to assess its relationships to comorbidities such as malnutrition and associated comorbid diseases. This case-control study included 50 HD patients, 30 ESRD patients, and 30 healthy controls. HD patients were classified into different subgroups according to the Davies comorbidity index and malnutrition score. Plasma PTX-3 was analyzed by a sandwich ELISA technique. Plasma level of PTX-3 reached its highest levels in HD patients followed by ESRD patients as compared to healthy controls. Moreover, within the different subgroups, the highest levels and the highest odd ratio of PTX-3 were detected in the subgroups having the highest Davies comorbidity index or the highest malnutrition score as compared to the other subgroups. At a cutoff of 0.6 ng/mL, PTX-3 was able to discriminate HD patients with low Davies comorbidity index from those with both medium and high Davies comorbidity index with a diagnostic sensitivity of 92.5% and a diagnostic specificity of 70.0%. Meanwhile, the best cutoff of plasma PTX-3 for discriminating patients with mild malnutrition from severe and moderate malnutrition was 0.6 ng/mL with a diagnostic sensitivity of 90.9% and a diagnostic specificity of 41.2%. In conclusion, PTX-3 appears to be a clinically useful marker for the early identification of patients with renal failure on maintenance HD who are at substantially increased risk of morbidity. These patients may require care and aggressive follow-up in more specialized units and an early referral to a renal transplant center.