Pregnancy-Associated Plasma Protein A2 in Hemodialysis Patients: Significance for Prognosis

Kidney Blood Press Res. 2017;42(3):509-518. doi: 10.1159/000479847. Epub 2017 Aug 30.


Background: Pregnancy-associated plasma protein A (PAPP-A) is associated with adverse outcome of long-term hemodialysis patients (HD). The aim of the study was to test whether its homolog pregnancy-associated plasma protein A2 (PAPP-A2) can be detected in serum of HD patients and to define its significance.

Methods: The studied group consisted of 102 long-term HD patients and 25 healthy controls. HD patients were prospectively followed up for five years (2009-2014). PAPP-A2 was measured by surface plasmon resonance biosensor, PAPP-A by time resolved amplified cryptate emission.

Results: PAPP-A2, similarly as PAPP-A, was significantly increased in HD patients (median (interquartile range)) PAPP-A2: 6.2 (2.6-10.8) ng/mL, vs. 3.0 (0.7-5.9) ng/mL, p=0.006; PAPP-A: 18.9 (14.3-23.4) mIU/L, vs. 9.5 (8.4-10.5) mIU/L, p<0.001). In HD patients, PAPP-A2 correlated weakly but significantly with PAPP-A (τ=0.193, p=0.004). Unlike PAPP-A, PAPP-A2 was not significant for prognosis of HD patients when tested alone. There was a significant interaction between PAPP-A and PAPP-A2 on the mortality due to infection of HD patients (p=0.008). If PAPP-A was below median, mortality due to infection was significantly higher for patients with PAPP-A2 values above median than for patients with low PAPP-A2 levels (p=0.011).

Conclusion: PAPP-A2 is increased in HD patients and interacts with PAPP-A on patients´ prognosis.

Keywords: Hemodialysis; Infection; Mortality; PAPP-A; PAPP-A2; Surface plasmon resonance.

MeSH terms

  • Biomarkers / blood
  • Case-Control Studies
  • Humans
  • Infections / mortality
  • Kidney Failure, Chronic / blood
  • Kidney Failure, Chronic / diagnosis*
  • Pregnancy-Associated Plasma Protein-A / analysis*
  • Prognosis
  • Prospective Studies
  • Renal Dialysis


  • Biomarkers
  • PAPPA2 protein, human
  • Pregnancy-Associated Plasma Protein-A