Serum Mannose-Binding Lectin Levels in Maintenance Hemodialysis Patients: Impact on All-Cause Mortality

Abstract

Background/Aims: Mannose-binding lectin (MBL) is characteristic of an acute-phase-reacting protein like C-reactive protein (CRP). However, the prognostic value of the serum MBL level has not been examined. The aim of this study was to evaluate whether the serum MBL level can predict all-cause mortality in hemodialysis (HD) patients. Methods: A total of 131 patients without active infection, who had been on maintenance HD for at least 2 years, were included in this study. The serum MBL, high-sensitivity CRP (hs-CRP) level, nutrition markers, and biochemical parameters were measured in June 1999. The cohort was then followed prospectively for 36 months, and clinical data were recorded. Results: The MBL level of the 131 HD patients was 9.054 ± 5.115 µg/ml (mean ± SD). During the follow-up period, 18 patients (9 males and 9 females) died and 113 (64 males and 49 females) survived. The two leading causes of death were cardiovascular events (n = 6, 33.3%) and infection (n = 4, 22.2%). The serum MBL level was significantly lower among the nonsurvivors (6.596 ± 4.990 µg/ml) than among the survivors (9.445 ± 5.046 µg/ml; p < 0.05). There was a significant, although very weak, correlation between the MBL level and albumin level (p < 0.05), but there was no correlationbetween the MBL level and the hs-CRP level. The patients were divided into two groups according to the serum MBL level (<5 and >5 µg/ml). Multivariate analysis of factors predicting all-cause mortality in multivariate logistic regression analysis identified a serum MBL level <5 µg/ml as a variable that independently predicted all-cause mortality (adjusted odds ratio: 7.632; 95% CI: 2.244–25.961; p = 0.0011). Other significant and independent predictors for mortality included the hs-CRP level (every 100 µg/dl increase), hypertension and diabetes mellitus. Conclusions: Our findings suggest that the serum MBL level is a significant predictor of outcome in HD patients. HD patients with a low level of serum MBL should be carefully monitored.

Functional Mannose-Binding Lectin Levels in Patients with End-Stage Renal Disease on Maintenance Hemodialysis

“…However, inasmuch as oligomer MBL is characteristic of positive acute-phase proteins like CRP, functional and oligomer MBL levels showed no correlations with CRP levels. Interestingly, in a report by Akbari et al [35], the correlation between MBL and CRP levels was not significant in HD patients, which concurred with the correlation between oligomer MBL and high-sensitivity CRP levels found in our previous study [34]. MBL and CRP are both primarily synthesized in the liver, and levels of proinflammatory cytokines such as interleukin-6, interleukin-1 and tumor necrosis factor-α are generally affected.…”

“…The oligomer MBL levels were measured with a commercial ELISA kit (MBL oligomer ELISA kit; BioProto Diagnostics). Previously, the serum oligomer MBL levels were measured by an ELISA using polyclonal rabbit IgG and a monoclonal antibody directed against MBL (3E7) [31,32,33,34]. Both primary and secondary antibodies were different using the two ELISA methods.…”

Early Posttransplant Serum Osteoprotegerin Levels Predict Long-Term (8-Year) Patient Survival and Cardiovascular Death in Renal Transplant Patients

“…This finding is supported to some extent by the results of a large Danish population-based follow-up study (8 to 24 yr) of approximately 10,000 adults that showed that MBL deficiency is not a major risk factor for morbidity and death (46). However, our results are in contrast with the Japanese 3-yr follow-up study of hemodialysis patients that showed lower serum MBL concentrations in nonsurvivors (15). To our knowledge, no other study has addressed the possible associations between MBL, MASP-2, and MASP-3 and CV end points in RTR, and further studies obviously are needed.…”

“…MBL has been suggested to have beneficial effects on atherosclerotic events (14), and the serum MBL levels were significantly lower among nonsurvivors than survivors in a recently published 3-yr follow-up study of 131 Japanese hemodialysis patients (15). Furthermore, Fiane et al (16) demonstrated that MBL deficiency (Ͻ100g/L) was associated with allograft vasculopathy and acute rejection in human heart transplant recipients.…”

Mannose-binding lectin and its associated proteases (MASPs) mediate coagulation and its deficiency is a risk factor in developing complications from infection, including disseminated intravascular coagulation

“…Infection arises as a result of bacteremia from reduced opsonophagocytic killing and reduced lectin complement pathway activation (Moller-Kristensen, et al, 2006, Shi, et al, 2004). Recent clinical studies have reported an association of MBL deficiency with increased morbidity and mortality (Garred, et al, 1999, Mullighan and Bardy, 2004, Satomura, et al, 2006, Tran, et al, 2007). …”