Kidney Week

Abstract: SA-PO390

Lectin Pathway Initiators Ficolin-1 and Collectin-11 Are Associated with Mortality in Patients on Hemodialysis

Session Information

• Hemodialysis and Frequent Dialysis - 2
  October 26, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• De Laval, Philip, Department of Medical Sciences, Uppsala University, Uppsala, Sweden

Philip De Laval, MD

• Glerup, Rie Io, Department of Nephrology, Aalborg University Hospital, Aalborg, Denmark

Rie Io Glerup, MD, PhD

• Svensson, My, Department of Nephrology, Aalborg University Hospital, Aalborg, Denmark

My Svensson, MD, PhD, MPA

• Eriksson, Niclas, Uppsala Clinical Research Center, Uppsala, Sweden

Niclas Eriksson, MSc, PhD

• Pérez Alós, Laura, Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark

Laura Pérez Alós, MSc, PhD

• Garred, Peter, Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark

Peter Garred, DrMed, PhD

• Nilsson, Bo, Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden

Bo Nilsson, MD, DrPH

• Ekdahl, Kristina N., Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden

Kristina N. Ekdahl, PhD

• Fellstrom, Bengt C., Department of Medical Sciences, Uppsala University, Uppsala, Sweden

Bengt C. Fellstrom, MD, PhD

• Soveri, Inga, Department of Medical Sciences, Uppsala University, Uppsala, Sweden

Inga Soveri, MD, PhD

Background

Cardiovascular disease (CVD) is the leading cause of death in hemodialysis (HD) patients. The complement system may contribute to inflammation, which is considered a non-traditional risk factor for CVD, through activation of the lectin pathway during HD. Intradialytic complement activation has been linked to cardiovascular (CV) events but studies on the lectin pathway with regards to outcome in HD are few. We aimed to assess if baseline levels of lectin pathway factors are associated with clinical outcome in HD patients.

Methods

We conducted a cohort study with five years of follow-up. All patients > 18 years of age in five HD facilities in Jutland, Denmark without acute kidney injury were asked to participate. Plasma levels of complement factors C3a, sC5b-9, C3(H₂O), MBL, ficolin-1,-2,-3, pentraxin 3, collectin-11, MASP-1- and MASP-2-Antithrombin/C1-inhibitor complexes, MASP-3 and MAP-1 were analyzed using ELISAs. The endpoints were all-cause mortality, infection-related mortality, CV-mortality and CV-events. Hazard ratios (HR) were modeled using cox regression on one standard deviation increase in log₂ complement levels. Known risk factors for mortality in HD were added in a second model. These were age, log₂ dialysis vintage, diabetes mellitus, previous CVD and log₂ albumin, CRP, troponin I, and troponin T.

Results

In total, 331 patients were included. During follow-up, 198 (60%) died. Ficolin-1 and collectin-11 levels were associated with all-cause mortality in both the crude (Fig. 1A) and adjusted (Fig. 1B) model. Collectin-11 was significantly associated with CV-mortality in the adjusted (HR 1.35 [95% CI 1.02-1.77]) but not in the crude model (HR 1.26 [95% CI 0.98-1.63]).

Conclusion

Lectin pathway initiators ficolin-1 and collectin-11 are associated with death in HD patients, independently of known risk factors. This suggests an adverse role for the lectin complement pathway in HD patients.

Funding

• Private Foundation Support