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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

Editor-in-Chief: Plebani, Mario

Ed. by Gillery, Philippe / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Payne, Deborah A. / Schlattmann, Peter / Tate, Jillian R.

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Pregnancy-associated plasma protein A in dialysis patients

Abdurrahman Coskun1 / Zerrin Bicik2 / Sadik Duran3 / Aytekin Alcelik4 / Zeki Soypacaci5 / Ozlem Yavuz6 / Sukru Oksuz7








Corresponding author: Abdurrahman Coskun, MD, Duzce University, School of Medicine, Department of Clinical Biochemistry, 81620 Konuralp, Duzce, Turkey Phone: +90-542-2380639, Fax: +90-380-5414105,

Citation Information: Clinical Chemical Laboratory Medicine. Volume 45, Issue 1, Pages 63–66, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: 10.1515/CCLM.2007.007, January 2007

Publication History

August 23, 2006
October 4, 2006
Published Online:


Background: Pregnancy-associated plasma protein A (PAPP-A) was recently described as a new marker of cardiovascular events and of inflammation in uremic patients. The aim of this study was to determine levels of PAPP-A in chronic dialysis patients and its possible relationships with renal osteodystrophy.

Methods: A total of 99 adult chronic hemodialysis patients, 14 peritoneal dialysis patients and 41 control subjects were included in the study. Serum PAPP-A, intact parathormone (iPTH), calcium, phosphorus and alkaline phosphatase (ALP) were measured. The correlations between PAPP-A and iPTH, calcium, phosphorus and ALP were determined.

Results: PAPP-A levels were significantly higher in peritoneal dialysis [4.5 (3.2–6.7) mU/L, median (interquartile range)], and hemodialysis patients [4.7 (3.8–6.5) mU/L] in comparison to control subjects [3.4 (3.0–5.0) mU/L] (p<0.05). In hemodialysis patients, post-dialysis PAPP-A levels [6.2 (4.7–9.4) mU/L] were significantly higher than pre-dialysis levels [4.7 (3.8–6.5) mU/L] (p<0.05). There was a weak but statistically significant positive correlation between serum PAPP-A and iPTH (r=0.216; p=0.041) and ALP (r=0.205; p=0.044) in the hemodialysis group. Correlation between the duration of dialysis therapy and PAPP-A levels was also significant (r=0.267; p=0.008) in the hemodialysis group.

Conclusions: PAPP-A levels are elevated in acute coronary syndromes and are closely related to inflammation and oxidative stress. We conclude that PAPP-A levels are increased in dialysis patients and may reflect a greater degree of chronic inflammation than osteodystrophy in uremic patients.

Clin Chem Lab Med 2007;45:63–6.

Keywords: hemodialysis; insulin-like growth factor; insulin-like growth factor-binding protein; osteodystrophy; pregnancy-associated plasma protein A; renal insufficiency

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