Relationship between Circulating Galectin-3, Systemic Inflammation, and Protein-Energy Wasting in Chronic Hemodialysis Patients

Abstract

Galectin-3 reportedly participates in the inflammatory process that causes insulin resistance in the target tissues. However, the role of high plasma galectin-3 levels as an indicator of protein-energy wasting (PEW) in patients undergoing maintenance hemodialysis remains unclear. This study included 240 hemodialysis patients (64.5 [55.3-74.0] years, 35.8% women) from a tertiary medical center. A baseline assessment of demographic and clinical data, biochemical parameters, and body composition was conducted. Plasma galectin-3 and other biomarkers were measured using a multiplex bead-based immunoassay. Participants were then divided into two subgroups depending on the median value of plasma galectin-3. Malnutrition was identified using the geriatric nutritional risk index (GNRI) and the criteria of the International Society of Renal Nutrition and Metabolism. Independent risk factors for elevated plasma galectin-3 and malnutrition were identified by multivariate logistic regression. The high galectin-3 group was more likely to be older, have lower lean tissue mass and GNRI scores, be diagnosed with PEW, dialyze through a tunneled catheter, and have higher circulating IL-6, TNF-α, and MCP-1 concentrations than the low galectin-3 group. After multivariate adjustment, only low mean arterial pressure, dialyzing with tunneled cuffed catheters, and elevated systemic inflammatory markers correlated with high galectin-3 levels. Plasma galectin-3 concentrations also increased significantly in hemodialysis patients with PEW. However, compared with other commonly used nutritional indicators, galectin-3 did not show superiority in predicting PEW. Although the plasma galectin-3 levels correlated with PEW severity, this correlation disappeared after adjustment for potential confounding variables (OR, 1.000; 95% CI, 0.999-1.001). In conclusion, plasma galectin-3 is a valuable biomarker for systemic inflammation but is less prominent for PEW in patients with maintenance hemodialysis. Further identification of novel biomarkers is required to detect patients at risk for malnutrition and implement appropriate interventions.

Keywords: galectin-3; hemodialysis; lean tissue mass; protein-energy wasting; systemic inflammation.

Figure 1

(A) The correlation matrix summarizes the strength of the association among body composition indices, systemic inflammatory factors, geriatric nutritional risk index, and plasma galectin-3 in adults undergoing maintenance hemodialysis. The numbers in each cell represent the value of the Spearman’s correlation coefficient. (B) The table represents the corresponding p values in (A). BMI: body mass index, FFMI: fat-free mass index, FMI: fat mass index, GNRI: geriatric nutritional risk index,IL-6:interleukin-6, TNF-α: tumor necrosis factor-alpha, MCP-1: monocyte chemoattractant protein-1

Figure 2

Plasma galectin-3 concentrations and predictive power for PEW in chronic hemodialysis patients. (A) In hemodialysis patients with PEW, plasma galectin-3 concentrations were significantly (p < 0.01) elevated as compared to subjects without PEW. (B) Receiver operating characteristic (ROC) curve analyses comparing the predictive accuracy in identifying PEW of galectin-3 with other classical nutritional and inflammatory indices.