Pentraxin 3 – A Novel Prognostic Biomarker For Endothelial Dysfunction In Esrd Patients

Endothelial dysfunction is a common feature in the uremic environment that develops relatively early in the pathogenesis of CKD. It is associated with chronic inflammation, and predicts both cardiovascular events and adverse patient outcomes. The aim of this review is to present Pentraxin 3 (PTX3) as a new prognostic biomarker with plasma levels that exhibit notably enhanced accuracy in outcome prediction. It demonstrates a consistent correlation with other inflammatory markers, disorders of lipid metabolism, and adipokines, and functions independently as a risk factor for unfavorable outcomes, malnutrition, and cardiovascular risks in patients undergoing hemodialysis (HD). ESRD patients exhibit notably elevated PTX3 levels, aligned with heightened vascular resistance and accelerated atherosclerosis, effectively aligning with well-established markers of endothelial dysfunction. In HD patients, PTX3 levels display more variation compared to CRP, and their sustained elevation over three months associates with an augmented risk of cardiovascular mortality. Paradoxically, heightened PTX3 levels, despite increased RNA expression in adipose tissue, coincide with poorer nutritional status and malnutrition. Notably, dialysis procedures themselves stimulate additional PTX3 production, prompting inquiries into the enhanced biocompatibility of HD membranes and exploring the effects of highflux HD and online hemodiafiltration on plasma PTX3 levels. Furthermore, negative correlations between PTX3, albuminuria in diabetics at various stages of diabetic nephropathy, and PTX3 and GFR in early CKD stages challenge its predictive role and relevance in disease onset and progression. In conclusion, the highlighted unresolved issues, along with the persistently elevated mortality rate within the rapidly growing ESRD patient population, position PTX3 as a promising marker capable of altering prognoses in the early stages. Therefore, it is necessary to conduct more complex studies and develop a strategic approach, considering its potential therapeutic implications.