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Abstract: SA-PO181

Is Zinc-Alpha2-Glycoprotein (ZAG) a Predictor of Mortality in Patients on Hemodialysis?

Session Information

Category: Nutrition, Inflammation, and Metabolism

  • 1401 Nutrition, Inflammation, Metabolism


  • Bouchara, Anaïs, Hôpital Lyon Sud, LYON, France
  • Yi, Dan, INSA-Lyon, VILLEURBANE, France
  • Pastural, Myriam, AURAL, LYON, France
  • Laville, Maurice, Hôpital Lyon Sud, LYON, France
  • Pelletier, Solenne, Centre hospitalier Lyon Sud, Pierre-Bénite, France
  • Fouque, Denis, Hôpital Lyon Sud, LYON, France
  • Soulage, Christophe O., CarMeN, INSERM u1060, INSA LYON, VILLEURBANNE, France
  • Koppe, Laetitia, Hôpital Lyon Sud, LYON, France

Zinc alpha 2 glycoproteine (ZAG) is a new adipokine involved in cachexia due to its potent lipolytic effects. It has been shown that plasma ZAG concentration was increased in chronic kidney disease (CKD) and patients on hemodialysis treatment (HD). However, the impact of ZAG accumulation on mortality and cardio-vascular risks has never been studied.


Plasma ZAG concentration was measured by enzyme immuno-assays (EIA ZAG, Raybiotech, USA) in 253 patients on HD for at least 3 months, without progressive cancer. Mortality and cardio-vascular events have been registered during 4 years.


During the follow-up period (31.3 ± 17.1 months), a total of 49 patients died (among which 16 from cardio-vascular events). Plasma ZAG concentration was inversely correlated with serum albumin (p=0.008), creatinine (p=0.007) and triglycerides (p=0.04). By contrast, it was positively correlated with age (p=0.002). Plasma ZAG concentration was independent of serum CRP, parathyroid hormone, LDL cholesterol and glycated hemoglobin. Kaplan-Meier analysis showed a significant correlation between plasma ZAG concentration and overall mortality (log rank, p<0.05) and cardio-vascular events (log rank, p<0.01). After Cox multivariate analysis, the association between plasma ZAG concentration and cardio-vascular events persisted after adjustment for demographic factors (age, sex, dialysis vintage), metabolic parameters (serum albumin, prealbumin, triglycerides, nPCR, BMI) and cardio-vascular risks (diabetes, dyslipidemia, hypertension, tobacco). Plasma ZAG concentration was however not associated with protein energy wasting.


Plasma ZAG accumulation does not correlate with protein energy wasting by contrast with patients having a cancer. ZAG does not seem to be involved in metabolic disturbances (type 2 diabetes, dyslipidemia) as observed in obese patien.
ZAG accumulation seems to be associated with an excess overall mortality and cardiovascular mortality risk in HD patients. Complementary studies will be necessary to define the role of ZAG and the pathophysiological mechanisms in cardiovascular events in patients with CKD.