Galectin-3 as a prognostic biomarker in haemodialysis patients with preserved or mildly reduced ejection fraction.

Background: Risk prediction for heart failure (HF) and mortality in haemodialysis (HD) patients with preserved or mildly reduced left ventricular ejection fraction (LVEF) is challenging, as conventional markers often underperform. Galectin-3, a biomarker of fibrosis and inflammation, may offer prognostic value, but its utility in this population remains unclear. Methods: We prospectively enrolled 244 incident HD patients with an LVEF ≥40%. The primary outcome was a composite of cardiovascular (CV) death or acute HF hospitalization. Secondary outcomes included all-cause mortality and individual primary outcome components. Predictive performance was assessed by comparing a baseline clinical model with models incorporating brain natriuretic peptide (BNP) and/or galectin-3, using the area under the curve (AUC), net reclassification improvement (NRI) and integrated discrimination improvement (IDI). Results: The mean baseline LVEF was 59.5% and the median BNP and galectin-3 levels were 357.5 pg/ml and 34.3 ng/ml, respectively. Over a median follow-up of 37 months, high galectin-3 levels (≥34.3 ng/ml) were associated with higher incidence rates of the primary outcome [14.09 versus 5.87 per 100 person-years (PY)] and all-cause mortality (14.09 versus 6.33 per 100 PY). In multivariate analysis, elevated galectin-3 independently predicted the composite outcome {hazard ratio [HR] 2.16 [95% confidence interval (CI) 1.17-4.00], P = .014], acute HF [HR 2.11 (95% CI 1.07-4.14), P = .033] and all-cause mortality [HR 1.90 (95% CI 1.04-3.55), P = .043]. Adding galectin-3 to the clinical model significantly improved discrimination (AUC 0.735 versus 0.678; ΔAUC 0.057; P = .025) and reclassification metrics (NRI 0.565; IDI 0.058; both P < .001). In contrast, BNP addition did not significantly enhance prediction. Conclusion: In incident HD patients with an LVEF ≥40%, elevated galectin-3 was an independent predictor of CV death or acute HF events and provided incremental prognostic value beyond conventional clinical parameters and BNP. These findings support galectin-3 as a complementary biomarker for enhanced risk stratification in this population.