Abstract: Objective   To investigate the relationship between serum fatty acid binding protein 4 (FABP4), C1q/tumor necrosis factor related protein 3 (CTRP3), and major adverse cardiovascular events (MACE) in patients undergoing maintenance hemodialysis (MHD).  Methods  A total of 140 patients with MHD treated at Handan First Hospital between June 2020 and December 2022 were enrolled. Pearson correlation analysis was used to assess correlations. Relative risk (RR) was applied to analyze the impact on MACE occurrence. Multivariate logistic regression was used to identify factors associated with MACE, and receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of serum FABP4 and CTRP3 for MACE.  Results  A total of 132 patients completed the 2-year follow-up period, including 47 patients (35.61%) in the MACE group and 85 patients (64.39%) in the non-MACE group. Serum FABP4 was positively correlated with hs-CRP (r=0.487,P <0.001) and TG (r=0.452,P<0.001), and negatively correlated with CTRP3 (r=−0.503,P<0.001). Serum CTRP3 was negatively correlated with hs-CRP (r=−0.495,P<0.001) and TG (r = −0.416,P=0.005). Among MHD patients, those with high serum FABP4 levels had an approximately 1.4-fold increased risk of MACE (RR=1.437,95%CI:1.130～1.919,P=0.003), while those with low CTRP3 levels had an approximately 1.6-fold increased risk (RR=1.559,95%CI: 1.183～2.054,P=0.001). FABP4 (OR=3.178, 95%CI:1.783～5.666,P<0.001), hs-CRP (OR=2.532, 95%CI:1.401～4.576,P=0.002), and iPTH (OR=2.484, 95%CI:1.283～4.809,P=0.007) were risk factors for MACE in MHD patients, while CTRP3 was a protective factor (OR=0.392, 95%CI: 0.244～0.630, P<0.001). The area under the curve (AUC) of the combination of serum FABP4 and CTRP3 for predicting MACE in MHD patients was higher than that of either indicator alone (Z=2.517,2.055;P=0.008,0.023).  Conclusion  Elevated serum FABP4 levels and reduced CTRP3 levels are associated with the occurrence of MACE in  MHD patients. The combination of these two markers may serve as a serum indicator for predicting MACE.

Key words: Maintenance hemodialysis, Fatty acid binding protein 4, C1q/tumor necrosis factor related protein 3, Major adverse cardiovascular events