title: Serum fetuin-A levels link inflammation and cardiovascular calcification in hemodialysis patients.
abstract: BACKGROUND
  Cardiovascular disease (CVD) is the leading cause of mortality in hemodialysis (HD). An elevated incidence of cardiovascular calcifications (CVC) is observed in HD. Fetuin-A is an important inhibitor of CVC. Reduced fetuin-A levels associate with inflammation and increased cardiovascular (CV) mortality in HD. In this study we investigated the association of fetuin-A levels and CVC.
  
  
  METHODS
  We evaluated a cohort of 115 patients (67 males), aged 63 +/- 16 years with a HD vintage >or=9 months. Presence of CVC was assessed by ultrasound imaging of the abdominal aorta, common carotid arteries, bilateral ilio-femoral axis, aortic and mitral cardiac valves. The presence of CVC was analyzed as a CVC score (CVCS) (0-7) according to the number of CVC sites. Patients were arbitrary stratified in three groups: group I (CVCS = 0), group II (0 < CVCS < 6) and group III (CVCS >or= 6). Patients without CVC were younger, non-diabetic and with a negative history for CV events.
  
  
  RESULTS
  Patients with evidence of CVC in more than 5 sites had lower serum fetuin-A levels (0.41 +/- 0.22 g/l) compared to patients with CVCS = 0 (0.51 +/- 0.17 g/l, p = 0.048). In addition a worse CVCS was associated with higher serum levels of C-reactive protein (p = 0.002) and fibrinogen (p < 0.001). Serum fetuin-A levels lower than 0.290 g/l were associated with higher risk of a worse CVCS, independently from traditional risk factors.
  
  
  CONCLUSIONS
  Chronic inflammation in HD patients leads to lower serum fetuin-A levels. The present study confirms the independent and significant association between reduced serum fetuin-A levels and multi-site CVC in HD.
authors.affiliation: Renal Division, S. Paolo Hospital, University of Milan, Milan, Italy. mariocozzolino@hotmail.com
authors.forename: Mario
authors.initials: M
authors.lastname: Cozzolino
authors.forename: Andrea
authors.initials: A
authors.lastname: Galassi
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Biondi
authors.forename: Olivia
authors.initials: O
authors.lastname: Turri
authors.forename: Sergio
authors.initials: S
authors.lastname: Papagni
authors.forename: Nicola
authors.initials: N
authors.lastname: Mongelli
authors.forename: Luigi
authors.initials: L
authors.lastname: Civita
authors.forename: Maurizio
authors.initials: M
authors.lastname: Gallieni
authors.forename: Diego
authors.initials: D
authors.lastname: Brancaccio
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001798:Blood Proteins / Q000378:metabolism*; D002114:Calcinosis / Q000097:blood* / Q000000981:diagnostic imaging / Q000473:pathology*; D002318:Cardiovascular Diseases / Q000097:blood* / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D014463:Ultrasonography; D060749:alpha-2-HS-Glycoprotein
chemical_list: C556354:AHSG protein, human; D015415:Biomarkers; D001798:Blood Proteins; D060749:alpha-2-HS-Glycoprotein