Serum fetuin-A levels link inflammation and cardiovascular calcification in hemodialysis patients.
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.
Cozzolino
Mario
M
Renal Division, S. Paolo Hospital, University of Milan, Milan, Italy. mariocozzolino@hotmail.com
Galassi
Andrea
A
Biondi
Maria Luisa
ML
Turri
Olivia
O
Papagni
Sergio
S
Mongelli
Nicola
N
Civita
Luigi
L
Gallieni
Maurizio
M
Brancaccio
Diego
D
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
C556354:AHSG protein, human; D015415:Biomarkers; D001798:Blood Proteins; D060749:alpha-2-HS-Glycoprotein