Serum fetuin a in hemodialysis: a link between derangement of calcium-phosphorus homeostasis and progression of atherosclerosis?
BACKGROUND
Fetuin A, a circulating inhibitor of ectopic calcification, is downregulated in hemodialysis and has been shown to predict cardiovascular mortality in this setting. The association of altered calcium-phosphorus with serum fetuin A levels is still a matter of debate. Although carotid intima-media thickness (cIMT) is a strong predictor of major cardiovascular events, its association with serum fetuin A levels is poorly defined.


METHODS
Cohort study.


METHODS
174 uremic patients on long-term hemodialysis therapy enrolled in 4 university hospitals.


METHODS
Serum fetuin A levels at the beginning of the study (T0) and after 12 months (T12).


RESULTS
Progression of atherosclerosis assessed by means of cIMT measurements at 24 months (T24); cardiovascular morbidity and mortality at 36 months.


RESULTS
Serum fetuin A concentrations at T0 and T12 were 282.3 +/- 79.4 and 290.0 +/- 92.2 microg/mL, respectively. Mean T0 and T24 cIMT values were 1.02 +/- 0.2 and 1.06 +/- 0.2 mm, respectively (P < 0.001). Fatal and nonfatal cardiovascular disease occurred in 36 and 86 patients by 36 months, respectively. In multivariate logistic regression, higher calcium-phosphorus product was associated with lower serum fetuin A level (odds ratio, 0.96; 95% confidence interval [CI], 0.93 to 1.00; P = 0.02). Multiple regression analysis showed that T0 serum fetuin A level was associated with T24 cIMT (P = 0.01) after adjustments for age, cholesterol level, high-sensitivity C-reactive protein level, previous cardiovascular events, and T0 cIMT. In a multivariate Cox regression analysis, cardiovascular mortality was independently associated with a 1-tertile lower T0 serum fetuin A level, and a 1-tertile higher T0 cIMT value was independently associated with greater cardiovascular mortality (hazard ratio, 0.45; 95% CI, 0.15 to 0.65; P = 0.007 and hazard ratio, 10.00; 95% CI, 3.16 to 31.73; P < 0.001, respectively) after adjustment for age and previous cardiovascular events.


CONCLUSIONS
Length of follow-up.


CONCLUSIONS
Calcium-phosphorus product in hemodialysis patients inversely correlated with serum fetuin A level, which, in turn, was associated inversely with progression of atherosclerotic lesions and cardiovascular mortality in this study population.
Pertosa
Giovanni
G
Nephrology, Dialysis, and Transplantation Unit, University of Bari, Bari, Italy. g.pertosa@nephro.uniba.it
Simone
Simona
S
Ciccone
Marco
M
Porreca
Silvia
S
Zaza
Gianluigi
G
Dalfino
Giuseppe
G
Memoli
Bruno
B
Procino
Alfredo
A
Bonomini
Mario
M
Sirolli
Vittorio
V
Castellano
Giuseppe
G
Gesualdo
Loreto
L
Ktena
Maria
M
Schena
Francesco Paolo
FP
Grandaliano
Giuseppe
G
D000368:Aged; D050197:Atherosclerosis / Q000097:blood* / Q000209:etiology*; D002118:Calcium / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology / Q000401:mortality; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006706:Homeostasis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010758:Phosphorus / Q000378:metabolism*; D006435:Renal Dialysis; D000509:alpha-Fetoproteins / Q000032:analysis*
D000509:alpha-Fetoproteins; D010758:Phosphorus; D002118:Calcium