Association of low serum fetuin A levels with poor arteriovenous access patency in patients undergoing maintenance hemodialysis.
BACKGROUND
Fetuin A, a predictor of mortality in dialysis patients, is associated with vascular calcification and atherosclerosis in hemodialysis (HD) patients. Whether it predicts arteriovenous (AV) access patency is unknown. This study aimed to investigate the association between fetuin A and AV access patency in HD patients.


METHODS
Prospective observational study.


METHODS
238 prevalent HD patients (127 women and 111 men; mean age, 60 ± 12 years) were followed up for AV access patency for 32 months.


METHODS
Tertiles of baseline circulating fetuin A levels, corresponding to 0.15-0.25, 0.26-0.32, and 0.33-0.51 g/L.


RESULTS
The major outcome was loss of unassisted AV access patency, defined as AV access thrombosis or need for intervention.


METHODS
Fetuin A and other markers of inflammation.


RESULTS
100 patients had loss of AV access patency (42%) on follow-up. Patients in the lowest fetuin A tertile had the worst AV access patency (log-rank test, χ(2) = 8.68; P = 0.01). Using Cox proportional hazards regression with patients in the lowest fetuin A tertile as reference, patients in the intermediate tertile had an HR of 0.49 (95% CI, 0.29-0.82), whereas those in the highest fetuin A tertile had an HR of 0.43 (95% CI, 0.25-0.75) for loss of AV access patency. Similarly, considering patients using AV fistulas or grafts separately, patients in the highest fetuin A tertile had less risk of losing AV access patency than patients in the other tertiles (HR, 0.40 [95% CI, 0.19-0.84] for patients with AV fistulas and HR, 0.25 [95% CI, 0.10-0.65] for patients with AV grafts).


CONCLUSIONS
Focus on the patency of prevalent rather than new AV access in maintenance hemodialysis patients.


CONCLUSIONS
Fetuin A deficiency is associated with a higher risk of loss of AV access patency in either native AV fistulas or AV grafts in HD patients.
Chen
Hung-Yuan
HY
Division of Nephrology, Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan.
Chiu
Yen-Ling
YL
Chuang
Yi-Fang
YF
Hsu
Shih-Ping
SP
Pai
Mei-Fen
MF
Lai
Chun-Fu
CF
Yang
Ju-Yeh
JY
Peng
Yu-Sen
YS
Tsai
Tun-Jun
TJ
Wu
Kwan-Dun
KD
D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood; D002408:Catheters, Indwelling / Q000009:adverse effects*; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014654:Vascular Patency; D000509:alpha-Fetoproteins / Q000032:analysis*
D015415:Biomarkers; D000509:alpha-Fetoproteins