title: Association of low serum fetuin A levels with poor arteriovenous access patency in patients undergoing maintenance hemodialysis.
abstract: 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.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan.
authors.forename: Hung-Yuan
authors.initials: HY
authors.lastname: Chen
authors.forename: Yen-Ling
authors.initials: YL
authors.lastname: Chiu
authors.forename: Yi-Fang
authors.initials: YF
authors.lastname: Chuang
authors.forename: Shih-Ping
authors.initials: SP
authors.lastname: Hsu
authors.forename: Mei-Fen
authors.initials: MF
authors.lastname: Pai
authors.forename: Chun-Fu
authors.initials: CF
authors.lastname: Lai
authors.forename: Ju-Yeh
authors.initials: JY
authors.lastname: Yang
authors.forename: Yu-Sen
authors.initials: YS
authors.lastname: Peng
authors.forename: Tun-Jun
authors.initials: TJ
authors.lastname: Tsai
authors.forename: Kwan-Dun
authors.initials: KD
authors.lastname: Wu
mesh_terms: 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*
chemical_list: D015415:Biomarkers; D000509:alpha-Fetoproteins