title: Fetuin A/nutritional status predicts cardiovascular outcomes and survival in hemodialysis patients.
abstract: BACKGROUND
  Fetuin A - a predictor of cardiovascular (CV) outcomes in dialysis patients - is correlated with over-nutrition in the general population. Whether fetuin A and nutritional status interact with each other to alter CV outcomes and survival in hemodialysis (HD) patients remains unknown.
  
  
  METHODS
  We performed a prospective study on 388 prevalent HD patients. We used the geriatric nutritional risk index (GNRI) for the evaluation of nutritional status. Study outcomes included the occurrence of CV event, CV death, and all-cause mortality during follow-up; interactions between parameters for predicting outcomes were assessed by the interaction terms in a Cox regression model.
  
  
  RESULTS
  Overall, 131 patients experienced CV events and 92 patients died, with 51 CV deaths. HD patients with higher fetuin A levels had lower numbers of CV events (adjusted hazard ratio [HR], 0.9; 0.81-0.99) and all-cause mortality (adjusted HR, 0.97; 0.91-0.99). However, patients with higher GNRI had lower all-cause mortality (adjusted HR, 0.79; 0.51-0.98, for every 10-unit increase). Fetuin A levels and GNRI showed a significant interaction in the prediction of CV events (adjusted HR, 1.01; 1.008-1.02) but not for all-cause or CV mortality. In patients with poor nutritional status, higher fetuin A levels were associated with fewer CV events; however, in contrast, in subjects with better nutritional status, higher fetuin A levels appeared to lead to a higher number of CV events.
  
  
  CONCLUSIONS
  Fetuin A showed a remarkable interaction with nutritional status in evaluating the risks of CV morbidities in prevalent HD patients.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
authors.forename: Hung-Yuan
authors.initials: HY
authors.lastname: Chen
authors.forename: Yen-Ling
authors.initials: YL
authors.lastname: Chiu
authors.forename: Shih-Ping
authors.initials: SP
authors.lastname: Hsu
authors.forename: Mei-Fen
authors.initials: MF
authors.lastname: Pai
authors.forename: Ju-Yeh
authors.initials: JY
authors.lastname: Yang
authors.forename: Yu-Sen
authors.initials: YS
authors.lastname: Peng
mesh_terms: D000368:Aged; D001835:Body Weight; D002318:Cardiovascular Diseases / Q000401:mortality* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D015995:Prevalence; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012044:Regression Analysis; D006435:Renal Dialysis / Q000401:mortality*; D016896:Treatment Outcome; D060749:alpha-2-HS-Glycoprotein / Q000737:chemistry*
chemical_list: D060749:alpha-2-HS-Glycoprotein