BACKGROUND: Fetuin-A, a negative acute phase protein that inhibits vascular calcification, has a controversial association with mortality in chronic kidney disease (CKD) patients. Chronic inflammation, which is common in CKD, may promote vascular calcification. MATERIALS AND METHODS: We investigated the impact of inflammation on the relationship between serum fetuin-A and mortality (42 months) in 222 prevalent haemodialysis (HD) patients. RESULTS: Serum fetuin correlated negatively with comorbidity score (assessed by Davies score) and circulating inflammatory markers. Patients with low fetuin-A levels (< median) had higher mortality (Hazard ratio 'HR' 2.2; CI 1.4-3.5, P < 0.001), but this association was lost after adjustment for age, gender, comorbidities score, dialysis vintage and inflammation (CRP > median). In inflamed patients with low fetuin a significantly independent association with mortality (HR 2.3; CI 1.2-4.5, P = 0.01) was observed compared to non-inflamed patients with high fetuin-A, after adjusting for the same variables. Non-inflamed patients with low fetuin-A and inflamed patients with high fetuin-A did not have increased mortality compared to non-inflamed patients with high fetuin-A. CONCLUSIONS: The results show that low levels of serum fetuin-A are associated with increased mortality in HD patients only in the presence of inflammation. This suggests that coexistence of a low serum fetuin-A level and low-grade inflammation exerts an additive effect on the risk of death in HD patients.
BACKGROUND:Fetuin-A, a negative acute phase protein that inhibits vascular calcification, has a controversial association with mortality in chronic kidney disease (CKD) patients. Chronic inflammation, which is common in CKD, may promote vascular calcification. MATERIALS AND METHODS: We investigated the impact of inflammation on the relationship between serum fetuin-A and mortality (42 months) in 222 prevalent haemodialysis (HD) patients. RESULTS: Serum fetuin correlated negatively with comorbidity score (assessed by Davies score) and circulating inflammatory markers. Patients with low fetuin-A levels (< median) had higher mortality (Hazard ratio 'HR' 2.2; CI 1.4-3.5, P < 0.001), but this association was lost after adjustment for age, gender, comorbidities score, dialysis vintage and inflammation (CRP > median). In inflamed patients with low fetuin a significantly independent association with mortality (HR 2.3; CI 1.2-4.5, P = 0.01) was observed compared to non-inflamed patients with high fetuin-A, after adjusting for the same variables. Non-inflamed patients with low fetuin-A and inflamed patients with high fetuin-A did not have increased mortality compared to non-inflamed patients with high fetuin-A. CONCLUSIONS: The results show that low levels of serum fetuin-A are associated with increased mortality in HDpatients only in the presence of inflammation. This suggests that coexistence of a low serum fetuin-A level and low-grade inflammation exerts an additive effect on the risk of death in HDpatients.
Authors: Alberto Ortiz; Ziad A Massy; Danilo Fliser; Bengt Lindholm; Andrzej Wiecek; Alberto Martínez-Castelao; Adrian Covic; David Goldsmith; Gültekin Süleymanlar; Gérard M London; Carmine Zoccali Journal: Nat Rev Nephrol Date: 2011-11-01 Impact factor: 28.314
Authors: F Roshanzamir; M Miraghajani; M H Rouhani; M Mansourian; R Ghiasvand; S M Safavi Journal: J Endocrinol Invest Date: 2017-06-22 Impact factor: 4.256
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Authors: Qi Sun; Monik C Jiménez; Mary K Townsend; Eric B Rimm; JoAnn E Manson; Christine M Albert; Kathryn M Rexrode Journal: J Am Heart Assoc Date: 2014-06-24 Impact factor: 5.501