Evaluation of serum fetuin-A relationships with biochemical parameters in patients on hemodialysis.

Complications associated with atherosclerosis in dialysis patients are attracting attention. Fetuin-A, a circulating calcium-regulatory glycoprotein that inhibits vascular calcification, is associated with inflammation and outcome in dialysis patients. In this study, the relation between serum fetuin-A concentration and biochemical parameters in patients on hemodialysis was investigated. Forty hemodialysis patients, 22 men and 18 women, aged 57 +/- 12 years; and 20 controls, 10 men and 10 women, aged 50 +/- 10 years, participated in this study. We measured serum fetuin-A by enzyme-linked immunosorbent assay. The biochemical parameters of serum albumin, alkaline phosphatase, calcium, phosphate, intact parathyroid hormone, total cholesterol, triglyceride, lipoprotein (a), brain natriuretic peptide (BNP), highly sensitive C-reactive protein (hsCRP), hemoglobin, and hematocrit in whole blood were also measured before starting dialysis sessions. Other parameters included the cardio ankle vascular index, age, mean arterial pressure, total weekly urea clearance (Kt/V), smoking habit, body mass index (BMI), and duration of dialysis. These variables were included in simple regression analysis. Levels of serum fetuin-A in the hemodialysis patients (331 +/- 55 microg/ml) were significantly lower than those in the healthy controls (361 +/- 55 microg/ml; P < 0.05). There was a negative correlation between serum fetuin-A levels and duration of dialysis (r = -0.37, P < 0.01), BNP (r = -0.37, P < 0.001), and hsCRP (r = -0.40, P < 0.01), and a positive association with serum albumin (r = 0.31, P < 0.05). These data suggest that a low fetuin-A level is a useful predictor of malnutrition and inflammation, as well as being a useful predictor of the cardiac failure caused by an increased ventricular load in hemodialysis patients.