Associations of fetuin-A and osteoprotegerin with arterial stiffness and early atherosclerosis in chronic hemodialysis patients

Abstract

BackgroundCardiovascular morbidity and mortality remains excessive in patients with chronic kidney disease. The association of vascular changes with regulators of extraosseous calcification in this patient population is still under investigation. The aim of the present study was to investigate the associations of the calcification inhibitor fetuin-A, and the anti-osteoclastic factor osteoprotegerin (OPG) with vascular pathology in chronic hemodialysis patients.MethodsIn this cross-sectional study including 81 stable chronic hemodialysis patients, we measured carotid-to-femoral pulse wave velocity (cfPWV) with applanation tonometry, reflecting arterial stiffness, and common carotid intima-media thickness (ccIMT), a surrogate of early atherosclerosis, as well as serum levels of fetuin-A and OPG. Co-morbidities, traditional cardiovascular risk factors, inflammatory markers and mineral-bone disease serology parameters were also recorded.ResultscfPWV correlated inversely with fetuin-A (r=−0.355, p=0.001) and positively with OPG (r=0.584, p<0.001). In multilinear regression analysis including age, gender, diabetes, cardiovascular disease, hypertension, pulse pressure, LDL, logCRP, both fetuin-A and OPG were independently associated with cfPWV (p=0.024 and p=0.041 respectively). ccIMT was negatively associated with fetuin-A (r=−0.312, p=0.005) and positively with OPG (r=0.521, p<0.0001); however these associations lost statistical significance after adjustment for age.ConclusionIn chronic hemodialysis patients both fetuin-A and OPG levels are independently associated with arterial stiffness but not with early atherosclerotic vascular changes.

Cardiovascular Calcification in Chronic Hemodialysis Patients: Contributors Interplay

“…This finding is in agreement with those of Moe and Chen and Wang and his colleagues, they stated that fetuin A is a potent inhibitor of vascular calcification and its low levels were associated with coronary artery calcification [52 & 53]. Also in a recent study, fetuin-A showed a significant negative association with CIMT[ [26].…”

“…Also, our results showed a strong association between OPG levels and CIMT and valvular calcification. A recent study documented a positive association of CIMT with OPG [26]. Grzegorzewska and Mlot reported that elevated serum OPG levels were found to be correlated with the rapid progression of coronary artery calcification and mortality [55].…”

Higher Serum Levels of Osteoglycin Are Associated with All-Cause Mortality and Cardiovascular and Cerebrovascular Events in Patients with Advanced Chronic Kidney Disease

“…Our rationale for the difference in predictive value according to diabetes mellitus is as follows: first, as expected, diabetes mellitus was the most powerful predictor for MACCEs or composite outcome in our study. In other words, diabetes mellitus might overshadow biomarkers including OGN as a predictor of clinical outcomes, as presented in other studies (Pateinakis et al 2013;Scialla et al 2014). Second, CKD (Nakano et al 2013) and diabetes mellitus (Michel et al 2011) are risk factors for intraplaque hemorrhage in coronary arteries, related to the physiology of OGN.…”

Relationship of apelin, procalcitonin, and fetuin-A concentrations with carotid intima-media thickness in acromegaly

“…[19][20][21] Fetuin-A, a liver-derived inhibitor of calcification, has been inversely associated with arterial stiffness and cardiovascular morbidity and mortality. 22 Prospective studies have suggested that low serum fetuin-A concentrations may be a predictor of coronary artery disease incidence, severity, and related mortality. [23][24][25] The cardioprotective role of fetuin-A has been supported by low circulating fetuin-A concentration as a negative predictor of acute coronary disease evolution.…”