Serum Fetuin A in Hemodialysis: A Link Between Derangement of Calcium-Phosphorus Homeostasis and Progression of Atherosclerosis?

Pertosa, Giovanni; Simone, Simona; Ciccone, Marco Matteo; Porreca, Silvia; Zaza, Gianluigi; Dalfino, Giuseppe; Memoli, Bruno; Procino, Alfredo; Bonomini, Mario; Sirolli, Vittorio; Castellano, Giuseppe; Gesualdo, Loreto; Ktena, Maria; Schena, Francesco Paolo; Grandaliano, Giuseppe

doi:10.1053/j.ajkd.2008.10.046

Cited by 26 publications

(21 citation statements)

References 27 publications

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“…Studies proposed that venous neointimal hyperplasia could lead to late AVF stenosis [31]. The active process of vascular calcification might cause atherosclerosis [32], which accelerated the progression of neointimal hyperplasia and thrombosis [14,19].…”

Section: Discussionmentioning

confidence: 99%

Vascular Calcification Markers and Hemodialysis Vascular Access Complications

et al. 2018

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Background: Arteriovenous (AV) access dysfunction is a common complication in hemodialysis patients. Markers of vascular calcification are associated with cardiovascular outcomes and mortality in this population, but their association with vascular access outcomes is unknown. In this study, we aimed to evaluate the association between selected vascular calcification makers and vascular access complications in a cohort of hemodialysis patients. Method: Fetuin-A, osteopontin (OPN), osteoprotegerin (OPG), and bone morphogenetic protein-7 (BMP-7) were measured in blood samples from 219 dialysis patients in the Choice for Healthy Outcomes in Caring for end-stage renal disease study; these patients were using a permanent vascular access. Participants were followed for up to 1 year or until the occurrence of a vascular access intervention or replacement. Associations with AV fistula (AVF) and AV graft (AVG) intervention-free survival were assessed in models adjusted for demographic characteristics, comorbidities, and inflammation. Results: A total of 24 out 103 participants with an AVF and 43 out of 116 participants with an AVG had an intervention during follow-up. Lower fetuin-A, higher OPN, and higher BMP-7 were associated with a higher risk of AVF intervention (adjusted hazard ratios [aHR] for highest versus lowest tertile = 0.30 [95% CI 0.10–0.94]) for fetuin-A, 3.84 (95% CI 1.16–12.74) for OPN, and 3.49 (95% CI 1.16–10.52) for BMP-7. OPG was not significantly associated with the risk of AVF intervention. The associations of OPN and BMP-7 with AVF intervention appeared stronger among participants without diabetes (aHR 8.06; 95% CI 1.11–58.57 for OPN and aHR 2.55; 95% CI 1.08–6.08 for BMP-7, respectively) than among their counterparts with diabetes (p interaction = 0.06). None of the markers studied were significantly associated with AVG interventions. Conclusion: Lower fetuin-A and higher OPN and BMP-7 are associated with complications in AVF but not in AVG, suggesting a role for calcification in the pathogenesis AVF failure.

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Section: Discussionmentioning

confidence: 99%

Vascular Calcification Markers and Hemodialysis Vascular Access Complications

et al. 2018

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“…This protein is an inverse marker of inflammation (low levels denote inflammation) and a circulating inhibitor of ectopic calcification. Plasma fetuin A levels are low in patients on hemodialysis and have been associated with all-cause and cardiovascular mortality in four studies, [46][47][48][49] but studies that document its usefulness in clinical practice are lacking. A complex of fetuin A and calcium was more strongly associated with coronary calcification than fetuin A alone in a series of 73 patients with CKD and diabetes mellitus.…”

Section: Protein-energy Wasting and Inflammationmentioning

confidence: 99%

Clinical usefulness of novel prognostic biomarkers in patients on hemodialysis

et al. 2011

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Prognosis, risk stratification and monitoring the effects of treatment are fundamental elements in the decision-making process when implementing prevention strategies for chronic kidney disease. The use of biomarkers is increasingly proposed as a method to refine risk stratification and guide therapy. In this Review, we present basic concepts regarding the validation of biomarkers and highlight difficulties inherent to the identification of useful new biomarkers in patients on hemodialysis. We focus on prognostic biomarkers that have been consistently linked to survival in this group of patients. To date, no biomarker has had sufficient full-scale testing to qualify as a useful addition to standard prognostic factors or to guide the prescription of specific treatments in this population. Furthermore, little information exists on the relative strength of various biomarkers for their prediction of mortality. A multimarker approach might refine prognosis in patients on hemodialysis, but this concept needs to be properly evaluated in large longitudinal studies and clinical trials. The potential of proteomics for the identification and study of new biomarkers in the pathophysiology of cardiovascular disease in patients with end-stage renal disease is also discussed.

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“…Similar to FGF23, the association of fetuin-A with atherosclerosis is controversial. Several studies have shown a negative relationship between fetuin-A and subclinical atherosclerosis in patients with end-stage renal disease and obstructive sleep apnea syndrome (Akyuz et al, 2013;Pertosa et al, 2009). By contrast, and similar to our findings, fetuin-A has been found to be positively correlated with carotid artery intima-media thickness in patients with non-alcoholic fatty liver disease (Dogru et al, 2013) or in patients with normal renal function (Fiore et al, 2007).…”

Section: Discussionmentioning

confidence: 99%