Serum levels of fetuin-A predictor of all-cause, cardiovascular, and non-cardiovascular mortality in dialysis patients, a Dutch study found.


Marc M.H. Hermans, MD, of the Academic Hospital Maastricht in the Netherlands, and his colleagues prospectively studied 987 dialysis patients (93% Caucasian)—664 on hemodialysis (HD) and 323 on peritoneal dialysis (PD). The median and maximum follow-up time was 2.8 and 8.5 years, respectively. Decreasing levels of serum fetuin-A were associated with increases in cardiovascular and non-cardiovascular mortality.

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Each 0.1 g/L increase in serum fetuin-A was associated with a 13% decrease in all-cause mortality, a 10% decrease in cardiovascular mortality, and 17% decrease in non-cardiovascular mortality, after adjusting for age, gender, diabetes mellitus, primary renal disease, CVD, dialysis modality, and current smoking, the investigators reported in Kidney International (2007;72:202-207).


Compared with PD patients, HD patients had a lower fetuin-A concentration (0.60 vs. 0.72 g/L), and a greater levels of high-sensitivity C-reactive protein ((5.8 vs. 3.1 g/L). Still, the investigators observed no significant difference between the two groups in the association of fetuin-A with cardiovascular and non-cardiovascular mortality.


The authors explained that cardiovascular mortality in patients with end-stage renal disease (ESRD) is increased and substantially related to accelerated calcifying atherosclerosis, which is controlled by calcification inhibitors and inducers.


Fetuin-A is one of the more potent circulating calcification inhibitor of hydroxyapatite formation, which is part of the calcification process. Previous research has shown that serum fetuin-A levels in ESRD patients were associated with increased coronary arterial and valvular calcification scores.