ABSTRACT: Background: Fetuin A, a circulating inhibitor of ectopic calcification, is downregulated in hemodialysis and has been shown to predict cardiovascular mortality in this setting. The association of altered calcium-phosphorus with serum fetuin A levels is still a matter of debate. Although carotid intima-media thickness (cIMT) is a strong predictor of major cardiovascular events, its association with serum fetuin A levels is poorly defined. Study Design: Cohort study. Participants & Settings: 174 uremic patients on long-term hemodialysis therapy enrolled in 4 university hospitals. Predictors: Serum fetuin A levels at the beginning of the study (T0) and after 12 months (T12). Outcomes: Progression of atherosclerosis assessed by means of cIMT measurements at 24 months (T24); cardiovascular morbidity and mortality at 36 months. Results: Serum fetuin A concentrations at T0 and T12 were 282.3 79.4 and 290.0 92.2 g/mL, respectively. Mean T0 and T24 cIMT values were 1.02 0.2 and 1.06 0.2 mm, respectively (P 0.001). Fatal and nonfatal cardiovascular disease occurred in 36 and 86 patients by 36 months, respectively. In multivariate logistic regression, higher calcium-phosphorus product was associated with lower serum fetuin A level (odds ratio, 0.96; 95% confidence interval [CI], 0.93 to 1.00; P 0.02). Multiple regression analysis showed that T0 serum fetuin A level was associated with T24 cIMT (P 0.01) after adjustments for age, cholesterol level, high-sensitivity C-reactive protein level, previous cardiovascular events, and T0 cIMT. In a multivariate Cox regression analysis, cardiovascular mortality was independently associated with a 1-tertile lower T0 serum fetuin A level, and a 1-tertile higher T0 cIMT value was independently associated with greater cardiovascular mortality (hazard ratio, 0.45; 95% CI, 0.15 to 0.65; P 0.007 and hazard ratio, 10.00; 95% CI, 3.16 to 31.73; P 0.001, respectively) after adjustment for age and previous cardiovascular events.
American Journal of Kidney Diseases 01/2009; · 5.43 Impact Factor