Relationship Between Fetuin-A Concentration, Elevated Levels of Inflammatory Markers, and Arterial Wall Stiffness in End-Stage Kidney Disease

The risk of cardiovascular mortality is significantly heightened in chronic dialysis patients. Aortic wall stiffness, as reflected by aortic pulse-wave velocity (PWV), is a strong predictor of cardiovascular events. Loss of the aortic wall's elasticity is accelerated in dialysis patients because of calcifying medial arteriosclerosis, an active cellular process, controlled by calcification inducers and inhibitors. A pivotal role in the inhibition of calcium × phosphorus (Ca × P) precipitation is played by fetuin-A, a circulating plasma glycoprotein. In hemodialysis patients, lower fetuin-A concentrations were associated with increases in both cardiovascular and overall mortality. In our own study, a significant negative correlation was established between fetuin-A level and aortic PWV in chronic hemodialysis patients. The arterial-stiffening process was unaffected by the Ca × P product, but occurred independent of elevated interleukin-6 levels.