Serum fetuin-A is associated with the components of MIAC (malnutrition, inflammation, atherosclerosis, calcification) syndrome in different stages of chronic kidney disease

Abstract

Background/aim: Fetuin-A, a circulating inhibitor of calcification, is a marker of inflammatory-nutritional state. We evaluated theassociation between serum fetuin-A levels and vascular calcification, intima-media thickness, and nutritional and inflammatorymarkers in different stages of chronic kidney disease (CKD).Materials and methods: CKD patients were sampled for calcium-phosphate parameters and nutritional and inflammatory markers[highly sensitive C-reactive protein (hs-CRP)], and serum fetuin-A levels. Intima-media thicknesses of the common carotid arteries(CIMT) were measured. Peripheral artery calcification scores were obtained.Results: A total of 238 patients were included in the study. Fetuin-A levels in patients with end-stage renal disease were significantlylower than those in patients with stage-3 and stage-4 CKD (stage-5 vs. stage-4, P < 0.001; stage-5 vs. stage-3, P < 0.001). Fetuin-A wasnegatively correlated with creatinine (P < 0.001), Ca × P product (P < 0.001), hs-CRP (P = 0.01), vascular calcification score (P < 0.001),and CIMT (P < 0.001), and positively correlated with BMI (P < 0.001, r = 0.30) and serum albumin (P < 0.001).Conclusion: Lower levels of fetuin-A were associated with higher vascular calcification scores, CIMT, hs-CRP levels, and lower BMI andalbumin. Fetuin-A deficiency may be a key element for MIAC syndrome.