Back
Fetuin-A is a multifunctional liver-derived protein found in high concentrations in human serum. In end-stage renal disease populations, especially dialysis patients, lower plasma fetuin-A levels are associated with greater prevalence and severity of vascular calcification and increased risk of cardiovascular events and all-cause mortality independent of traditional cardiovascular and kidney disease risk factors. The present study was designed to clarify the precise role and to determine the effectiveness of plasma fetuin-A level as a bioindicator of 3-years of survival and mortality in hemodialysis patients.
This was a single-center observational prospective cohort study conducted in Medan, North Sumatera, Indonesia. We measured plasma fetuin-A on 75 hemodialysis patients recruited in December 2019. Demographic and clinical data were recorded for all enrolled patients. A receiver operating characteristic curve and Cox regression models were used to verify the association between plasma fetuin-A levels, survival rate and mortality risk. Survival curves were constructed and compared using the log-rank test. A two-sided value of P <0.05 was considered statistically significant.
Of the 75 patients who met the inclusion and exclusion criteria, the majority of the sample was male (60.0%), with a mean of age 48.64 ± 11.45 years. From laboratory findings, the average calcium and phosphate levels were 9.70 mg/dL and 5.10 mg/dL, respectively. Using ELISA, the median of Fetuin-A concentration was 208.0 pg/mL (range 172–249). During 3 years of follow-up, 25 deaths (33.3%) were recorded while 50 (66.7%) survived until the end of the research. Based on the receiving operating characteristics curve, the cut-off plasma fetuin-A level was 187 pg/mL, with an area under the curve was 96.3% (p < 0.001), and the sensitivity and specificity values were 90.0% and 88.0%, respectively. Statistical tests with the Kaplan-Meier method found a significant effect on fetuin-A levels <187 pg/mL on the 3-year survival rate of hemodialysis patients (p <0.001). The group of patients with fetuin-A levels <187 pg/mL had a survival rate of 32,74% (vs 58,00% in the group of patients with fetuin-A levels >187 pg/mL. After adjusting the variables fetuin-A levels, calcium and phosphate levels, magnesium and hemoglobin levels, diabetes mellitus, and hypertension, it was found only fetuin-A levels [hazard ratio (HR): 8.350, 95% CI: 2.299-30.329] and phosphate levels (HR: 3.217, 95% CI: 1.134–9.125) influencing 3-years mortality (p = 0.001 and p = 0.028, respectively).
Our prospective data reveal that lower plasma fetuin-A levels are associated with increased risks of all-cause mortality in hemodialysis patients. The role of plasma fetuin-A as a bioindicator of 3-years of survival and mortality in hemodialysis patients warrants more investigation.