The Significance Of Fetuin A In Vascular Calcification Of Non-diabetic Chronic Kidney Disease Patients

Objective:To test fetuin A levels in serum and to explore the relationgship between fetuin A and vascular calcification in non-diabetic chronic kidney disease(CKD2-5) patients.Methods: The non-diabetic chronic kidney disease patients attended in Nephrology Department of the Second Affiliated Hospital of Dalian Medical University from 2014 August to 2014 December were enrolled, patients of following situations were excluded:(1) diabetes(2) chronic hepatitis, cirrhosis, hepatorenal syndrom and drug-induced liver disease(3) serious infection, acute vasculitis(4) hyperthyroidism,hyperparathyroidism and parathyroidectomy(5) malignant tumor(6) kidney transplant recipients(7) recently taking steroid, immunosuppressant or nephrotoxic drugs. The glomerular filtration rate of the patients was calculated by MDRD formula. According to the K/DOQI guidelines of the diagnosis and staging of chronic kidney disease, the patients were divided into CKD2-4 period group: 15 <eGFR <89ml/(min·1.73m2); CKD5 period group: eGFR <15ml /(min·1.73m2), further, CKD5 period group was subdivided into Non-dialysis group and Dialysis group. People who do physical examination were selected in the Second Affiliated Hospital of Dalian Medical University as Control group. All the objects were voluntary. Recorded the clinical characteristics of all objects,including age, gender, and so on. The albumin, cholesterol, low density lipoprotein-cholesterol, high density lipoprotein-cholesterol, triglyceride, serum creatinine, high-sensitivity C-reactive protein, serum calcium and serum phosphorus were assessed by autobiochemistry machine. Intact parathyroid hormone(iPTH) was detected by radioimmunoassay. Further, we calculate the correction of serum calcium levels and calcium-phosphorus product. The fetuin A levels of all research objects were tested by enzyme-linked immunosorbent assay. Detectived darotid artery calcification by color doppler.All records were performed and analysesd by SPSS 17.0.Results: 44 CKD patients were recruited out, CKD2-4 period group and CKD5 period group were 22 cases respectively(within CKD5 period group, 13 cases under dialysis). 22 cases were selected out in Control group. Fetuin A levels of patients both in CKD 2-4 group and CKD 5 group were lower than that of Control group(p<0.01), moreover, Fetuin A levels of patients in CKD 5 group were lower than that of CKD 2-4 group(p<0.01). Fetuin A levels of Diaiysis group were lower than Non-dialysis group(p<0.01). Comparison were performed in the incidence of carotid artery calcification, the incidence of carotid artery calcification in CKD 5 group was higher than that in Control group, the difference was statistical significant(p<0.01); the incidence of carotid artery calcification in CKD 2-4 group was slight higher than Control group, while the difference was not statistical significant(p>0.05); the incidence of carotid artery calcification in CKD 5 group was obviously higher than CKD 2-4 group(p<0.05). Based on the intima-middle thickness(IMT) of the carotid artery, the patients in CKD stages 2-5 were divided into Calcified group and Non-calcified group. Analysis showed that fetuin A levels of Calcified group was significantly lower than Non-calcified group(p<0.01), however the CRP and serum phosphorus were higher in Calcified group than Non-calcified group(p<0.05). Correlation analysis showed that the levels of fetuin A were negatively correlated with serum phosphorus and CRP(r=-0.62,-0.55, all p<0.05), positively related with albumin(r=0.54, p<0.05). Howerer there were no correlations between fetuin A and serum calcium, phosphorus product, iPTH. Treating vascular calcification as the dependent variable, while the fetuin A, age, triglyceride, cholesterol, HDL-C, LDL-C, albumin, serum calcium, serum phosphorus, phosphorus product, CRP, iPTH as the independent variable, Logistic regression analysis showed that serum phosphorus and fetuin A correlated with the occurrence of vascular calcification, further on, the serum phosphorus was a risk factor for the occurrence of vascular calcification, while the fetuin A was a protective factor for the occurrence of vascular calcification.Conclusions: The decline in the level of fetuin A following kindey function’s downgrade companied with aggravation of arterial calcification at non-diabetic CKD patients, implied that fetuin A may play a role in the progress of vascular calcification at CKD patients.