Study On The Relationship Between Serum Fetuin-A And Klotho Protein Levels And Abdominal Aortic Calcification In Patients With End-stage Renal Disease

Objective To observe the levels of fetuin-A（FA）and Klotho protein in serum of patients with end-stage renal disease（ESRD）,and analyze their relationship with abdominal aortic calcification（AAC）.Method In strict accordance with the inclusion criteria and exclusion criteria,the data of ESRD patients hospitalized in the Department of Nephrology,the first affiliated Hospital of Bengbu Medical College from May 2020 to March 2021 were collected,and the age and sex matched healthy persons were collected as the control group.The general clinical data and laboratory indexes of the experimental group and the control group were collected,and the levels of serum Fetuin-A and Klotho protein were detected by enzyme-linked immunosorbent assay（ELISA）.The differences of clinical blood indexes between ESRD patients（n=161）and control patients（n=114）,maintenance hemodialysis patients（n=85）and non-dialysis patients（n=76）among ESRD patients were compared respectively.According to the results of calcification of abdominal aorta in ESRD patients,the subjects were divided into abdominal aortic calcification group（n=89）and non-calcification group（n=72）.The clinical data and blood indexes of the two groups were statistically analyzed.Results 1.Compared with healthy control group,the levels of serum Fetuin-A,Klotho protein,serum calcium,albumin,high density lipoprotein and 25-hydroxyvitamin D in ESRD group were lower than those in control group（P<0.05）.The levels of creatinine,uric acid,alkaline phosphatase,serum phosphorus,calcium-phosphorus product,triglyceride,C-reactive protein（CRP）and parathyroid hormone（PTH）in ESRD group were significantly higher than those in control group（P<0.05）.2.The levels of serum Fetuin-A,Klotho protein and 25-hydroxyvitamin D in patients with abdominal aortic calcification were lower than those in non-calcification group（P<0.05）.The age,prevalence of diabetes and coronary heart disease,serum calcium,phosphorus,calcium-phosphorus product,CRP and PTH in abdominal aortic calcification group were higher than those in non-calcification group（P<0.05）.3.Binary logistic regression analysis showed that age（OR=1.062,95%CI=1.008 ~1.119,P=0.024）,diabetes mellitus（OR=5.821,95%CI=1.244~27.244,P=0.025）,calcium-phosphorus product（OR=4.621,95%CI=1.562~13.647,P=0.006）,PTH（OR=1.005,95%CI=1.001~1.008,P=0.008）,CRP（OR=1.159,95%CI=1.032~1.301,P=0.013）,is an independent risk factor for abdominal aortic calcification in patients with end-stage renal disease.Fetuin-A（OR=0.964,95%CI=2.0.946~0.982,P<0.001）and Klotho protein（OR=0.968,95%CI=0.951~0.985,P<0.001）were independent protective factors of abdominal aortic calcification in patients with end-stage renaldisease.4.The results of correlation analysis showed that abdominal aortic calcification in end-stage renal disease was positively correlated with age,prevalence of diabetes and coronary heart disease,serum calcium,phosphorus,calcium-phosphorus product,CRP and PTH,and negatively correlated with 25-hydroxyvitamin D,Fetuin-A and Klotho protein（P<0.05）.Fetuin-A was negatively correlated with age,coronary heart disease,CRP,PTH and calcification of abdominal aorta,but positively correlated with Klotho protein（P<0.05）.Klotho protein was negatively correlated with age,serum phosphorus,calcium-phosphorus product,CRP,PTH and abdominal aortic calcification,while positively correlated with 25-hydroxyvitamin D and Fetuin-A（P<0.05）.5.The incidence of vascular calcification and calcification score in end-stage renal disease patients with maintenance hemodialysis were significantly higher than those in non-dialysis patients（P<0.05）,and there was no significant difference in the severity of vascular calcification（mild calcification,moderate calcification,severe calcification）between the two groups.The level of serum Klotho protein in dialysispatients was lower than that in non-dialysis patients,and the difference was statistically significant（P<0.05）,but there was no significant difference in Fetuin-A level between the two groups（P>0.05）.Conclusion 1.The levels of serum Fetuin-A and Klotho proteins in patients with ESRD are significantly decreased,and they are related to abdominal aortic calcification,which has a certain protective effect on vascular calcification.2.Abdominal aortic calcification is more likely to occur in hemodialysis patients,and the level of serum Klotho protein is lower.There is no difference in serum Fetuin-A level between hemodialysis patients and non-dialysis patients.