Low serum fetuin A levels and incident stroke in patients with maintenance haemodialysis

Authors

  • Hung-Yuan Chen,

    1. Division of Nephrology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
    2. Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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  • Yen-Ling Chiu,

    1. Division of Nephrology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
    2. Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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  • Shih-Ping Hsu,

    1. Division of Nephrology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
    2. Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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  • Mei-Fen Pai,

    1. Division of Nephrology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
    2. Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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  • Ju-Yeh Yang,

    1. Division of Nephrology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
    2. Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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  • Yu-Sen Peng

    Corresponding author
    1. Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
    • Division of Nephrology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
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Correspondence to: Yu-Sen Peng, MD, Division of Nephrology, Department of Internal Medicine, Far Eastern Memorial Hospital, #21 Nan-Ya South Rd., Section 2, Pan-Chiao, New Taipei City, Taiwan. Tel.: +886 2 8966 7000, ext. 1163; fax: +886 2 8966 7000, ext. 1162; e-mail: taan70@yahoo.com.tw

Abstract

Background and objectives

Fetuin A, a predictor of mortality in dialysis patients, is associated with vascular calcification and atherosclerosis in haemodialysis (HD) patients. Whether it predicts stroke remains unknown. This study aimed to investigate the association between fetuin A and incident stoke in maintenance HD patients.

Design, setting, participants and measurements

This is a prospective observational study. 238 prevalent HD patients (127 women and 111 men; mean age, 60 ± 12 years) were followed up for the occurrence of stroke for 55 months. Baseline circulating fetuin A levels, biochemical data and other markers of inflammation were measured. The major outcome was the occurrence of incident ischaemic or haemorrhagic stroke.

Results

Thirty one patients had incident strokes; an incidence of 38·4/1000 patient-years (95% confidence interval (CI) 36·5–39·8/1000 patient-years) on follow-up. Patients in the lowest tertile of fetuin A concentration had highest risk to have incident stroke (P < 0·001, log-rank test). By Cox proportional-hazards regression, patients with higher fetuin A levels experienced lower incidence of stroke, hazard ratio (HR) of 0·89 (95% CI, 0·84–0·96), while those with higher mean arterial blood pressure had an HR of 1·19 (95% CI, 1·07–1·34) and those with higher calcium phosphate product (CaxP) had an HR of 1·39 (95% CI, 1·1–1·73) for having strokes. For patients without previous history of diabetes and cerebrovascular disease, fetuin A deficiency also predicts the occurrence of incident stroke.

Conclusions

Fetuin A deficiency is associated with a higher risk of incident stroke among prevalent HD patients.

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