Fetuin A is assessing of developing bone mineral disorders and cardiovascular calcifi cation formation risk marker in patients with stage 5 chronic kidney disease

Abstract

INTRODUCTION. Recent years clinical studies have shown that bone mineral disorders in chronic kidney disease (CKD) increase the risk of cardiovascular mortality . Factors involved in mineral metabolism , dysregulation of the synthesis of which increases the risk of cardiovascular calcification in CKD S5D include fetuin A. A decrease in the level of fetuin A can lead to the development and progression of processes of extraossal calcification and increased cardiovascular mortality in patients with CKD S5D. THE AIM: to determination of Fetuin A level n and assessment of its relationship with factors involved in mineral metabolism to identify the risk of cardiovascular calcification in patients with CKD S5D. PATIENTS AND METHODS. 84 patients with stage 5 CKD receiving hemodialysis treatment were examined , of which 40 are female and 44 are male . The average age of patients was 55.6±14.9 years . All patients underwent routine examinations , as well as echocardioscopy with an assessment of calcification of the heart valves , radiography of the abdominal organs in a lateral projection with aortic calcification assessment , an analysis of indicators characterizing phosphorus-calcium metabolism was carried out . The level of serum fetuin A was determined , along with the level of calcitriol (1.25 (OH)D), fibroblast growth factor -23 (FGF-23), parathyroid hormone (PTH), alpha-klotho (A- klotho ), phosphorus (P) and calcium ( Ca ) of blood . Statistical analysis was carried out using the program «STATISTICA 12.6» (« StatSoft Inc.», USA). RESULTS. It was found that the level of fetuin A in the blood of patients is 0.78± 0.11 ng / ml and ranges from 0.45 to 0.95 ng / ml , signs of calcification of the heart valves and / or aortic wall were noted in 51.2 % of patients . It was revealed that fetuin A has a positive correlation with albumin , its level decreases in patients with age , in patients with low values of " dry weight ", indicating the presence of protein-energy deficiency in this category of patients . It has been shown that a decrease in fetuin A level is associated with an increase in FGF-23 and a decrease in A- klotho and indicates an increase in the potential of vascular calcification . The effect of a decrease in the level of fetuin A on the risk of detection of calcification of the aortic wall and heart valves was confirmed . It was revealed that a low level of fetuin A not only increases the p robability of calcification itself , but also its severity . We have established that fetuin A is able to do this in conjunction with A- klotho . Since both factors have protective properties against calcification , their friendly reduction also contributes to its development . CONCLUSION. A decrease in the level of fetuin A in patients blood with CKD S5D contributes to an increased risk of calcification of the heart valves and the aortic wall , both independently and in combination with a decrease in the level of A- klotho . Low fetuin A values increase the severity of cardiovascular calcification .