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

Abstract

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