Serum Fetuin A, hs-CRP and homocysteine as biochemical markers of cardiovascular complications in chronic dialysis patients

Abstract

Introduction: Chronic kidney disease (CKD) patients are considered a high risk group of cardiovascular disease in which vascular calcification plays central role. A pivotal role in the inhibition of calcification is played by fetuin-A. The measurement of inflammatory markers such as high sensitivity C-reactive protein (hs-CRP) and homocysteine which promotes atherosclerosis is helpful in predicting cardiovascular disease in ESRD patients on regular dialysis. Material and Method: The study included 40 adult CKD patients divided into 30 ESRD patients on conventional hemodialysis, 15 with CVD and 15 without CVD, as well as 10 CKD patients on conservative treatment. Ten healthy subjects served as a control group. Enzyme-linked immunosorbent assays were used for fetuin-A, hs-CRP and homocysteine. Results: ESRD patients showed a significant increase in serum hs-CRP, homocysteine and decrease in fetuin-A compared to control group. In addition, ESRD patients with CVD and without CVD showed a significant increase in hs-CRP, homocysteine and only those with CVD had significantly decreased fetuin-A in relation to CKD patients. The study revealed increased levels of hs-CRP and decrease in fetuin-A in ESRD patients with CVD compared to ESRD patients without CVD. Fetuin-A showed a negative correlation with hs-CRP and homocysteine in ESRD patients with and without CVD. Conclusion: The combined use of hs-CRP at a cutoff of (10 mg/dL) with either fetuin-A at a cutoff value of (0.26 g/L) or alternatively with homocysteine at a cutoff value of (48.23 μmol/L) proved to be effective for discrimination of CVD patients from other ESRD or CKD patients.