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

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.