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Low serum fetuin A levels and incident stroke in patients with maintenance haemodialysis
Author(s) -
Chen HungYuan,
Chiu YenLing,
Hsu ShihPing,
Pai MeiFen,
Yang JuYeh,
Peng YuSen
Publication year - 2013
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1111/eci.12057
Subject(s) - medicine , hazard ratio , stroke (engine) , dialysis , proportional hazards model , incidence (geometry) , diabetes mellitus , prospective cohort study , confidence interval , fetuin , cardiology , endocrinology , mechanical engineering , physics , optics , engineering , glycoprotein , microbiology and biotechnology , biology
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.