Association Among Serum Fetuin-A Level, Coronary Artery Calcification, and Bone Mineral Densitometry in Maintenance Hemodialysis Patients

Patients with end‐stage renal disease have a very high prevalance and extent of arterial calcification. A number of studies suggest that similar pathophysiologic mechanisms are responsible for development and progression of calcification of atherosclerotic plaque and bone formation. Fetuin‐A is a potent calcification inhibitor and is expressed in bone, with not‐yet well‐defined functions. The aim of this study was to investigate the relation between bone mineral densitometry parameters, coronary artery calcification, and serum fetuin‐A levels. In a cross‐sectional design, we included 72 maintenance hemodialysis (HD) patients and 30 age‐ and gender‐ matched healthy controls. Serum fetuin‐A levels were studied both in maintenance HD patients and healthy controls. Maintenance HD patients had radius, hip, and lumbar spine bone mineral density (BMD) assessed by dual‐energy X‐ray absorptiometry and coronary artery calcification score (CACS) measured by electron‐beam computed tomography. The associations between site‐specific BMD parameters, CACS, and serum fetuin‐A levels were studied in maintenance HD patients. CACS, mass, and volume of plaques in coronary arteries were significantly higher in patients with a T‐score below ?2.5 than above in the proximal region of the radius, neck and trochanter of the femur, and the lumbar spine. Mean serum fetuin‐A concentration was 0.636 ± 0.118 g/L in maintenance HD patients and it was less than healthy controls (0.829 ± 0.100 g/L, P < 0.0001). CACS, mass, and volume of plaques in coronary arteries correlated significantly with the serum fetuin‐A levels. Moreover, significant positive correlations were shown between the serum fetuin‐A levels, BMD values, and T‐scores of proximal radius, neck, and trochanter of the femur, but not with the lumbar spine. The present study demonstrates an association between serum fetuin‐A levels, coronary artery calcification, and bone mineral densities—except for the lumbar spine, in maintenance HD patients. However, the results should be interpreted with caution because of the cross‐sectional design of the study.