1. ¹Department of Internal Medicine and Nephrology, Academic Hospital Maastricht, Maastricht, The Netherlands
2. ²Department of Nephrology and Clinical Immunology, University Hospital Aachen, RWTH, Germany
3. ³Hans Mak Institute, Naarden, The Netherlands
4. ⁴Department of Nephrology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
5. ⁵Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands

Correspondence: MMH Hermans, Department of Internal Medicine and Nephrology, Academic Hospital Maastricht, P. Debeyelaan 25, 6229 HX Maastricht, The Netherlands. E-mail:mherm@sint.azm.nl

⁶These authors contributed equally to this work

Received 3 March 2006; Revised 9 January 2007; Accepted 17 January 2007; Published online 7 March 2007.

Abstract

Calcifying atherosclerosis is an active process, which is controlled by calcification inhibitors and inducers. Fetuin-A, an acute phase glycoprotein, is one of the more powerful circulating inhibitors of hydroxyapatite formation. A prospective multicenter cohort study was initiated to include both hemodialysis (HD) and peritoneal dialysis (PD) patients in an evaluation of the association of serum fetuin-A levels with both cardiovascular (CV) and non-CV mortality. An increase in the serum fetuin-A concentration of 0.1 g/l was associated with a significant reduction in all-cause mortality of 13%. There was a significant 17% reduction in non-CV mortality and a near significant reduction in CV mortality. This association of fetuin-A and mortality rates was comparable in both HD and PD patients even when corrected for factors, including but not limited to age, gender, primary kidney disease, C-reactive protein levels, and nutritional status. We conclude that serum fetuin-A concentrations may be a general predictor of mortality in dialysis patients.