| Association of low fetuin-A (AHSG) concentrations in serum with cardiovascular mortality in patients on dialysis: a cross-sectional study. | |
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MedLine Citation:
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PMID: 12642050 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Vascular calcification is the most prominent underlying pathological finding in patients with uraemia, and is a predictor of mortality in this population. Fetuin-A (alpha2-Heremans Schmid glycoprotein; AHSG) is an important circulating inhibitor of calcification in vivo, and is downregulated during the acute-phase response. We aimed to investigate the hypothesis that AHSG deficiency is directly related to uraemic vascular calcification. METHODS: We did a cross-sectional study in 312 stable patients on haemodialysis to analyse the inter-relation of AHSG and C-reactive protein (CRP) and their predictive effect on all-cause and cardiovascular mortality, over a period of 32 months. Subsequently, we tested the capacity of serum to inhibit CaxPO4 precipitation in patients on long-term dialysis (n=17) with apparent soft-tissue calcifications, and in those on short-term dialysis (n=8) without evidence of calcifications and cardiovascular disease. FINDINGS: AHSG concentrations in serum were significantly lower in patients on haemodialysis (mean 0.66 g/L [SD 0.28]) than in healthy controls (0.72 [0.19]). Low concentrations of the glycoprotein were associated with raised amounts of CRP and with enhanced cardiovascular (p=0.031) and all-cause mortality (p=0.0013). Sera from patients on long-term dialysis with low AHSG concentrations showed impaired ex-vivo capacity to inhibit CaxPO4 precipitation (mean IC50: 9.0 microL serum [SD 3.1] vs 7.5 [0.8] in short-term patients and 6.4 [2.6] in controls). Reconstitution of sera with purified AHSG returned this impairment to normal. Interpretation AHSG deficiency is associated with inflammation and links vascular calcification to mortality in patients on dialysis. Activated acute-phase response and AHSG deficiency might account for accelerated atherosclerosis in uraemia. |
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Authors:
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Markus Ketteler; Philipp Bongartz; Ralf Westenfeld; Joachim Ernst Wildberger; Andreas Horst Mahnken; Roland Böhm; Thomas Metzger; Christoph Wanner; Willi Jahnen-Dechent; Jürgen Floege |
Publication Detail:
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Type: Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Lancet Volume: 361 ISSN: 0140-6736 ISO Abbreviation: Lancet Publication Date: 2003 Mar |
Date Detail:
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Created Date: 2003-03-18 Completed Date: 2003-04-04 Revised Date: 2009-11-03 |
Medline Journal Info:
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Nlm Unique ID: 2985213R Medline TA: Lancet Country: England |
Other Details:
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Languages: eng Pagination: 827-33 Citation Subset: AIM; IM |
Affiliation:
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Department of Nephrology and Immunology, University Hospital Aachen, Aachen, Germany. mketteler@ukaachen.de |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Blood Proteins
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deficiency*,
metabolism Calcinosis / etiology Cardiovascular Diseases / blood, mortality* Case-Control Studies Cross-Sectional Studies Female Germany Humans Male Middle Aged Renal Dialysis* |
| Chemical | |
Reg. No./Substance:
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0/Blood Proteins; 0/alpha2HS glycoprotein |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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