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Saudi Journal of Kidney Diseases and Transplantation
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Year : 2015  |  Volume : 26  |  Issue : 2  |  Page : 370-372
The effect of serum fetuin-A on atherosclerosis in hemodialysis patients

1 Department of Biochemistry, Sirnak Military Hospital, Sirnak, Turkey
2 Department of Biochemistry, Agri Military Hospital, Agri, Turkey
3 Department of Biochemistry, GATA School of Medicine, Ankara, Turkey

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Date of Web Publication3-Mar-2015

How to cite this article:
Aydin FN, Agilli M, Cayci T, Kurt YG. The effect of serum fetuin-A on atherosclerosis in hemodialysis patients. Saudi J Kidney Dis Transpl 2015;26:370-2

How to cite this URL:
Aydin FN, Agilli M, Cayci T, Kurt YG. The effect of serum fetuin-A on atherosclerosis in hemodialysis patients. Saudi J Kidney Dis Transpl [serial online] 2015 [cited 2021 May 18];26:370-2. Available from: https://www.sjkdt.org/text.asp?2015/26/2/370/152537
To the Editor,

We read with great interest the article by Haddad et al entitled "Association of serum fetuin-A and biochemical parameters in hemodialysis patients," in which they aimed to evaluate the association between fetuin-A and other biochemical parameters as facilitator factors for developing atherosclerosis in hemodialysis (HD) patients. The authors reported that the serum fetuin-A level in HD patients was lower than that in the controls. They suggested that the low fetuin-A level is associated with atherosclerosis, inflammation and malnutrition in the HD patients. [1] However, we think that some points should be discussed.

Firstly, the authors aimed to evaluate the association between fetuin-A as an inhibitor factor for vascular calcification, atherosclerosis and biochemical parameters as facilitating factors for developing atherosclerosis in HD patients. Recent studies have shown that the predictors, including epicardial adipose tissue thickness, carotid intima-media thickness, cardio-ankle vascular index and ankle- brachial index, are markers of atherosclerosis. [2],[3],[4] However, Haddad et al have not designed a measure to indicate atherosclerosis.

Secondly, the authors have reported that the mean fetuin-A and low-density lipoprotein (LDL)-cholesterol levels were significantly different statistically in the HD patients compared with the healthy controls (P <0.001 and P <0.02, respectively). Fetuin-A, α2-Heremans Schmid glycoprotein (AHSG), is a negative acute phase reactant encoded by the AHSG gene. There is low-grade inflammation in chronic kidney disease patients. This state is correlated with low serum fetuin-A levels. [6] Polymorphisms in the AHSG gene, plasma cholesterol levels and a history of smoking influence fetuin-A levels in HD patients. [7]

Thirdly, Stefan et al have demonstrated that blood AHSG and fetuin-A levels are negatively associated with insulin sensitivity, while they are positively associated with liver fat and obesity. [8] , [9] Furthermore, it has shown that there is a significant correlation between fetuin-A levels and parameters of insulin resistance, such as fasting C-peptide and C-peptide to glucose ratio. [10] Additionally, fetuin-A has been linked to obesity in a study performed in patients with morbid obesity. [9] The authors did not investigate the presence of obesity, insulin resistance and non-alcoholic fatty liver disease in this study.

Finally, the mineral disturbances including lifestyle, smoking, high calcium-phosphorus products, adynamic bone disease and using active vitamin D metabolites could affect the blood fetuin-A levels. They should have excluded these factors that affect the mineral disturbances. [11],[12]

In conclusion, the explanation of these concerns will certainly provide clearer information for the readers.

Authors' Reply

To the Editor,

Thanks to Dr. Aydin and colleagues for their due attention to the paper on the association of serum fetuin-A and biochemical parameters in hemodialysis patients. They indicated four points mentioned in the manuscript. As stated in the article, inflammation is a multifactorial process in end-stage renal disease, and it seems that it is a resultant effect of common and uncommon risk factors. Also, in numerous investigations, the association of calcification with inflammation and atherosclerosis or related serum parameters has been confirmed. [1],[2],[3],[4]

The second point raised many factors that can affect the levels of LDL and fetuin-A. Polymorphisms in genes involved in this process are not the aim of this study. The direct or inverse relationship was investigated between fetuin-A and LDL levels. The researchers suggest that this aspect can be considered in the design of future studies. In addition, regular consumption of cigarettes in the past six months was among the exclusion criteria.

The aim of this study was not to investigate the relationship between insulin with fetuin-A. However, there are several conflicting studies about the positive or negative association between insulin level with fetuin-A. [5],[6]

The patient and control groups were randomly selected. Given the high prevalence of vitamin D deficiency in Iran and the random selection of the two groups, any effect of this will also be observed in patients in the control group. [7]

Dr. Mahbobeh Haddad [1] , Dr. Ramin Tajbakhsh [2] , Dr. Mehran Farajollahi [3] , Dr. Mostafa Qorbani [4] , Dr. Sima Besharat [5] , Dr. Hamid Reza Joshaghani [6]

[1] Clinical Research Development Unit, 5-Azar Medical-Educational Center, Golestan University of Medical Sciences, Gorgan, [2] Department of Internal Medicine, Alborz University of Medical Sciences, Karaj, [3] Department of Internal Medicine, Golestan University of Medical Sciences, Gorgan, [4] Department of Epidemiology, Tehran University of Medical Sciences, [5] Liver and Pancreatobiliary Disease Research Center, Digestive Research Institute, Tehran University of Medical Sciences, Tehran, [6] Department of Medical Laboratory Sciences, Golestan Research Center of Gastroenterology and Hepatology (GRCGH), Golestan University of Medical Sciences, Gorgan, Iran E-mail: [email protected]


  1. Goodman WG, Goldin J, Kuizon BD, et al. Coronary-artery calcification in young adults with end-stage renal disease who are undergoing dialysis. N Engl J Med 2000;342:1478-83.
  2. Guérin AP, London GM, Marchais SJ, Metivier F. Arterial stiffening and vascular calcifications in end-stage renal disease. Nephrol Dial Transplant 2000;15:1014-21.
  3. Stompór T, Pasowicz M, Sulłowicz W, et al. An association between coronary artery calcification score, lipid profile, and selected markers of chronic inflammation in ESRD patients treated with peritoneal dialysis. Am J Kidney Dis 2003;41:203-11.
  4. Nascimento MM, Hayashi SY, Riella MC, Lindholm B. Elevated levels of plasma osteoprotegerin are associated with all-cause mortality risk and atherosclerosis in patients with stages 3 to 5 chronic kidney disease. Braz J Med Biol Res 2014;47:995-1002.
  5. Yin L, Cai WJ, Chang XY, et al. Association between fetuin-A levels with insulin resistance and carotid intima-media thickness in patients with new-onset type 2 diabetes mellitus. Biomed Rep 2014;2:839-42.
  6. Jullig M, Yip S, Xu A, et al. Lower fetuin-A, retinol binding protein 4 and several metabolites after gastric bypass compared to sleeve gastrectomy in patients with type 2 diabetes. PLoS One 2014;9:e96489.
  7. Faghih S, Abdolahzadeh M, Mohammadi M, Hasanzadeh J. Prevalence of vitamin D deficiency and its related factors among university students in Shiraz, Iran. Int J Prev Med 2014;5:796-9.

   References Top

Haddad M, Tajbakhsh R, Farajollahi M, Qorbani M, Besharat S, Joshaghani HR. Association of serum fetuin-A and biochemical parameters in hemodialysis patients. Saudi J Kidney Dis Transpl 2014;25:769-73.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
Taslipinar A, Yaman H, Yilmaz MI, et al. The relationship between inflammation, endothelial dysfunction and proteinuria in patients with diabetic nephropathy. Scand J Clin Lab Invest 2011;71:606-12.  Back to cited text no. 2
Altun B, Tasolar H, Eren N, et al. Epicardial Adipose Tissue Thickness in Hemodialysis Patients. Echocardiography 2014;31:941-6.  Back to cited text no. 3
Garimella PS, Ix JH, Katz R, et al. Association of Albumin-Creatinine Ratio and Cystatin C With Change in Ankle-Brachial Index: The Multi-Ethnic Study of Atherosclerosis (MESA). Am J Kidney Dis 2015;65:33-40.  Back to cited text no. 4
Lebreton JP, Joisel F, Raoult JP, Lannuzel B, Rogez JP, Humbert G. Serum concentration of human alpha 2 HS glycoprotein during the inflammatory process: Evidence that alpha 2 HS glycoprotein is a negative acute-phase reactant. J Clin Invest 1979;64:1118-29.  Back to cited text no. 5
Ketteler M, Bongartz P, Westenfeld R, et al. Association of low fetuin-A (AHSG) concentrations in serum with cardiovascular mortality in patients on dialysis: A cross-sectional study. Lancet 2003;361:827-33.  Back to cited text no. 6
Maréchal C, Schlieper G, Nguyen P, et al. Serum fetuin-A levels are associated with vascular calcifications and predict cardiovascular events in renal transplant recipients. Clin J Am Soc Nephrol 2011;6:974-85.  Back to cited text no. 7
Stefan N, Hennige AM, Staiger H, et al. Alpha2-Heremans-Schmid glycoprotein/fetuin-A is associated with insulin resistance and fat accumulation in the liver in humans. Diabetes Care 2006;29:853-7.  Back to cited text no. 8
Brix JM, Stingl H, Höllerl F, Schernthaner GH, Kopp HP, Schernthaner G. Elevated Fetuin-A concentrations in morbid obesity decrease after dramatic weight loss. J Clin Endocrinol Metab 2010;95:4877-81.  Back to cited text no. 9
Kalabay L, Cseh K, Pajor A, et al. Correlation of maternal serum fetuin/alpha2-HS-glycoprotein concentration with maternal insulin resistance and anthropometric parameters of neonates in normal pregnancy and gestational diabetes. Eur J Endocrinol 2002;147:243-8.  Back to cited text no. 10
Pencak P, Czerwieñska B, Ficek R, et al. Calcification of coronary arteries and abdominal aorta in relation to traditional and novel risk factors of atherosclerosis in hemodialysis patients. BMC Nephrol 2013; 14:10.  Back to cited text no. 11
Coen G, Pierantozzi A, Spizzichino D, et al. Risk factors of one year increment of coronary calcifications and survival in hemodialysis patients. BMC Nephrol 2010;11:10.  Back to cited text no. 12

Correspondence Address:
Dr. Fevzi Nuri Aydin
Department of Biochemistry, Sirnak Military Hospital, Sirnak
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DOI: 10.4103/1319-2442.152537

PMID: 25758894

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