Association of serum fetuin-A and fetuin-A gene polymorphism in relation to mineral and bone disorders in patients with chronic kidney disease

Osteopontin, kidney injury molecule-1, and fetuin-A as prognostic markers of end-stage renal disease: A systematic review and meta-analysis

BACKGROUND

The global prevalence of chronic kidney disease (CKD) as a major renal disease is increasing rapidly. The progression of CKD may lead to end-stage renal disease (ESRD). Current diagnostic and prognostic methods still have some limitations. This study aims to evaluate the potential and predictive ability of Osteopontin (OPN), Kidney injury molecule-1 (KIM-1), and Fetuin-A on the incidence of ESRD in CKD patients.

METHODS

A systematic review and meta-analysis were carried out based on the PRISMA guideline on registered databases for studies published up to December 21, 2023. The concentrations of each marker were then reported in pooled standardized mean difference (SMD) and hazard ratio (HR). Subgroup analysis was performed based on age, location, and KIM-1 specimen.

RESULTS

We included 21 studies involving 15,983 patients. Meta-analysis revealed that increasing OPN (SMD = 5.52, 95% CI = 1.59-9.44, p = 0.01) and KIM-1 (SMD = 1.45, 95% CI = 0.50-2.39, p = 0.0027), as well as decreasing Fetuin-A level (SMD = -1.31, 95% CI = -2.37 - -0.26, p = 0.01) were significant in CKD patients with ESRD. Chronic kidney disease patients with increased KIM-1 levels showed 1.13 times increased risk of ESRD (HR = 1.13, 95% CI = 1.10-1.17, p <0.0001). Subgroup analysis showed that increased KIM-1 in urine or blood was strongly associated with ESRD, and decreased Fetuin-A levels in Asians had a significant association with the incidence of ESRD.

CONCLUSION

Osteopontin, KIM-1, and Fetuin-A significantly reflect ESRD in CKD patients, making them potential prognostic indicators.

Gender-Related Differences in Chronic Kidney Disease-Associated Vascular Calcification Risk and Potential Risk Mediators: A Scoping Review

Vascular calcification (VC) involves the deposition of calcium apatite in vascular intima or media. Individuals of advanced age, having diabetes mellitus or chronic kidney disease (CKD) are particularly at risk. The pathogenesis of CKD-associated VC evolves considerably. The core driver is the phenotypic change involving vascular wall constituent cells toward manifestations similar to that undergone by osteoblasts. Gender-related differences are observed regarding the expressions of osteogenesis-regulating effectors, and presumably the prevalence/risk of CKD-associated VC exhibits gender-related differences as well. Despite the wealth of data focusing on gender-related differences in the risk of atherosclerosis, few report whether gender modifies the risk of VC, especially CKD-associated cases. We systematically identified studies of CKD-associated VC or its regulators/modifiers reporting data about gender distributions, and extracted results from 167 articles. A significantly higher risk of CKD-associated VC was observed in males among the majority of original investigations. However, substantial heterogeneity exists, since multiple large-scale studies yielded neutral findings. Differences in gender-related VC risk may result from variations in VC assessment methods, the anatomical segments of interest, study sample size, and even the ethnic origins of participants. From a biological perspective, plausible mediators of gender-related VC differences include body composition discrepancies, alterations involving lipid profiles, inflammatory severity, diversities in matrix Gla protein (MGP), soluble Klotho, vitamin D, sclerostin, parathyroid hormone (PTH), fibroblast growth factor-23 (FGF-23), and osteoprotegerin levels. Based on our findings, it may be inappropriate to monotonously assume that male patients with CKD are at risk of VC compared to females, and we should consider more background in context before result interpretation.

Association of AHSG gene polymorphisms with serum Fetuin-A levels in individuals with cardiovascular calcification in west of Iran

Fetuin-A (AHSG) is a multifunctional secretory protein and acts as an ectopic valve and artery calcification inhibitor. We assessed the correlation between serum levels of Fetuin-A and both exon 6 (248 C/T) and exon 7 (256 C/G) mutations in patients with coronary artery calcification (CAC), mitral annular calcification (MAC), and aortic valve calcification (AVC). 184 patients and 184 healthy individuals as control group were included. The genetic variants of rs4917 and rs4918 for the AHSG gene were determined by PCR-RFLP and T-ARMS PCR techniques. Fetuin-A levels, fasting blood sugar (FBS), urea, creatinine, calcium phosphorus, and lipid profile were measured. Fetuin-A levels were remarkedly lower in individuals with AVC, MAC, and CAC comparing to the control group (p < 0.001). The CT + TT genotypes and the T allele (AHSG Thr248Met) were associated with the risk of calcification of heart valves and coronary artery by 1.31 and 1.27 times in the patient group, respectively. The frequency of CT genotype and T allele was considerably higher in the patient group comparing to the control group. Patients with T allele (CT + TT) had higher levels of FBS, urea, low-density lipoproteins (LDL)-C, phosphorus, systolic blood pressure (SBP), diastolic blood pressure (DBP) while decreased levels of triglyceride, high-density lipoproteins (HDL)-C, calcium and fetuin-A in comparison to control group. Additionally, there was a positive correlation between serum FBS, urea, creatinine, HDL-C, calcium with fetuin-A, and a negative correlation between phosphorous level, SBP, and DBP with fetuin-A. T allele in rs4917 Single nucleotide polymorphism (SNP) is the risk allele of calcification of heart valves and coronary arteries and fetuin-A levels correlates negatively with the occurrence of the disease.