Is fetuin-A a biomarker of dialysis access dysfunction?

Evaluation of the relationship between proximal upper-extremity arteriovenous fistula patency and atherogenic index of plasma

BACKGROUND

The continuity of arteriovenous fistula (AVF) patency is essential for effective hemodialysis. In the present study, we aimed to investigate the relationship between AVF patency and atherogenic index of plasma (AIP) in patients with native proximal upper-extremity AVF.

METHODS

A total of 143 patients with native proximal upper-extremity AVF created in our clinic between January 2014 and April 2022 were analyzed retrospectively. Those with at least 24 months of follow-up and intact AVF were defined as "Group 1" (n = 97), and those with AVF thrombosis were defined as "Group 2" (n = 46).

RESULTS

The primary patency rates of the patient groups included in the study were found to be 88.1% at 6th month, 79% at 12th month, and 67.8% at 24th month. The mean AIP values that were calculated in Group 2 were found to be statistically significantly higher than the mean value calculated in Group 1 (0.30 ± 0.12 vs 0.20 ± 0.10, p < 0.001). In a multivariate logistic regression analysis made to identify the predictors of proximal upper-extremity AVF thrombosis development, total cholesterol (OR [odds ratio] = 2.259, 95% CI [confidence interval] = 1.468-3.475, p < 0.001), and triglyceride (OR = 13.777, 95% CI = 3.740-50.750, p < 0.001) were identified as independent predictors.

CONCLUSION

A significant relationship was detected in the analyses between the easily calculated AIP values and the development of AVF thrombosis. The AIP is a remarkable preoperative parameter regarding proximal upper-extremity AVF patency.

The comparison of paricalcitol and calcitriol effects on pulse wave velocity, osteocalcin, and fetuin-A in chronic hemodialysis patients

INTRODUCTION

Vascular calcification is an intervenable factor in the pathophysiology of cardiovascular disease. Treatment-related factors might worsen the arterial stiffness in chronic hemodialysis patients. The aim of the study is to compare the effects of 1-year treatment with paricalcitol or calcitriol on pulse wave velocity (PWV), which is an indicator of arterial stiffness and osteocalcin and fetuin-A levels.

METHODS

Seventy-six hemodialysis patients who had similar PWV1 at the beginning were evaluated after a 1-year treatment of paricalcitol or calcitriol. PWV2, serum osteocalcin, and fetuin-A levels were measured at the end of the study.

RESULTS

At the end of the study, PWV2 of paricalcitol group was statistically lower than the calcitriol group. Osteocalcin levels were statistically lower and fetuin-A levels were statistically higher in the paricalcitol group than the calcitriol group at the end of the study. The number of patients with PWV2 > 7 m/s and using paricalcitol was 16 (39%) but 25 (41%) patients were using calcitriol; the differences were statistically significant.

CONCLUSIONS

The long-term benefits of paricalcitol were superior to the benefits of calcitriol. Paricalcitol has protective effects from vascular calcification in chronic hemodialysis patients.