Association of Low Serum Fetuin A Levels With Poor Arteriovenous Access Patency in Patients Undergoing Maintenance Hemodialysis
Association of Low Serum Fetuin A Levels With Poor Arteriovenous Access Patency in Patients Undergoing Maintenance Hemodialysis
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DOI：
10.1053/j.ajkd.2010.06.015
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发表时间：
2010-10-01
影响因子：
13.2
通讯作者：
Wu, Kwan-Dun
中科院分区：
文献类型：
--
作者：
Chen, Hung-Yuan;Chiu, Yen-Ling;Wu, Kwan-Dun
背景资料：胎球蛋白A是透析患者死亡率的预测因子，与血液透析（HD）患者的血管钙化和动脉粥样硬化相关。它是否预测动静脉（AV）通路通畅尚不清楚。本研究旨在探讨胎球蛋白A与血液透析患者房室通路通畅性之间的关系。研究设计：前瞻性观察研究。（127名女性和111名男性;平均年龄60 ± 12岁）随访32个月的AV通路通畅性。基线循环胎球蛋白A水平的三分位数，对应于0.15-0.25、0.26-0.32和0.33-0.51 g/L。结果：主要结果是无辅助AV通路通畅性丧失，定义为AV通路血栓形成或需要干预。结果：100例患者在随访时AV通路通畅性丧失（42%）。胎球蛋白A最低三分位数的患者AV通路通畅率最差（对数秩检验，卡方检验（2）= 8.68; P = 0.01）。使用考克斯比例风险回归，以最低胎球蛋白A三分位数的患者作为参考，中间三分位数的患者AV通路通畅性丧失的HR为0.49（95% CI，0.29-0.82），而最高胎球蛋白A三分位数的患者的HR为0.43（95% CI，0.25-0.75）。同样，考虑到分别使用动静脉瘘或移植物的患者，胎球蛋白A最高三分位数的患者失去动静脉通路通畅的风险低于其他三分位数的患者。（AV瘘患者的HR为0.40 [95% CI，0.19-0.84]，AV移植物患者的HR为0.25 [95% CI，0.10-0.65]）。局限性：重点是通畅的流行，而不是新的AV接入在维持性血液透析patients.Conclusions：胎球蛋白A缺乏症与更高的风险损失的AV接入通畅性无论是本地AV瘘或AV移植在HD患者。美国肾脏病杂志56：720-727。(C)2010年，美国国家肾脏基金会（National Kidney Foundation，Inc.）
Background: Fetuin A, a predictor of mortality in dialysis patients, is associated with vascular calcification and atherosclerosis in hemodialysis (HD) patients. Whether it predicts arteriovenous (AV) access patency is unknown. This study aimed to investigate the association between fetuin A and AV access patency in HD patients.Study Design: Prospective observational study.Setting & Participants: 238 prevalent HD patients (127 women and 111 men; mean age, 60 +/- 12 years) were followed up for AV access patency for 32 months.Predictors: Tertiles of baseline circulating fetuin A levels, corresponding to 0.15-0.25, 0.26-0.32, and 0.33-0.51 g/L.Outcome: The major outcome was loss of unassisted AV access patency, defined as AV access thrombosis or need for intervention.Measurements: Fetuin A and other markers of inflammation.Results: 100 patients had loss of AV access patency (42%) on follow-up. Patients in the lowest fetuin A tertile had the worst AV access patency (log-rank test, chi(2) = 8.68; P = 0.01). Using Cox proportional hazards regression with patients in the lowest fetuin A tertile as reference, patients in the intermediate tertile had an HR of 0.49 (95% CI, 0.29-0.82), whereas those in the highest fetuin A tertile had an HR of 0.43 (95% CI, 0.25-0.75) for loss of AV access patency. Similarly, considering patients using AV fistulas or grafts separately, patients in the highest fetuin A tertile had less risk of losing AV access patency than patients in the other tertiles (HR, 0.40 [95% CI, 0.19-0.84] for patients with AV fistulas and HR, 0.25 [95% CI, 0.10-0.65] for patients with AV grafts).Limitations: Focus on the patency of prevalent rather than new AV access in maintenance hemodialysis patients.Conclusions: Fetuin A deficiency is associated with a higher risk of loss of AV access patency in either native AV fistulas or AV grafts in HD patients. Am J Kidney Dis 56: 720-727. (C) 2010 by the National Kidney Foundation, Inc.