Fetuin A is assessing of developing bone mineral disorders and cardiovascular calcifi cation formation risk marker in patients with stage 5 chronic kidney disease

INTRODUCTION. Recent years clinical studies have shown that bone mineral disorders in chronic kidney disease (CKD) increase the risk of cardiovascular mortality. Factors involved in mineral metabolism, dysregulation of the synthesis of which increases the risk of cardiovascular calcification in CKD S5D include fetuin A. A decrease in the level of fetuin A can lead to the development and progression of processes of extraossal calcification and increased cardiovascular mortality in patients with CKD S5D. THE AIM: to determination of Fetuin A level n and assessment of its relationship with factors involved in mineral metabolism to identify the risk of cardiovascular calcification in patients with CKD S5D. PATIENTS AND METHODS. 84 patients with stage 5 CKD receiving hemodialysis treatment were examined, of which 40 are female and 44 are male. The average age of patients was 55.6±14.9 years. All patients underwent routine examinations, as well as echocardioscopy with an assessment of calcification of the heart valves, radiography of the abdominal organs in a lateral projection with aortic calcification assessment, an analysis of indicators characterizing phosphorus-calcium metabolism was carried out. The level of serum fetuin A was determined, along with the level of calcitriol (1.25 (OH)D), fibroblast growth factor -23 (FGF-23), parathyroid hormone (PTH), alpha-klotho (A-klotho), phosphorus (P) and calcium (Ca) of blood. Statistical analysis was carried out using the program «STATISTICA 12.6» («StatSoft Inc.», USA). RESULTS. It was found that the level of fetuin A in the blood of patients is 0.78± 0.11 ng/ml and ranges from 0.45 to 0.95 ng/ml, signs of calcification of the heart valves and/or aortic wall were noted in 51.2 % of patients. It was revealed that fetuin A has a positive correlation with albumin, its level decreases in patients with age, in patients with low values of "dry weight", indicating the presence of protein-energy deficiency in this category of patients. It has been shown that a decrease in fetuin A level is associated with an increase in FGF-23 and a decrease in A-klotho and indicates an increase in the potential of vascular calcification. The effect of a decrease in the level of fetuin A on the risk of detection of calcification of the aortic wall and heart valves was confirmed. It was revealed that a low level of fetuin A not only increases the probability of calcification itself, but also its severity. We have established that fetuin A is able to do this in conjunction with A-klotho. Since both factors have protective properties against calcification, their friendly reduction also contributes to its development. CONCLUSION. A decrease in the level of fetuin A in patients blood with CKD S5D contributes to an increased risk of calcification of the heart valves and the aortic wall, both independently and in combination with a decrease in the level of A-klotho. Low fetuin A values increase the severity of cardiovascular calcification.

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