Background: There is a disproportionate burden of vascular disease in patients with chronic kidney disease (CKD). Both aortic stiffness, as measured by carotid-femoral pulse wave velocity (C-F PWV), and deficiency in inhibitors of vascular calcification, such as Fetuin-A, have been implicated in the higher rates of cardiovascular mortality observed in this population. We sought to determine whether Fetuin-A concentration was inversely associated with progressive aortic stiffness.

Methods: 54 stable outpatients enrolled in a prospective cohort study of cardiovascular risk in CKD stages 3 and 4 underwent measurement of C-F PWV using Complior under standardized conditions at baseline and 12 months. Baseline plasma Fetuin-A concentration was determined using the Biovendor ELISA kit.

Results: The population was aged 68.0±10.4 years, 80% male, 11% diabetic with a mean eGFR of 32.0±11.5. Baseline Fetuin-A did not correlate with patient age, eGFR, mean arterial blood pressure, albumin, calcium-phosphate product, parathyroid hormone or CRP. Baseline Fetuin-A was inversely correlated with the change in PWV over 1 year (rho=−0.52, p<0.001). After adjustment for change in mean arterial pressure between visits, age, eGFR and presence of diabetes the correlation was maintained (r_p=−0.54, p<0.001). Using stepwise multiple linear regression with a model including age, change in eGFR, parathyroid hormone, CRP and diabetic status, Fetuin-A was the only independent predictor of change in aortic stiffness adjusted for change in MAP (β-coefficient −0.61, p<0.001; R² total 0.36).

Conclusion: In a cohort of patients with CKD stages 3 and 4 there is an independent negative association between Fetuin-A and progressive aortic stiffness.