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Published in: Clinical and Experimental Nephrology 10/2019

01-10-2019 | Kidney Transplantation | Original article

The association between cardiac valvular calcification and fetuin-A levels in kidney transplant recipients

Authors: Nizameddin Koca, Alparslan Ersoy, Barış Şensoy, Emine Kırhan, Sümeyye Güllülü, Canan Ersoy, Melahat Dirican, Emre Sarandöl

Published in: Clinical and Experimental Nephrology | Issue 10/2019

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Abstract

Objectives

Low fetuin-A levels in hemodialysis patients can be associated with development of vascular and valvular calcifications. The mechanisms underlying vascular and valvular calcifications are multifactorial. There are a few studies showing the relationship between low fetuin-A levels and valvular calcification after kidney transplantation. We aimed to evaluate the association between serum fetuin-A levels and valvular calcification in kidney transplant recipients.

Methods

The cardiac valvular calcification was assessed by echocardiography in 56 recipients. Patients were divided into two groups as those with (n = 11) and without (n = 45) aortic and/or mitral valve calcification. The extent of valvular calcification was visually assessed according to the standard visual score method: moderately (multiple larger spots) and heavily calcified (extensive thickening and calcification) of all cusps. Serum fetuin-A levels were measured.

Results

The demographic features of both groups were comparable. There was no significant difference between regular physical exercise (63.6% vs. 55.6%), obesity (18.2% vs. 17.8%), abdominal obesity (54.5% vs. 46.7%), smoking (0% vs. 13.3%), hypertension (63.6% vs. 68.9%), left ventricular hypertrophy (45.5% vs. 33.3%) and diabetes mellitus (9.1% vs. 20%) ratios in groups with or without valvular calcification, respectively (p > 0.05). Fetuin-A levels of both groups did not differ. Fetuin-A levels positively correlated with serum creatinine (r 0.326, p = 0.014), and negatively correlated with estimated glomerular filtration rate (r − 0.297, p = 0.026).

Conclusions

We could not find a relationship between serum fetuin-A levels and valvular calcification in kidney recipients. In this population, further studies are needed to assess the role of serum fetuin-A in valvular calcification.
Literature
1.
go back to reference Efstratiadis G, Koskinas K, Pagourelias E. Coronary calcification in patients with end-stage renal disease: a novel endocrine disorder? Hormones (Athens). 2007;6(2):120–31.CrossRef Efstratiadis G, Koskinas K, Pagourelias E. Coronary calcification in patients with end-stage renal disease: a novel endocrine disorder? Hormones (Athens). 2007;6(2):120–31.CrossRef
2.
go back to reference Wang AY. Vascular and other tissue calcification in peritoneal dialysis patients. Perit Dial Int. 2009;29(Suppl 2):S9–S14.PubMed Wang AY. Vascular and other tissue calcification in peritoneal dialysis patients. Perit Dial Int. 2009;29(Suppl 2):S9–S14.PubMed
3.
go back to reference Blacher J, et al. Arterial calcifications, arterial stiffness, and cardiovascular risk in end-stage renal disease. Hypertension. 2001;38(4):938–42.CrossRefPubMed Blacher J, et al. Arterial calcifications, arterial stiffness, and cardiovascular risk in end-stage renal disease. Hypertension. 2001;38(4):938–42.CrossRefPubMed
4.
go back to reference Wang AY, et al. Cardiac valve calcification as an important predictor for all-cause mortality and cardiovascular mortality in long-term peritoneal dialysis patients: a prospective study. J Am Soc Nephrol. 2003;14(1):159–68.CrossRefPubMed Wang AY, et al. Cardiac valve calcification as an important predictor for all-cause mortality and cardiovascular mortality in long-term peritoneal dialysis patients: a prospective study. J Am Soc Nephrol. 2003;14(1):159–68.CrossRefPubMed
5.
go back to reference Nguyen PT, et al. Coronary artery calcification: a strong predictor of cardiovascular events in renal transplant recipients. Nephrol Dial Transplant. 2010;25(11):3773–8.CrossRefPubMed Nguyen PT, et al. Coronary artery calcification: a strong predictor of cardiovascular events in renal transplant recipients. Nephrol Dial Transplant. 2010;25(11):3773–8.CrossRefPubMed
6.
go back to reference Braun J, et al. Electron beam computed tomography in the evaluation of cardiac calcification in chronic dialysis patients. Am J Kidney Dis. 1996;27(3):394–401.CrossRefPubMed Braun J, et al. Electron beam computed tomography in the evaluation of cardiac calcification in chronic dialysis patients. Am J Kidney Dis. 1996;27(3):394–401.CrossRefPubMed
7.
go back to reference Ossareh S. Vascular calcification in chronic kidney disease: mechanisms and clinical implications. Iran J Kidney Dis. 2011;5(5):285–99.PubMed Ossareh S. Vascular calcification in chronic kidney disease: mechanisms and clinical implications. Iran J Kidney Dis. 2011;5(5):285–99.PubMed
8.
go back to reference Komaba H, Fukagawa M. Fetuin-mineral complex: a new potential biomarker for vascular calcification? Kidney Int. 2009;75(9):874–6.CrossRefPubMed Komaba H, Fukagawa M. Fetuin-mineral complex: a new potential biomarker for vascular calcification? Kidney Int. 2009;75(9):874–6.CrossRefPubMed
9.
go back to reference Heiss A, et al. Structural basis of calcification inhibition by alpha 2-HS glycoprotein/fetuin-A. Formation of colloidal calciprotein particles. J Biol Chem. 2003;278(15):13333–411.CrossRefPubMed Heiss A, et al. Structural basis of calcification inhibition by alpha 2-HS glycoprotein/fetuin-A. Formation of colloidal calciprotein particles. J Biol Chem. 2003;278(15):13333–411.CrossRefPubMed
11.
go back to reference Kuro OM. A phosphate-centric paradigm for pathophysiology and therapy of chronic kidney disease. Kidney Int Suppl (2011). 2013;3(5):420–6.CrossRef Kuro OM. A phosphate-centric paradigm for pathophysiology and therapy of chronic kidney disease. Kidney Int Suppl (2011). 2013;3(5):420–6.CrossRef
13.
go back to reference Johnson RC, Leopold JA, Loscalzo J. Vascular calcification: pathobiological mechanisms and clinical implications. Circ Res. 2006;99(10):1044–59.CrossRefPubMed Johnson RC, Leopold JA, Loscalzo J. Vascular calcification: pathobiological mechanisms and clinical implications. Circ Res. 2006;99(10):1044–59.CrossRefPubMed
14.
go back to reference Reynolds JL, et al. Human vascular smooth muscle cells undergo vesicle-mediated calcification in response to changes in extracellular calcium and phosphate concentrations: a potential mechanism for accelerated vascular calcification in ESRD. J Am Soc Nephrol. 2004;15(11):2857–67.CrossRefPubMed Reynolds JL, et al. Human vascular smooth muscle cells undergo vesicle-mediated calcification in response to changes in extracellular calcium and phosphate concentrations: a potential mechanism for accelerated vascular calcification in ESRD. J Am Soc Nephrol. 2004;15(11):2857–67.CrossRefPubMed
15.
go back to reference Tintut Y, et al. Monocyte/macrophage regulation of vascular calcification in vitro. Circulation. 2002;105(5):650–5.CrossRefPubMed Tintut Y, et al. Monocyte/macrophage regulation of vascular calcification in vitro. Circulation. 2002;105(5):650–5.CrossRefPubMed
16.
go back to reference Ix JH, et al. Association of fetuin-A with mitral annular calcification and aortic stenosis among persons with coronary heart disease: data from the Heart and Soul Study. Circulation. 2007;115(19):2533–9.CrossRefPubMedPubMedCentral Ix JH, et al. Association of fetuin-A with mitral annular calcification and aortic stenosis among persons with coronary heart disease: data from the Heart and Soul Study. Circulation. 2007;115(19):2533–9.CrossRefPubMedPubMedCentral
17.
go back to reference Wang AY, et al. Associations of serum fetuin-A with malnutrition, inflammation, atherosclerosis and valvular calcification syndrome and outcome in peritoneal dialysis patients. Nephrol Dial Transplant. 2005;20(8):1676–85.CrossRefPubMed Wang AY, et al. Associations of serum fetuin-A with malnutrition, inflammation, atherosclerosis and valvular calcification syndrome and outcome in peritoneal dialysis patients. Nephrol Dial Transplant. 2005;20(8):1676–85.CrossRefPubMed
18.
go back to reference Ketteler M, et al. Association of low fetuin-A (AHSG) concentrations in serum with cardiovascular mortality in patients on dialysis: a cross-sectional study. Lancet. 2003;361(9360):827–33.CrossRefPubMed Ketteler M, et al. Association of low fetuin-A (AHSG) concentrations in serum with cardiovascular mortality in patients on dialysis: a cross-sectional study. Lancet. 2003;361(9360):827–33.CrossRefPubMed
19.
go back to reference van Summeren MJ, et al. Circulating calcification inhibitors and vascular properties in children after renal transplantation. Pediatr Nephrol. 2008;23(6):985–93.CrossRefPubMed van Summeren MJ, et al. Circulating calcification inhibitors and vascular properties in children after renal transplantation. Pediatr Nephrol. 2008;23(6):985–93.CrossRefPubMed
20.
go back to reference Marechal C, et al. Serum fetuin-A levels are associated with vascular calcifications and predict cardiovascular events in renal transplant recipients. Clin J Am Soc Nephrol. 2011;6(5):974–85.CrossRefPubMedPubMedCentral Marechal C, et al. Serum fetuin-A levels are associated with vascular calcifications and predict cardiovascular events in renal transplant recipients. Clin J Am Soc Nephrol. 2011;6(5):974–85.CrossRefPubMedPubMedCentral
21.
22.
go back to reference Rosenhek R, et al. Predictors of outcome in severe, asymptomatic aortic stenosis. N Engl J Med. 2000;343(9):611–7.CrossRefPubMed Rosenhek R, et al. Predictors of outcome in severe, asymptomatic aortic stenosis. N Engl J Med. 2000;343(9):611–7.CrossRefPubMed
23.
go back to reference Devereux RB, Reichek N. Echocardiographic determination of left ventricular mass in man. Anatomic validation of the method. Circulation. 1977;55(4):613–8.CrossRefPubMed Devereux RB, Reichek N. Echocardiographic determination of left ventricular mass in man. Anatomic validation of the method. Circulation. 1977;55(4):613–8.CrossRefPubMed
25.
go back to reference Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972;18(6):499–502.PubMed Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972;18(6):499–502.PubMed
27.
go back to reference Lebreton JP, et al. Serum concentration of human alpha 2 HS glycoprotein during the inflammatory process: evidence that alpha 2 HS glycoprotein is a negative acute-phase reactant. J Clin Investig. 1979;64(4):1118–29.CrossRefPubMed Lebreton JP, et al. Serum concentration of human alpha 2 HS glycoprotein during the inflammatory process: evidence that alpha 2 HS glycoprotein is a negative acute-phase reactant. J Clin Investig. 1979;64(4):1118–29.CrossRefPubMed
29.
go back to reference Rajamannan NM, et al. Calcific aortic valve disease: not simply a degenerative process: a review and agenda for research from the National Heart and Lung and Blood Institute Aortic Stenosis Working Group. Executive summary: Calcific aortic valve disease-2011 update. Circulation. 2011;124(16):1783–91.CrossRefPubMedPubMedCentral Rajamannan NM, et al. Calcific aortic valve disease: not simply a degenerative process: a review and agenda for research from the National Heart and Lung and Blood Institute Aortic Stenosis Working Group. Executive summary: Calcific aortic valve disease-2011 update. Circulation. 2011;124(16):1783–91.CrossRefPubMedPubMedCentral
30.
go back to reference Sainger R, et al. Comparison of transesophageal echocardiographic analysis and circulating biomarker expression profile in calcific aortic valve disease. J Heart Valve Dis. 2013;22(2):156–65.PubMedPubMedCentral Sainger R, et al. Comparison of transesophageal echocardiographic analysis and circulating biomarker expression profile in calcific aortic valve disease. J Heart Valve Dis. 2013;22(2):156–65.PubMedPubMedCentral
31.
go back to reference Koos R, et al. Association of fetuin-A levels with the progression of aortic valve calcification in non-dialyzed patients. Eur Heart J. 2009;30(16):2054–61.CrossRefPubMed Koos R, et al. Association of fetuin-A levels with the progression of aortic valve calcification in non-dialyzed patients. Eur Heart J. 2009;30(16):2054–61.CrossRefPubMed
32.
go back to reference Kocyigit I, et al. Association between cardiac valvular calcification and serum fetuin-A levels in renal transplant recipients. Transplant Proc. 2015;47(5):1398–401.CrossRefPubMed Kocyigit I, et al. Association between cardiac valvular calcification and serum fetuin-A levels in renal transplant recipients. Transplant Proc. 2015;47(5):1398–401.CrossRefPubMed
33.
go back to reference Caglar K, et al. Endothelial dysfunction and fetuin A levels before and after kidney transplantation. Transplantation. 2007;83(4):392–7.CrossRefPubMed Caglar K, et al. Endothelial dysfunction and fetuin A levels before and after kidney transplantation. Transplantation. 2007;83(4):392–7.CrossRefPubMed
34.
go back to reference Di Minno A, et al. Could circulating fetuin A be a biomarker of aortic valve stenosis? Int J Cardiol. 2017;249:426–30.CrossRefPubMed Di Minno A, et al. Could circulating fetuin A be a biomarker of aortic valve stenosis? Int J Cardiol. 2017;249:426–30.CrossRefPubMed
35.
go back to reference Stefan N, Häring H-U. Circulating fetuin-A and free fatty acids interact to predict insulin resistance in humans. Nat Med. 2013;19(4):394–5.CrossRefPubMed Stefan N, Häring H-U. Circulating fetuin-A and free fatty acids interact to predict insulin resistance in humans. Nat Med. 2013;19(4):394–5.CrossRefPubMed
36.
go back to reference Floege J, Ketteler M. Vascular calcification in patients with end-stage renal disease. Nephrol Dial Transplant. 2004;19(Suppl 5):V59–66.CrossRefPubMed Floege J, Ketteler M. Vascular calcification in patients with end-stage renal disease. Nephrol Dial Transplant. 2004;19(Suppl 5):V59–66.CrossRefPubMed
37.
go back to reference Block GA, et al. Mineral metabolism, mortality, and morbidity in maintenance hemodialysis. J Am Soc Nephrol. 2004;15(8):2208–18.CrossRefPubMed Block GA, et al. Mineral metabolism, mortality, and morbidity in maintenance hemodialysis. J Am Soc Nephrol. 2004;15(8):2208–18.CrossRefPubMed
38.
go back to reference Sasaki N, et al. Glucocorticoid decreases circulating osteoprotegerin (OPG): possible mechanism for glucocorticoid induced osteoporosis. Nephrol Dial Transplant. 2001;16(3):479–82.CrossRefPubMed Sasaki N, et al. Glucocorticoid decreases circulating osteoprotegerin (OPG): possible mechanism for glucocorticoid induced osteoporosis. Nephrol Dial Transplant. 2001;16(3):479–82.CrossRefPubMed
39.
go back to reference Laissy J-P, et al. Aortic valve calcification using multislice CT. Imaging Med. 2011;3(3):313–20.CrossRef Laissy J-P, et al. Aortic valve calcification using multislice CT. Imaging Med. 2011;3(3):313–20.CrossRef
40.
go back to reference Ossareh S, Marghoob M, Robabeh B. Relationship between Fetuin-A and vascular or valvular calcification in hemodialysis patients. J Clin Nephrol. 2019;3(1):001–11.CrossRef Ossareh S, Marghoob M, Robabeh B. Relationship between Fetuin-A and vascular or valvular calcification in hemodialysis patients. J Clin Nephrol. 2019;3(1):001–11.CrossRef
41.
go back to reference Brix JM, et al. Elevated fetuin-A concentrations in morbid obesity decrease after dramatic weight loss. J Clin Endocrinol Metab. 2010;95(11):4877–81.CrossRefPubMed Brix JM, et al. Elevated fetuin-A concentrations in morbid obesity decrease after dramatic weight loss. J Clin Endocrinol Metab. 2010;95(11):4877–81.CrossRefPubMed
42.
go back to reference Liabeuf S, et al. Vascular calcification in chronic kidney disease: are biomarkers useful for probing the pathobiology and the health risks of this process in the clinical scenario? Nephrol Dial Transplant. 2014;29(7):1275–84.CrossRefPubMed Liabeuf S, et al. Vascular calcification in chronic kidney disease: are biomarkers useful for probing the pathobiology and the health risks of this process in the clinical scenario? Nephrol Dial Transplant. 2014;29(7):1275–84.CrossRefPubMed
Metadata
Title
The association between cardiac valvular calcification and fetuin-A levels in kidney transplant recipients
Authors
Nizameddin Koca
Alparslan Ersoy
Barış Şensoy
Emine Kırhan
Sümeyye Güllülü
Canan Ersoy
Melahat Dirican
Emre Sarandöl
Publication date
01-10-2019
Publisher
Springer Singapore
Published in
Clinical and Experimental Nephrology / Issue 10/2019
Print ISSN: 1342-1751
Electronic ISSN: 1437-7799
DOI
https://doi.org/10.1007/s10157-019-01761-2

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