الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Fetuin-A (α2-Heremans Schmid glycoprotein: AHSG) with a molecular weight of about 60 kDa, is synthesized by hepatocytes and, represents the most powerful circulating inhibitor of calcification and hydroxyapatite formation. Fetuin-A reacts as a negative acute phase protein, thus downregulation may occur in acute and chronic inflammatory states.
Objective: Evaluation of fetuin A plasma level correlating it with valvular calcification, malnutrition and atherosclerosis and outcome in end stage renal failure.
Patients and Method: We performed the study on 100 ESRD patients divided into three group (1)20 healthy control (2)20 patient with chronic renal failure on conservative treatment)(disease control)or(conservative). (Group 3) (30 patient with chronic renal failure on hemodialysis(A) and 30 patient with chronic renal failure on continuous ambulatory peritoneal dialysis(B) called (disease group) they were increased as statistically recommended and divided into 2 subgroups(i)less than 5years (ii)more than 5years duration of dialysis. Echocardiography was done to detect cardiac valvular calcification, doppler carotid to detect intima-media thickness and biochemical analysis performed for serum fetuin-A, albumin and (CRP) C-reactive protein and MCP-1(monocyte chemoattractant protien -1).All patients on the same dose of vitamin D and calcium based phosphate binder.
Results. This study shows statistically significant decrease in serum fetuin-A level in diseased group in comparison to disease control (P=0.001) and healthy controls(P=0.001). Also there was a statistically significant negative correlation between fetuin-A and LVH(P=0.016) , mitral calcification,(P=0.02),IMT lt(p=0.001),rt(p=0.001) and CRP (p=0.05).There was no significant correlation with MCP-1(P=0.05). There was a positive correlation between fetuin-A and albumin(p=0.05). This study shows that diseased group had higher serum phosphorus level than healthy controls(p=0.001) however there is significant negative correlation can be detected between serum fetuin-A and serum phosphorus level(p=0.001)and calcium phosphorus product(p=0.001) .Also calcium phosphorus product has direct statistical correlation with carotid calcification(p=0.05).also serum phosphorus level has direct statistical correlation with mitral and aortic calcification(p=0.03),(p=0.04)respectively. There was statistical significant increase in MCP-1 level in those patients group and there was statistical significant positive correlation with LVH (p=0.-5),vascular calcification(p=0.001) and statistical significant negative correlation with serum albumin(p=0.05),fetuin A(p=0.001).
Conclusions. Serum fetuin-A showed important associations with valvular calcification, atherosclerosis, malnutrition and inflammation, and was linked to mortality and cardiovascular events in dialysis patients via its close relationships with the MIAC syndrome.
Key words: fetuin A, atherosclerosis, calcification, inflammation, malnutrition, Haemodialysis. peritoneal dialysis.
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