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Kidney Week

Abstract: TH-PO133

Serum Calcification Propensity and Fetuin-A: Biomarkers of Cardiovascular Disease in Long-Term Kidney Transplant Recipients

Session Information

Category: Transplantation

  • 1802 Transplantation: Clinical

Author

  • Bostom, Andrew, Memorial Hospital of Rhode Island, Chepachet, Rhode Island, United States

Group or Team Name

  • For The FAVORIT Study Investigators
Background

“T50,” shortened transformation time from primary to secondary calciprotein particles, may reflect deranged mineral metabolism predisposing to vascular calcification, and cardiovascular disease [CVD]. The glycoprotein fetuin-A is a major T50 determinant.

Methods

The FAVORIT cohort, is a completed, large, multiethnic controlled clinical trial cohort of chronic, stable kidney transplant recipients (KTRs). We conducted a longitudinal case-cohort analysis using a randomly selected subcohort of patients, and all individual cases who developed CVD. Serum T50 and fetuin-A were determined in this total of n=685 FAVORIT trial participants at randomization.

Results

311 incident or recurrent CVD events occurred during a median surveillance of 2.18-years. Shorter T50 (minutes), or reduced fetuin-A concentrations (g/L) were associated with CVD after adjustment for treatment assignment, systolic blood pressure, age, sex, race, pre-existing CVD and diabetes, smoking, body mass index, total cholesterol/HDL cholesterol, kidney allograft vintage and type, calcineurin inhibitor, or lipid lowering drug use, estimated glomerular filtration rate, and urinary albumin/creatinine: tertile 1 (lowest) to tertile 3 (highest) comparisons, T50, [HR= 1.86; 95% CI= (1.20, 2.89)]; fetuin-A, [HR=2.25, 95% CI= (1.38, 3.69)]. Elevated high sensitivity c-reactive protein [hsCRP] was an effect modifier of both these associations.

Conclusion

Shortened T50, as well as reduced fetuin-A levels, ostensible promoters of vascular calcification, remained associated with greater risk for CVD outcomes, after adjustment for major CVD risk factors, measures of kidney function and damage, and KTR clinical characteristics and demographics, in a large, multiethnic cohort of long-term KTRs. Increased hs-CRP was an effect modifier of these CVD risk associations.