Vascular calcification (VC) has crucial importance in the accelerated arteriosclerosis of chronic renal disease patients. The aim of this study was to assess the extent of arteriosclerotic lesions and to relate vascular stiffness parameters to pro-inflammatory markers (hsCRP, TNF-α, TGF-β1) and to protective factors (α-Klotho, fetuin-A, vitamin D3) in patients on chronic hemodialysis.Design and Method:
96 consecutive patients in stable condition were enrolled. 20 healthy individuals served as controls. Beside routine biochemical parameters, TNF-α, TGF-β1 α-Klotho and fetuin-A were measured with ELISA. Carotid-femoral pulse wave velocity was measured using applanation tonometry (SphygmoCor, AtCor Medical Australia) before hemodialysis sessions. Carotid-femoral pulse wave velocity (cfPWV) was calculated.Results:
Pro-inflammatory (pro-calcigenic) biomarkers (hsCRP, TNF-α, TGF-β1) were elevated (p < 0.01), whereas anti-inflammatory (anti-atherosclerotic) factors (fetuin-A: p < 0.05, α-Klotho: p < 0.01, vitamin D3 p < 0.01) depressed compared to controls. cfPWV correlated positively with total cholesterol (r = 0.244, p < 0.05) and fetuin-A (r = 0.282, p < 0.05) but inversely with the time spent on dialysis (r = -0.262, p < 0.05). hsCRP was negatively influenced by plasma vitamin D3 (β = −0.23, p < 0.01), sodium (β = −0.26, p < 0.00) and albumin levels (β = −0.36, p < 0.00), positively by BMI (β = 0.76, p < 0.00). TNFα and TGFβ1 as dependent variables were found to correlate with α-Klotho (β = 0.41, p < 0.00) and plasma creatinine (β = 0.30, p < 0.003), as well as with fetuin-A (β = −0.24, p < 0.02) and plasma albumin (β = 0.33, p < 0.002), Fetuin-A showed significant negative correlation with age (β = −0.225, p < 0.05), TGF-β1 (β = −0.228, p < 0.02), and dialysis time (β = −0.26, p < 0.01), while positive relationship was found between fetuin-A and triglyceride levels (β = 0.43, p < 0.00). α-Klotho correlated positively with TNF-α (β = 0.44, p < 0.00) and negatively with plasma calcium (β = −0.24, p < 0.01).Conclusions:
Our study confirmed that the pro-inflammatory cascade of arteriosclerosis was activated and inflammatory biomarkers (hsCRP, TNF-α, TGF-β1) prevailed over protective factors (vitamin D, α-Klotho, Fetuin-A) in patients on hemodialysis. We demonstrated that PWV was significantly affected by total cholesterol, fetuin-A and dialysis time. Several clinical and laboratory factors were associated with pro- and anti-inflammatory biomarkers rather than PWV.