Fetuin‑A and dephosphorylated uncarboxylated matrix Gla protein levels in patients with established coronary heart disease undergoing hemodialysis

Fetuin‑A and matrix Gla protein (MGP) protect against vascular calcification. It has been suggested that low fetuin‑A levels or high levels of inactivated, dephosphorylated, uncarboxylated MGP (dp‑ucMGP) may be associated with poor cardiovascular outcomes. The present study evaluated the potential of fetuin‑A and dp‑ucMGP levels as markers of coronary heart disease (CHD) in patients undergoing hemodialysis (HD). A total of 126 patients undergoing HD (40 patients with established CHD) and 24 healthy subjects were enrolled in the study. Serum fetuin‑A and dp‑ucMGP levels were measured using ELISA. In the patients undergoing HD, fetuin‑A levels were significantly lower, whereas dp‑ucMGP levels were significantly higher than in the healthy subjects. In patients undergoing HD, fetuin‑A levels did not differ between those with or without CHD, diabetes mellitus, a C‑reactive protein (CRP) level >1 mg/dl, or heart failure. Dephosphorylated, uncarboxylated MGP was lower in patients with CHD, diabetes mellitus, a CRP level >1 mg/dl and heart failure with a reduced ejection fraction. Dephosphorylated, uncarboxylated MGP levels were shown to perform moderately well as an indicator of CHD‑free patients (area under the curve, 0.659). An increase in dp‑ucMGP by 1 ng/ml was found to decrease the risk of CHD by 23.4%. On the whole, the present study demonstrates that, in patients with HD, fetuin‑A levels are not associated with CHD. Conversely, elevated dp‑ucMGP levels indicate CHD‑free patients, although its accuracy is moderate.