الفهرس 
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Abstract
Coronary heart disease (CHD) is a serious ailment that presents a substantial risk to human health and general welfare. Acute coronary syndrome, which encompasses acute myocardial infarction, is occasionally known by this name. Coronary heart disease (CHD) mostly arises from the erosion or sudden rupture of atherosclerotic unstable plaques located on the outer surface of coronary arteries. As a consequence, blood clots are formed, causing a notable narrowing of the coronary artery. Inflammatory agents play a vital role in this process.
Individuals with chronic kidney disease (CKD) commonly experience coronary artery disease, which is linked to a more unfavorable prognosis. In this distinct demographic, uremia-specific risk factors, alongside the usual risk factors, significantly contribute to the accelerated advancement of coronary artery disease (CAD).
Chronic kidney disease (CKD) and end-stage renal disease not only elevate the likelihood of developing coronary artery disease (CAD), but they also alter its clinical appearance and fundamental symptoms. Managing coronary artery disease (CAD) in patients with chronic kidney disease (CKD) is intricate due to the existence of numerous concurrent medical diseases and the heightened probability of adverse outcomes during medical procedures.
Cardiovascular disease is a major predictor of death in people with end-stage kidney disease (ESKD), accounting for approximately 45% of deaths. Approximately 10 percent of these can be attributed to the consequences of coronary heart disease (CHD). Patients with varying degrees of chronic kidney dysfunction, who do not need dialysis, are at a greatly elevated risk of developing cardiovascular disease, specifically coronary heart disease, leading to increased morbidity and mortality.
Individuals suffering from end-stage renal disease (ESRD) exhibit reduced concentrations of fetuin-A in their bloodstream. Moreover, diminished concentrations of fetuin-A in the bloodstream are autonomously associated with a heightened susceptibility to cardiovascular disease and overall mortality in this cohort of individuals.
The association between blood fetuin-A levels and renal function, as well as the protein’s significance as a vital inhibitor of calcification in mild-to-moderate CKD, is still unclear. The objective of this study was to evaluate the correlation between four kidney function indicators (Mayo Clinic quadratic glomerular filtration rate, 24-hour urinary creatinine clearance, serum cystatin-C, and urinary albumin to creatinine ratio) and serum fetuin-A levels in a clearly defined cohort of 970 individuals with stable coronary artery disease.
The premise of our study was that there would exist a positive link between the levels of fetuin-A in the blood serum and the function of the kidneys, while there would be a negative correlation with the presence of proteinuria. The concentrations were anticipated to lie within the range observed in those without any kidney dysfunction and those with kidney dysfunction. This study aimed to examine the importance of Fetuin-A levels in the progression of coronary heart disease in both dialysis patients and non-dialysis patients.
This study was a prospective, cross-sectional, analytical, case-control study. It was conducted in the Department of Internal Medicine, Minia University in collaboration with the Clinical Pathology. The study included the following groups:
I. group I : 70 hemodialysis (HD) patients with coronary artery disease
II. group II: 77 CKD patients with coronary artery disease
III. group III: 30 healthy individuals as a control group
Summary of our results:
• There was no discernible difference in gender or age across the three categories. While groups II and III had considerably higher body mass indexes than group I (P = 0.044 and 0.004, respectively), no such difference existed between groups II and III.
• Rates of hypertension were considerably higher in groups I and II compared to group III (P value <0.001). However, the prevalence of hypertension did not differ significantly between groups I and II. In group I, the prevalence of DM was 36.67%, which was considerably greater than in group III (P value 0.030). Having said that, the incidence of DM did not differ significantly between groups II and I or III.
• There was no statistically significant difference between groups II and III, although group I had considerably greater PR and QRS values than groups II and III (P value <0.05). The QT interval was significantly shorter in group II compared to Groups I and III (P = 0.037 and 0.015, respectively). On the other hand, the QT interval was similar in groups I and III. In group I, the QTc interval was much longer than in groups II and III (P = 0.009 and <0.001 respectively), whereas in group II, it was much longer than in group III (P = 0.002).
• When compared to group III, both group I and group II exhibited noticeably reduced levels of hemoglobin (Hb) and platelets (P value<0.05). However, group I and group II did not differ significantly with respect to Hb or platelet levels. The TLC and INR levels were noticeably higher in groups I and II when contrasted with group III (P value<0.05). On the other hand, TLC and INR levels were not significantly different between the two groups.
• Significant differences in urea and creatinine levels were found across the three groups, as shown by a P value below 0.001. When comparing groups II and III, group I exhibited noticeably greater amounts of urea and creatinine (P value <0.001). In addition, group II had significantly higher quantities of urea and creatinine than group III (P value <0.001).
• Total cholesterol (TC), low-density lipoprotein (LDL), and triglyceride (TG) levels were not significantly different among the three groups. There was a statistically significant difference (P = 0.007) in the HDL values among the three categories. While there was no statistically significant difference in HDL levels between groups I and II, groups I and II showed significantly lower HDL levels than group III (P value 0.049 and 0.004 respectively).
• In comparison to groups I and II, group III had considerably higher potassium levels (P value <0.001). In terms of potassium levels, there was no obvious difference between the two groups. There was no statistically significant difference in sodium levels between groups II and III, however group I had considerably lower sodium levels compared to groups II and III (P value <0.001 and 0.001 respectively). group II and III had considerably lower phosphorus levels compared to group I (P value = 0.001 and <0.001 respectively). However, phosphorus levels were not significantly different between groups II and III.
• The three groups showed significantly different amounts of Fetuin-A (P value <0.001). There was a statistically significant difference (P=0.011) between the two groups, with the third having the substantially higher value. When compared to group I, both group I and group II showed noticeably lower results (P value <0.001).
Conclusion
The current study explored the role of Fetuin-A level in coronary heart disease in dialysis and non-dialysis patients. Fetuin-A showed significant decrease in hemodialysis group and there was a positive link between fetuin-A and HDL-C and serum total calcium.
In addition, we found a negative correlation between fetuin-A and age, serum creatinine, TNF-a, IL-6, and hs-CRP. Additionally, it exhibited a negative correlation with TC, TG, iPTH, and P due to its anti-inflammatory and calcification inhibitory abilities, suggesting a potential regulatory function in atherosclerosis. The primary reason for the decrease in fetuin levels in malnourished patients is an inflammatory response.
Thus, it is hypothesized that a decreased amount of fetuin-A is linked to the development of atherosclerosis, inflammation, and malnutrition. Efforts to enhance fetuin-A levels and address malnutrition in patients undergoing HD appear to be promising in preventing calcification. Additional research is necessary to comprehensively comprehend the functions of these proteins in CKD and to formulate approaches for their practical application in the treatment of CKD patients.
Recommendations
• It is recommended that healthcare providers consider the potential importance of monitoring serum fetuin-A concentrations in patients with CKD and ESRD who also have coronary heart disease as a biomarker of cardiovascular risk.
• Further research is needed to investigate the potential clinical implications of these findings and to explore the underlying mechanisms.