FETUIN-A, INDOXYLY SULFATE, VITAMIN K ANTAGONISTS EFFECTS ON VASCULAR CALCIFICATION AND AVF: A SYSTEMATIC REVIEW

Mercy Julian Mwamunyi, Zifang Li and Li-Jun Yao*

ABSTRACT

Background: Vascular calcification (VC) is a surrogate marker of vascular health. Functional vitamin K antagonists (VKA), fetuin-a and indoxyl sulfate (IS), are reported to have impacts on vascular calcification and may have clinical potential to modify the progression of vascular calcification and arteriovenous fistula failure status in the end stage renal disease. Methods: Studies evaluating the relationship of VKA, Fetuin-A, and IS with VC by at least stating one of the circulating compounds in animal models or patients either with CKD or patients receiving regular hemodialysis or on AVF were systematically identified. We searched English literature from January 1990 to November 2018 on the online MEDLINE and EMBASE. Results: Eight studies comprising a combined population of 2,766 participants were included after screening 449 distinctive abstracts. The included studies examined VKA, fetuin-a, IS effect on VC, and AVF. Conclusion: This paper is the first systematic review of the effect of vitamin K antagonists, Fetuin-A and IS status in VC and AVF. Our results suggest the quantification of the non-functional fractions of fetuin-a, IS, and VKA advocates their potential for detecting specific vascular calcification development in several patient cohorts. Lower fetuin-a levels and VKA in CKD subjects was linked to AVF failure. Further, studies with larger sample sizes are needed to enlighten whether their assessment can be of any clinical significance.

Keywords: fetuin-a, indoxyl sulfate, vitamin K antagonists, AVF, vascular calcification.