Fetuin-A as a risk factor for arteriovenous fistula failure in chronic kidney disease patients with hemodialysis through vascular calcification mechanism: Systematic review and meta-analysis

Arteriovenous Fistula (AVF) failure remains a significant challenge in patients on hemodialysis. No meta-analysis has concluded the relationship between fetuin-A serum levels, arterial calcification, and AVF failure. This study aims to evaluate the relationship between fetuin-A levels and AVF failure through vascular calcification in CKD patients undergoing hemodialysis. This meta-analysis was conducted according to the PRISMA guideline. On October 1st, 2024, a literature search was conducted in PubMed and ScienceDirect. Data were analyzed using Review Manager for pooled hazard ratio and standardized mean difference (SMD), while MedCalc software was used to calculate the pooled correlation coefficient. A total of 26 observational studies were included. Meta-analysis showed that fetuin-A levels were negatively correlated with vascular calcification (<i>r</i> = -0.530; 95% CI: -0.781 to -0.132; <i>p</i> = 0.011). The mean fetuin-A levels were lower in the group with vascular calcification than those without calcification (SMD = -1.71; 95% CI: -2.58 to -0.85; <i>p</i> = 0.0001). Patients with vascular calcification had a 2.98 times higher risk of AVF failure (OR = 2.98; 95% CI: 1.78-4.99; <i>p</i> < 0.0001). Three studies showed that high fetuin-A levels were a protective factor against AVF failure (HR = 0.76; 95% CI: 0.63-0.91; <i>p</i> = 0.003). Low fetuin-A levels were associated with increased vascular calcification and risk of AVF failure in CKD patients undergoing hemodialysis. These findings suggest the potential of fetuin-A as a predictive biomarker and therapeutic target in reducing AVF failure. Further studies with standard testing methods are recommended to confirm this association.