Background . Vascular calcification is highly prevalent in chronic kidney disease (CKD) patients. This calcification leads to arterial stiffening. Fetuin-A is an endogenous inhibitor of vascular calcification and has been associated with arterial stiffness and mortality in dialysis patients. We tested the relationship between fetuin-A and change in arterial stiffness in CKD stages 3 and 4.

Methods . We measured fetuin-A concentrations in 92 patients with CKD stages 3 and 4 and studied the association with clinical, biochemical and vascular parameters including arterial stiffness measured by carotid–femoral pulse wave velocity (PWV) at 0 and 12 months.

Results . Fetuin-A was significantly lower in the non-diabetic group (n = 73) compared to the diabetic group (n = 19, P = 0.018). There was a significant interaction between diabetic status and fetuin-A concentration. Univariate analysis of the non-diabetic group showed association between change in aortic stiffness over 1 year with fetuin-A (r = −0.481, P < 0.0001) and systolic blood pressure (r = 0.389, P = 0.001) and baseline PWV (r = 0.240, P = 0.041). In multivariate analysis, fetuin-A, systolic blood pressure and baseline PWV independently predicted change in carotid–femoral PWV at 1 year (β = −0.355, P = < 0.001; β = 0.426, P < 0.001; and β = −0.383, P < 0.001, respectively; model R² = 0.455).

Conclusions . In patients with non-diabetic CKD stages 3 and 4, fetuin-A is an independent risk factor for progressive arterial stiffness.