Background/Aims: A close relationship exists between inflammation and vascular calcification. Although fetuin-A is known to be an inhibitor of calcification, studies correlating levels of this glycoprotein to markers of inflammation are limited. To understand these relationships, we investigated the relationship between serum fetuin-A and proinflammatory cytokine levels in patients with chronic renal failure (CRF). Methods: Thirty-two patients on haemodialysis (HD), 32 conservatively managed chronic kidney disease (CKD) patients and a control group of 25 subjects with normal renal function were enrolled in this study. Serum fetuin-A, IL-1 beta, IL-6 and TNF-alpha levels were measured by ELISA. Correlations between serum fetuin-A and IL-1 beta, IL-6 and TNF-alpha concentrations were investigated by the Spearman correlation test. Results: In 64 CRF patients (on HID and with CKD), serum fetuin-A was significantly and inversely related to IL-1 beta (P < 0.001), IL-6 (P = 0.025) and TNF-alpha levels (P = 0.007), respectively. The serum fetuin-A levels of the control subjects were not significantly correlated to levels of the inflammatory markers IL-1 beta, IL-6 and TNF-beta (P = 0.551, 0.985 and 0.984, respectively). Conclusion: The negative correlation between serum fetuin-A and cytokine concentrations in CRF patients supports the hypothesis of inflammation-de pendent down-regulation of fetuin-A expression. (C) 2008 Elsevier Ltd. All rights reserved.