Abstract: Objective  To investigate the relationship between serum levels of stimulator of interferon genes (STING) and silent information regulator 3 (Sirt3) and vascular calcification (VC) in patients with chronic renal failure undergoing maintenance hemodialysis (MHD).  Methods  A total of 157 chronic renal failure patients undergoing MHD treated in Haimen District People's Hospital of Nantong City from January 2021 to May 2024 were assigned as study group, and 157 healthy volunteers for physical examination were recruited as control group. Based on the presence or absence of VC, the study group was further divided into the VC group (n=84) and the non-VC group (n=73). Multivariate logistic regression analysis was used to identify the risk factors for VC in MHD patients. Receiver operating characteristic (ROC) curves were plotted to evaluate the predictive value of serum STING and Sirt3 levels for VC in these patients.  Results  Compared with the control group, MHD patients had significantly higher serum STING level and lower Sirt3 level (t=15.967 and -19.484, P＜0.001). The incidence of VC among the 157 MHD patients was 53.50% (84/157). Compared with the non-VC group, the VC group showed significantly higher STING level and lower Sirt3 level (t=6.935 and -7.717, P＜0.001). Longer dialysis duration (OR=1.052, 95% CI: 1.022～1.083, P=0.001), elevated intact parathyroid hormone (iPTH) level (OR=1.003, 95% CI: 1.001～1.005, P=0.003), and elevated STING level (OR=1.083, 95% CI: 1.042～1.125, P＜0.001) were the independent risk factors for VC, while higher Sirt3 level (OR=0.493, 95% CI: 0.342～0.709, P＜0.001) was the independent protective factor for VC. The area under ROC curve (AUC) for prediction of VC using combined serum STING and Sirt3 levels was 0.871, which was significantly higher than that using STING (0.780) or Sirt3 (0.800) alone (Z=3.327 and 2.947, P=0.001 and 0.003).  Conclusion   Elevated serum STING and decreased Sirt3 are associated with an increased risk of VC in chronic renal failure patients undergoing MHD. Combined measurement of STING and Sirt3 can effectively predict the presence of VC in this patient population.

Key words: Chronic renal failure, Maintenance hemodialysis, Stimulator of interferon genes, Silent information regulator 3, Vascular calcification