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Peritoneal dialysis per se is a risk factor for sclerostin-associated adynamic bone disease

Rodrigo A de Oliveira1, Fellype C Barreto2, Monique Mendes3

  • 11] Department of Internal Medicine, Nephrology Division, Universidade de São Paulo, São Paulo, Brazil [2] Department of Integrated Medicine, Universidade Federal do Rio Grande do Norte, Natal, Brazil.

Kidney International
|December 11, 2014
PubMed

Insights

Adynamic bone disease is common in peritoneal dialysis (PD) patients with chronic kidney disease-mineral bone disorder (CKD-MBD). Sclerostin levels correlate with bone formation, and bone alkaline phosphatase best indicates bone turnover in PD patients.

Area of Science:

  • Nephrology
  • Endocrinology
  • Bone Metabolism

Background:

  • Chronic kidney disease-mineral bone disorder (CKD-MBD) is a complex syndrome.
  • CKD-MBD is well-studied in hemodialysis (HD) but less so in peritoneal dialysis (PD) patients.
  • Limited bone biopsy data exists for PD patients.

Purpose of the Study:

  • To investigate the pattern of renal osteodystrophy in prevalent PD patients.
  • To explore the association between serum sclerostin and bone formation rate.
  • To identify the best serum marker for bone turnover in PD patients.

Main Methods:

  • Study included 41 prevalent peritoneal dialysis (PD) patients.
  • Bone biopsy data was analyzed to determine renal osteodystrophy patterns.
  • Serum sclerostin and bone alkaline phosphatase levels were measured.
  • Comparison between nondiabetic PD and matched HD patients.

Main Results:

  • Adynamic bone disease was the most frequent presentation (49%) in PD patients.
  • Serum sclerostin showed an inverse association with bone formation rate.
  • Bone alkaline phosphatase demonstrated high sensitivity and specificity for detecting bone turnover.
  • Nondiabetic PD patients had lower 25-hydroxyvitamin D, worse bone mineralization, and lower bone turnover compared to HD patients.

Conclusions:

  • Adynamic bone disease is the predominant form of renal osteodystrophy in PD patients.
  • Sclerostin plays a role in the pathophysiology of adynamic bone disease.
  • Bone alkaline phosphatase is a reliable serum marker for assessing bone turnover in PD patients.

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