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Sclerostin quo vadis? - is this a useful long-term mortality parameter in prevalent hemodialysis patients?

Albina Nowak1, Ferruh Artunc, Andreas L Serra

  • 1Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland.

Kidney & Blood Pressure Research
|May 23, 2015
PubMed

Insights

Higher levels of FGF23, PTH, and AP, along with lower vitamin D, predict mortality in hemodialysis patients. Sclerostin levels did not show a significant association with mortality in this study.

Area of Science:

  • Nephrology
  • Cardiovascular Health
  • Bone Metabolism

Background:

  • Cardiovascular calcification is a major cause of mortality in hemodialysis patients.
  • Sclerostin, an antianabolic bone factor, is implicated in soft tissue calcification.
  • Existing data on sclerostin's association with mortality in hemodialysis patients are inconsistent.

Purpose of the Study:

  • To assess the association of sclerostin and bone remodeling markers with long-term mortality in hemodialysis patients.
  • To evaluate the relationship between circulating sclerostin, Fibroblast growth factor 23 (FGF23), and traditional bone remodeling markers.
  • To compare sclerostin levels between hemodialysis patients and healthy controls.

Main Methods:

  • A multicenter prospective longitudinal study involving 239 hemodialysis patients.
  • Assessment of sclerostin, FGF23, parathyroid hormone (PTH), alkaline phosphatase (AP), and 25(OH)vitamin D.
  • Cox regression analysis to determine associations with long-term mortality (median follow-up 1461 days).

Main Results:

  • FGF23, PTH, and AP were associated with increased mortality, while 25(OH)vitamin D was associated with decreased mortality.
  • Sclerostin levels were not significantly associated with mortality in hemodialysis patients.
  • Sclerostin showed negative associations with FGF23, PTH, and AP, and was lower in females than males.

Conclusions:

  • Elevated FGF23, PTH, AP, and reduced 25(OH)vitamin D predict long-term mortality in hemodialysis patients.
  • Sclerostin does not appear to be a significant predictor of mortality in this population.
  • Sclerostin's relationship with other bone markers and its sex-based difference warrant further investigation.
Abstract

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