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Sclerostin: a new biomarker of CKD-MBD
Andreja Figurek1, Merita Rroji2, Goce Spasovski3
1Medical University of Banja Luka, Banja Luka, Republic of Srpska, Bosnia and Herzegovina.
Insights
Sclerostin, a protein linked to chronic kidney disease-mineral bone disorder (CKD-MBD), may influence cardiovascular risk. Its exact role in CKD-MBD and patient outcomes requires further investigation.
Area of Science:
- Nephrology
- Endocrinology
- Cardiovascular Medicine
Background:
- Chronic kidney disease-mineral bone disorder (CKD-MBD) is linked to increased cardiovascular risk.
- Key CKD-MBD factors include hyperphosphatemia, vascular calcification, and elevated fibroblast growth factor 23 (FGF23).
- Sclerostin, a Wnt pathway inhibitor, is a potential biomarker in CKD-MBD.
Purpose of the Study:
- To investigate the role of sclerostin in chronic kidney disease-mineral bone disorder (CKD-MBD).
- To explore the association between sclerostin levels and cardiovascular risk in CKD patients.
- To determine whether sclerostin has a protective or detrimental effect in CKD-MBD pathophysiology.
Main Methods:
- Review of existing literature on sclerostin in CKD and CKD-MBD.
- Analysis of studies examining sclerostin levels in CKD patients.
- Exploration of the relationship between sclerostin, vascular calcification, and cardiovascular events.
Main Results:
- CKD patients exhibit higher sclerostin levels, which decrease with dialysis.
- Sclerostin is associated with vascular calcification and cardiovascular risk in CKD, though findings are debated.
- The precise role of sclerostin in CKD-MBD and its impact on mortality remain unclear.
Conclusions:
- The exact role of sclerostin in CKD-MBD pathophysiology and its impact on cardiovascular risk and mortality is still undetermined.
- Standardization of sclerostin assays and definition of clinical cut-off values are necessary.
- Further research is required to elucidate sclerostin's relationship with other CKD-MBD biomarkers for clinical application.
Abstract:
The causes of the increased cardiovascular risk associated with kidney diseases partly reside in the chronic kidney disease-mineral bone disorder (CKD-MBD) syndrome. Three cardiovascular risk factors [hyperphosphatemia, vascular calcification, and elevated fibroblast growth factor 23 (FGF23)] levels have been discovered within the CKD-MBD over the last decades. In addition, sclerostin is recently presented as a new bone and vascular disease biomarker. This 22-kDa glycoprotein, secreted mainly by osteocytes, is a soluble inhibitor of the canonical Wnt pathway that has a pivotal role in bone biology and turnover. CKD patients are reported with higher levels of sclerostin, and levels decrease during dialysis. Sclerostin is associated with vascular calcification and CV risk in CKD, although data are still controversial. The question whether serum sclerostin has protective or deleterious role in CKD-MBD pathophysiology, and therefore in cardiovascular risk and overall mortality, is still open and needs to be answered. The standardization of assays and the establishment of a clear cut-off values when sclerostin starts to switch from physiological to pathophysiological role have to be another important step. Further research is needed also to define its relationship with other CKD-MBD biomarkers for future diagnostic and therapeutic strategies.
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