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Vascular calcification relationship to vascular biomarkers and bone metabolism in advanced chronic kidney disease

Syazrah Salam1, Orla Gallagher2, Fatma Gossiel2

  • 1Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Foundation Trust, United Kingdom; Academic Unit of Bone Metabolism and Mellanby Centre for Bone Research, University of Sheffield, United Kingdom.

Bone
|October 22, 2020
PubMed

Insights

Vascular calcification (VC) is more severe in advanced chronic kidney disease (CKD) patients, particularly those with diabetes. Higher levels of parathyroid hormone (PTH) and fibroblast growth factor-23 (FGF23) are linked to increased VC in CKD.

Area of Science:

  • Nephrology
  • Endocrinology
  • Radiology

Background:

  • Vascular calcification (VC) and renal osteodystrophy are significant complications in advanced chronic kidney disease (CKD).
  • Lower leg arterial calcification (LLAC) is a quantifiable measure of VC in CKD patients.
  • The relationship between LLAC, vascular biomarkers, and bone health in CKD remains unclear.

Purpose of the Study:

  • To investigate the association between LLAC and various biomarkers in CKD patients.
  • To explore the correlation of LLAC with bone turnover and microstructure.
  • To identify independent predictors of LLAC in advanced CKD.

Main Methods:

  • Cross-sectional study involving 69 CKD stages 4-5D patients and 68 healthy controls.
  • Fasting blood samples analyzed for biomarkers.
  • High-resolution peripheral quantitative computed tomography (HRpQCT) assessed bone microstructure.
  • Trans-iliac bone biopsy performed on 43 CKD patients.

Main Results:

  • LLAC was significantly more severe in CKD patients than controls (p < 0.001).
  • CKD patients with diabetes exhibited substantially higher LLAC (p < 0.001).
  • LLAC correlated with serum phosphate, calcium x phosphate product, intact parathyroid hormone (iPTH), intact fibroblast growth factor-23 (iFGF23), and bone turnover markers. LLAC also correlated with poorer distal tibia cortical bone mineral density, thickness, and porosity.
  • No association was found between LLAC and bone turnover, mineralization, or volume on biopsy.

Conclusions:

  • Older age, diabetes, elevated iPTH, and iFGF23 are independently associated with LLAC in advanced CKD.
  • These factors may play crucial roles in the development of LLAC.
  • LLAC serves as a valuable indicator of vascular complications in CKD.
Abstract

Keywords:
Arterial calcificationDiabetes mellitusDialysisFGF23Renal osteodystrophy

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