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Vascular calcification in peritoneal dialysis patients and its association with bone-derived molecules and bone
Luciano Pereira1, Luís Mendonça1, Juliana Magalhães2
1Institute of Investigation and Innovation in Health, University of Porto, Porto, Portugal; INEB - National Institute of Biomedical Engineering, University of Porto, Porto, Portugal; Department of Nephrology, São João Hospital Center, Porto, Portugal; School of Medicine of University of Porto, Porto, Portugal.
Insights
Vascular calcification in peritoneal dialysis patients is linked to inflammation and diabetes, not bone disease. Higher erythrocyte sedimentation rate (ESR) was a significant predictor of vascular calcification.
Area of Science:
- Nephrology
- Vascular Biology
- Bone Metabolism
Background:
- Vascular calcification (VC) data in peritoneal dialysis (PD) patients is limited.
- The bone-vascular axis is known in hemodialysis (HD) but not well-studied in PD.
- The role of sclerostin, DKK-1, and OPG in PD-associated VC needs clarification.
Purpose of the Study:
- To investigate the relationship between bone disease and vascular calcification in PD patients.
- To explore the role of specific bone-related proteins (sclerostin, DKK-1, OPG) in VC within this population.
- To identify clinical and biochemical factors associated with VC in PD.
Main Methods:
- Bone biopsy with histomorphometric analysis in 47 PD patients.
- Pelvis and hands X-rays for VC assessment using the Adragão score (AS).
- Collection of clinical and biochemical data, including inflammatory markers and bone turnover markers.
Main Results:
- Vascular calcification (VC) was present in 27.7% of patients.
- VC was associated with older age, lower dialysis dose, higher glycosylated hemoglobin, and higher erythrocyte sedimentation rate (ESR).
- Higher sclerostin, DKK-1, and OPG levels were observed in patients with VC, but only ESR remained significant in multivariate analysis. Diabetes was strongly linked to VC.
Conclusions:
- Vascular calcification in PD patients is not associated with bone turnover or volume.
- Inflammation (indicated by ESR) and diabetes appear to be more significant contributors to VC in PD.
- Current laboratorial markers for mineral and bone disease did not differentiate patients with or without VC.
Introduction:
Data regarding vascular calcification (VC) in contemporary peritoneal dialysis (PD) patients is scarce. Bone-vascular axis has been demonstrated in hemodialysis (HD). However, studies showing the link between bone disease and VC in PD patients are lacking. The role of sclerostin, dickkopf-related protein 1 (DKK-1), receptor activator for nuclear factor kB ligand and osteoprotegerin (OPG) in VC in PD remains to clarify.
Materials And Methods:
Bone biopsy was performed in 47 prevalent PD patients with histomorphometric analysis. Patients were submitted to pelvis and hands X-ray to evaluate VC using the Adragão score (AS). Relevant clinical and biochemical data was collected.
Results:
Thirteen patients (27.7%) had positive AS (AS≥1). Patients with VC were significantly older (58.9 vs. 50.4 years, p=0.011), had a lower dialysis dose (KT/V 2.0 vs. 2.4, p=0.025) and a higher glycosylated hemoglobin (7.2 vs. 5.4%, p=0.001). There was not any laboratorial parameter of mineral and bone disease used in clinical practice different between patients with or without VC. All diabetic patients had VC but only 8.1% of non-diabetic had VC (p<0.001). Patients with VC showed significantly higher erythrocyte sedimentation rate (ESR) (91.1 vs. 60.0mm/h, p=0.001), sclerostin (2250.0 vs. 1745.8pg/mL, p=0.035), DKK-1 (1451.6 vs. 1042.9pg/mL, p=0.041) and OPG levels (2904.9 vs. 1518.2pg/mL, p=0.002). On multivariate analysis, only ESR remained statistically significant (OR 1.07; 95% CI 1.01-1.14; p=0.022). Bone histomorphometric findings were not different in patients with VC. There was no correlation between bone formation rate and AS (r=-0.039; p=0.796).
Conclusion:
The presence of VC was not associated with bone turnover and volume evaluated by bone histomorphometry. Inflammation and diabetes seem to play a more relevant role in VC in PD.
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