Details

Autor(en) / Beteiligte

• Barreto, Daniela Veit, MD
• Barreto, Fellype de Carvalho, MD
• de Carvalho, Aluízio Barbosa, MD
• Cuppari, Lilian, PhD
• Draibe, Sérgio Antonio, MD
• Dalboni, Maria Aparecida, PhD
• Moyses, Rosa Maria Affonso, MD
• Neves, Kátia Rodrigues, MD
• Jorgetti, Vanda, MD
• Miname, Márcio, MD
• Santos, Raul D., MD
• Canziani, Maria Eugênia F., MD

Titel

Association of Changes in Bone Remodeling and Coronary Calcification in Hemodialysis Patients: A Prospective Study

Ist Teil von

• American journal of kidney diseases, 2008-12, Vol.52 (6), p.1139-1150

Ort / Verlag

New York, NY: Elsevier Inc

Erscheinungsjahr

2008

Link zum Volltext

Quelle

Elsevier ScienceDirect Journals

Beschreibungen/Notizen

• Background Vascular calcification is common and constitutes a prognostic marker of mortality in the hemodialysis population. Derangements of mineral metabolism may influence its development. The aim of this study is to prospectively evaluate the association between bone remodeling disorders and progression of coronary artery calcification (CAC) in hemodialysis patients. Study Design Cohort study nested within a randomized controlled trial. Setting & Participants 64 stable hemodialysis patients. Predictor Bone-related laboratory parameters and bone histomorphometric characteristics at baseline and after 1 year of follow-up. Outcomes Progression of CAC assessed by means of coronary multislice tomography at baseline and after 1 year of follow-up. Baseline calcification score of 30 Agatston units or greater was defined as calcification. Change in calcification score of 15% or greater was defined as progression. Results Of 64 patients, 26 (40%) had CAC at baseline and 38 (60%) did not. Participants without CAC at baseline were younger ( P < 0.001), mainly men ( P = 0.03) and nonwhite ( P = 0.003), and had lower serum osteoprotegerin levels ( P = 0.003) and higher trabecular bone volume ( P = 0.001). Age ( P = 0.003; β coefficient = 1.107; 95% confidence interval [CI], 1.036 to 1.183) and trabecular bone volume ( P = 0.006; β coefficient = 0.828; 95% CI, 0.723 to 0.948) were predictors for CAC development. Of 38 participants who had calcification at baseline, 26 (68%) had CAC progression in 1 year. Progressors had lower bone-specific alkaline phosphatase ( P = 0.03) and deoxypyridinoline levels ( P = 0.02) on follow-up, and low turnover was mainly diagnosed at the 12-month bone biopsy ( P = 0.04). Low-turnover bone status at the 12-month bone biopsy was the only independent predictor for CAC progression ( P = 0.04; β coefficient = 4.5; 95% CI, 1.04 to 19.39). According to bone histological examination, nonprogressors with initially high turnover (n = 5) subsequently had decreased bone formation rate ( P = 0.03), and those initially with low turnover (n = 7) subsequently had increased bone formation rate ( P = 0.003) and osteoid volume ( P = 0.001). Limitations Relatively small population, absence of patients with severe hyperparathyroidism, short observational period. Conclusions Lower trabecular bone volume was associated with CAC development, whereas improvement in bone turnover was associated with lower CAC progression in patients with high- and low-turnover bone disorders. Because CAC is implicated in cardiovascular mortality, bone derangements may constitute a modifiable mortality risk factor in hemodialysis patients.