Vascular calcification in peritoneal dialysis patients and its association with bone-derived molecules and bone histomorphometry

Autores da FMUP

• Ricardo Morais Pereira Neto

  Autor

• Andreia Cristina Matos Oliveira

  Autor

Participantes de fora da FMUP

• Pereira, L
• Mendon?a, L
• Magalh?es, J
• Santos, J.
• Beco, A
• Fraz?o, J

Unidades de investigação

• Ciências da Saúde Pública e Forenses, e Educação Médica

• Medicina

Abstract

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 Adrag?o 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. 60.0 mm/h, p = 0.001), sclerostin (2250.0 vs. 1745.8 pg/mL, p = 0.035), DKK-1 (1451.6 vs. 1042.9 pg/mL, p = 0.041) and OPG levels (2904.9 vs. 1518.2 pg/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. ? 2023 Sociedad Espa?ola de Nefrolog?a