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Lu CW, Wang CH, Hsu BG, Tsai JP. Serum Osteoprotegerin Level Is Negatively Associated with Bone Mineral Density in Patients Undergoing Maintenance Hemodialysis. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:762. [PMID: 34440966 PMCID: PMC8399781 DOI: 10.3390/medicina57080762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/13/2021] [Accepted: 07/24/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Osteoprotegerin (OPG), a potent osteoclast activation inhibitor, decreases bone resorption and plays a role in mediating bone mineral density (BMD). Our aim was to evaluate the relationship between BMD and serum OPG in maintenance hemodialysis (MHD) patients. MATERIALS AND METHODS Fasting blood samples were obtained from 75 MHD patients. BMD was measured by dual-energy X-ray absorptiometry in lumbar vertebrae (L2-L4). The WHO classification criteria were applied to define osteopenia and osteoporosis. A commercial enzyme-linked immunosorbent assay was used to measure serum OPG values. RESULTS Among all MHD patients, seven (9.3%) and 20 patients (26.7%) were defined as osteoporosis and osteopenia, respectively. Female patients had lower lumbar BMD than males (p = 0.002). Older age (p = 0.023), increased serum OPG (p < 0.001) urea reduction rate (p = 0.021), Kt/V (p = 0.027), and decreased body mass index (p = 0.006) and triglycerides (p = 0.020) were significantly different between the normal, osteopenia, and osteoporosis groups. Lumbar spine BMD was positively correlated with body mass index (BMI) (p < 0.001) but negatively correlated with OPG (p < 0.001) and age (p = 0.003). After grouping patients into T scores < -1 and < -2.5, female sex and OPG (adjusted odds ratio [aOR] 1.022, 95% confidence interval [C.I.] 1.011-1.034, p < 0.001) were predictors of T scores < -1, whereas only OPG was predictive of T scores < -2.5 (aOR 1.015, 95% C.I. 1.005-1.026, p = 0.004) by multivariate stepwise logistic regression analysis. The areas under the curve for predicting T scores < -1 or < -2.5 were 0.920 (95% C.I. 0.834-0.970, p < 0.001) and 0.958 (95% C.I. 0.885-0.991, p < 0.001), respectively. CONCLUSIONS Increased serum OPG negatively correlated with lumbar BMD and could be a potential biomarker predictive of osteoporosis in MHD patients.
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Affiliation(s)
- Chia-Wen Lu
- Division of Nephrology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97004, Taiwan; (C.-W.L.); (C.-H.W.)
| | - Chih-Hsien Wang
- Division of Nephrology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97004, Taiwan; (C.-W.L.); (C.-H.W.)
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
| | - Bang-Gee Hsu
- Division of Nephrology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97004, Taiwan; (C.-W.L.); (C.-H.W.)
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
| | - Jen-Pi Tsai
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
- Department of Internal Medicine, Division of Nephrology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 62247, Taiwan
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Bone biomarkers in de novo renal transplant recipients. Clin Chim Acta 2019; 501:179-185. [PMID: 31734147 DOI: 10.1016/j.cca.2019.10.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 10/24/2019] [Indexed: 12/30/2022]
Abstract
Successful kidney transplantation (partly) corrects the physiologic and metabolic abnormalities driving chronic kidney disease - mineral and bone disorders. At the same time, renal transplant recipients are exposed to immunosuppressive agents that may affect bone metabolism. Bone biomarkers have been suggested as surrogates of or adjuncts to bone biopsy and imaging techniques to assess bone health and to classify risk of bone loss and fractures. Bone biomarkers may be classified as circulating factors that affect bone metabolism (commonly referred to as bone metabolism markers) or that reflect bone cell number and/or activity (commonly referred to as bone turnover markers). A growing body of evidence shows that successful renal transplantation has a major impact on both bone metabolism and bone turnover. Analytical issues, including the cross-reactivity with fragments, complicate the interpretation of bone biomarkers, especially in the setting of a rapid changing kidney function, as is the case after successful renal transplantation. Overall, bone turnover seems to decline following renal transplantation, but inter-individual variability is substantial. Preliminary evidence indicates that bone biomarkers may be useful in guiding mineral and bone therapy in renal transplant recipients.
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Correlation of Fgf23 and Balp with Bone Mineral Density in Hemodialysis Patients. J Med Biochem 2019; 38:418-426. [PMID: 31496905 PMCID: PMC6708290 DOI: 10.2478/jomb-2019-0002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 01/04/2019] [Indexed: 02/05/2023] Open
Abstract
Background Chronic kidney disease (CKD) is associated with numerous complications such as bone mineral disorder. The aim of our study was to analyze the correlation of bone turnover markers with Bone Mineral Density (BMD) measurements in Tunisian end stage renal diseases (ESRD) patients. Methods This study included 100 ESRD Tunisian patients. Their estimated glomerular filtration rate (eGFR) was < 15 mL × min-1 × (1.73 m2)-1, which requires hemodialysis. Bone-specific alkaline phosphatase (BALP) serum concentration was determined with a chemiluminescence immunoassay. Fibroblast Growth Factor 23 (FGF23) serum was assessed by Enzyme-Linked Immunosorbent Assay method. The serum levels of 25-Hydroxyvitamin D (25(OH)D), intact parathyroid hormone (iPTH) and Beta cross-laps (CTX) was measured by Electrochemiluminescence Technology. DEXA (dual-energy x-ray absorptiometry) technique was used to evaluate BMD. Results We observed a statistically significant negative correlation between BALP levels and total body BMD (r = -0.268; P = 0.015) particularly in femoral neck (FN) (r = -0.219; P = 0.037). BALP concentrations were negatively associated with total BMD especially in FN for patients with BMI < 30, FGF23 concentrations were also negatively correlated with BMD in lumbar spine site (LS) (r = -0.209; P = 0.046). For osteopenic patients we found an inverse correlation between 25(OH)D concentrations and BMD in LS position (r = -0.336; P = 0.038). In men group, we have also found a negative correlation between iPTH and total BMD (r = -0.326; P = 0.015). However we found a positive correlation between calcium expression and BMD in LS site (r = 0.270; P = 0.031). Conclusions FGF23 and BALP can predict bone loss in ESRD through their strong correlation with BMD in LS and FN sites respectively.
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Jørgensen HS, Winther S, Bøttcher M, Hauge EM, Rejnmark L, Svensson M, Ivarsen P. Bone turnover markers are associated with bone density, but not with fracture in end stage kidney disease: a cross-sectional study. BMC Nephrol 2017; 18:284. [PMID: 28874132 PMCID: PMC5586067 DOI: 10.1186/s12882-017-0692-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 08/18/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fracture risk is increased in chronic kidney disease (CKD), but assessment of bone fragility remains controversial in these patients. This study investigated the associations between bone turnover markers, bone mineral density (BMD), and prevalent fragility fracture in a cohort of kidney transplantation candidates. METHODS Volumetric BMD of spine and hip was measured by quantitative computed tomography. Parathyroid hormone (PTH), bone-specific alkaline phosphatase, procollagen type-1 N-terminal propeptide, tartrate resistant alkaline phosphatase, and C- and N-terminal telopeptides of type 1 collagen were analyzed from fasting morning blood samples. Fragility fractures included prevalent vertebral fractures and previous low-trauma clinical fractures. RESULTS The fracture prevalence was 18% in 157 adult kidney transplant candidates. Fractured patients had reduced BMD and Z-score at both spine and hip. Levels of bone turnover markers were significantly higher in patients on maintenance dialysis than in pre-dialysis patients; but did not differ between patients with and without fracture. There were strong, positive correlations between PTH and all bone turnover markers. PTH was negatively associated with Z-score at lumbar spine and total hip; in contrast, bone turnover markers were only negatively associated with total hip Z-score. CONCLUSIONS Bone turnover markers were negatively associated with bone density, but not associated with prevalent fracture in kidney transplantation candidates. The role of bone turnover markers in assessing bone fragility in CKD will require further investigation. TRIAL REGISTRATION This study was registered at ClinicalTrials.gov with identifier NCT01344434 .
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Affiliation(s)
- Hanne Skou Jørgensen
- Department of Renal Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark. .,Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Simon Winther
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Internal Medicine, Hospital Unit West, Herning, Denmark
| | - Morten Bøttcher
- Department of Internal Medicine, Hospital Unit West, Herning, Denmark
| | - Ellen-Margrethe Hauge
- Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Rejnmark
- Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - My Svensson
- Department of Nephrology, Division of Medicine, Akershus University Hospital, Oslo, Norway
| | - Per Ivarsen
- Department of Renal Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
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Moldovan D, Rusu C, Potra A, Moldovan I, Patiu IM, Gherman-Caprioara M, Kacso IM. Osteoprotegerin and uremic osteoporosis in chronic hemodialysis patients. Int Urol Nephrol 2017; 49:895-901. [PMID: 28161839 DOI: 10.1007/s11255-017-1529-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 01/25/2017] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Osteoprotegerin (OPG) is a powerful inhibitor of osteoclast activity, and it plays an important role in bone metabolism. In hemodialysis (HD) patients, the relationship between OPG and bone mineral density (BMD) is important, but remains unclear yet. The study objective was to assess the OPG role related to uremic osteoporosis in HD patients. METHODS This cross-sectional study has been realized on a cohort of 63 chronic HD patients. INCLUSION CRITERIA elderly prevalent HD patients with an age over 55 years old. EXCLUSION CRITERIA previous bone disease or previous renal transplant; neoplasia; parathyroidectomy, hormone replacement therapy. The data regarding demographical and clinical characteristics, including treatments for mineral and cardiovascular complications, were recorded. Serum OPG and mineral markers levels were measured. BMD was assessed by calcaneus quantitative ultrasound; it measured broadband ultrasound attenuation, speed of sound (SOS) and stiffness index (STI). RESULTS The high OPG levels were associated with higher bone mineral density (OPG-SOS P = 0.003; R = 0.37; OPG-STI P = 0.03; R = 0.28). Malnutrition, anemia and advanced age correlated with bone demineralization. Males had higher bone density parameters than females. In patients treated with vitamin D (P = 0.005), the BMD was increased comparing to patients without these treatments. CONCLUSIONS OPG levels had directly correlated with bone mineral density parameters. Our study further confirms the critical role of OPG in the pathogenesis of uremic osteoporosis in ESRD. Whether the increased circulant OPG protect against bone loss in patients undergoing HD remains to be established.
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Affiliation(s)
- Diana Moldovan
- Department of Nephrology, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania.
- Nephrology and Dialysis Clinic, Emergency County Hospital, "Mihai Manasia", 3-5 Clinicilor Street, Cluj-Napoca, Romania.
| | - Crina Rusu
- Department of Nephrology, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
| | - Alina Potra
- Department of Nephrology, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
| | | | | | - Mirela Gherman-Caprioara
- Department of Nephrology, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
| | - Ina Maria Kacso
- Department of Nephrology, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
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Lin YL, Lai YH, Wang CH, Kuo CH, Liou HH, Hsu BG. Triceps Skinfold Thickness Is Associated With Lumbar Bone Mineral Density in Peritoneal Dialysis Patients. Ther Apher Dial 2016; 21:102-107. [PMID: 27787966 DOI: 10.1111/1744-9987.12482] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 06/20/2016] [Accepted: 07/15/2016] [Indexed: 01/14/2023]
Abstract
Anthropometric measurements, including body mass index (BMI), body weight and total fat mass are associated with the bone mineral density (BMD) in the general population. Compared to that in the general population, BMD was lower in dialysis patients. However, the association between anthropometric measurements and BMD is not well-established among peritoneal dialysis (PD) patients. To study this, we conducted a cross-sectional study in 48 chronic PD patients. Anthropometric parameters, biochemical data, and BMD measured by dual energy X-ray absorptiometry in lumbar vertebrae (L2-L4) were collected. Among these PD patients, eight patients (16.7%) had osteoporosis and 22 patients (45.8%) osteopenia, while 18 patients were normal. Older age, decreased height, lower body weight, BMI, triceps skinfold thickness (TSF), mid-arm fat area (MAFA), and higher adiponectin levels were observed in our patients with lower lumbar T-scores. Height, body weight, waist circumference, BMI, body fat mass, TSF, mid-arm circumference, MAFA, and serum phosphorus levels were positively, while age, adiponectin levels were negatively correlated with lumbar BMD levels. According to our multivariate forward stepwise linear regression analysis, TSF (R2 change = 0.080, P = 0.017) and body weight (R2 change = 0.333, P = 0.002) were both correlated with low lumbar BMD. In conclusion, either TSF or body weight in our chronic PD patients was proved to be an independent predictor for osteolytic bone lesions.
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Affiliation(s)
- Yu-Li Lin
- Division of Nephrology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Yu-Hsien Lai
- Division of Nephrology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Chih-Hsien Wang
- Division of Nephrology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Chiu-Huang Kuo
- Division of Nephrology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | | | - Bang-Gee Hsu
- Division of Nephrology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
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Bergman A, Qureshi AR, Haarhaus M, Lindholm B, Barany P, Heimburger O, Stenvinkel P, Anderstam B. Total and bone-specific alkaline phosphatase are associated with bone mineral density over time in end-stage renal disease patients starting dialysis. J Nephrol 2016; 30:255-262. [PMID: 26994005 DOI: 10.1007/s40620-016-0292-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 02/15/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND Alkaline phosphatase (ALP) and bone-specific ALP (BALP) are implicated in the abnormal skeletal mineralization and accelerated vascular calcification in chronic kidney disease (CKD) patients. Whereas ALP and BALP may predict mortality in CKD, BALP is reported to have higher sensitivity and specificity than total ALP in reflecting histological alterations in bone; however, results on their associations with bone mineral density (BMD) are inconsistent. Here we evaluated associations of total ALP and BALP with BMD during up to 24 months in end-stage renal disease (ESRD) patients. METHODS In this longitudinal study, 194 ESRD patients (median age 57 years, 66 % male, 32 % diabetes mellitus, mean body mass index 24.8 kg/m2) underwent measurements of total ALP and BALP and total and regional body BMD (by dual-energy X-ray absorptiometry) at dialysis initiation (n = 194), and after 12 (n = 98) and 24 months (n = 40) on dialysis. RESULTS At baseline, patients had median total ALP 65.4 (43.3-126.4) U/l, BALP 13.5 (7.1-27.3) µg/l and BMD 1.14 (0.97-1.31) g/cm2. During the study period, serum concentrations of ALP and BALP increased significantly (p < 0.001), whereas total and regional BMD remained stable. BMD correlated inversely with total ALP (rho = -0.20, p = 0.005) and BALP (rho = -0.30, p < 0.001) at baseline, and correlations were similar also at 12 and 24 months. CONCLUSION ALP and BALP are equally accurate albeit weak predictors of BMD in ESRD patients, both at baseline and longitudinally. The dissociation between stable BMD and increasing ALP and BALP may possibly reflect increased soft tissue calcifications with time on dialysis.
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Affiliation(s)
- Annelie Bergman
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Hospital Huddinge, Karolinska University, KFC, Novum, 141 86, Stockholm, Sweden
| | - Abdul Rashid Qureshi
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Hospital Huddinge, Karolinska University, KFC, Novum, 141 86, Stockholm, Sweden
| | - Mathias Haarhaus
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Hospital Huddinge, Karolinska University, KFC, Novum, 141 86, Stockholm, Sweden
| | - Bengt Lindholm
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Hospital Huddinge, Karolinska University, KFC, Novum, 141 86, Stockholm, Sweden
| | - Peter Barany
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Hospital Huddinge, Karolinska University, KFC, Novum, 141 86, Stockholm, Sweden
| | - Olof Heimburger
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Hospital Huddinge, Karolinska University, KFC, Novum, 141 86, Stockholm, Sweden
| | - Peter Stenvinkel
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Hospital Huddinge, Karolinska University, KFC, Novum, 141 86, Stockholm, Sweden
| | - Björn Anderstam
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Hospital Huddinge, Karolinska University, KFC, Novum, 141 86, Stockholm, Sweden.
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Age and gender predict OPG level and OPG/sRANKL ratio in maintenance hemodialysis patients. Adv Med Sci 2013; 58:382-7. [PMID: 23959668 DOI: 10.2478/ams-2013-0026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE Cardiovascular disease (CVD) is a major cause of death among chronic hemodialysis (HD) patients. Gender and age belong to its classical risk factors. OPG/RANK/sRANKL (Osteoprotegerin/ Receptor Activator of Nuclear Factor κB/ soluble Receptor Activator of Nuclear Factor κB Ligand) axis constitute a system connecting bone and vascular remodeling. METHODS We aimed to evaluate the plasma levels of OPG, sRANKL and OPG/sRANKL ratio in 21 HD patients and 16 healthy volunteers in relation to gender, age and the other clinical parameters. RESULTS OPG and OPG/sRANKL ratio were significantly higher in HD patients than in controls whereas sRANKL was similar in both groups. Adjusted for gender, in controls OPG were higher in women whereas sRANKL did not differ between men and women. In HD group OPG and sRANKL were higher in women whereas OPG/sRANKL ratio was similar in both genders. Female patients compared to healthy women revealed 56% higher OPG concentration and 54% higher OPG/ sRANKL ratio. Comparison of male patients and controls revealed 61% higher level of OPG and 75% higher OPG/sRANKL ratio in HD group. Interestingly, OPG and OPG/sRANKL ratio positively correlated with age only in male patients. Contrary, the association between OPG/sRANKL ratio and age was negative in HD women. CONCLUSION Higher OPG levels in HD women comparing to age matched HD men indicate the necessity of more careful screening towards the presence of CVD and bone-mineral disorders. The negative association between age and OPG/ sRANKL ratio in HD women warrant in-depth study for thorough understanding of this complex interrelationship.
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Özkan O, Öztürk S, Karadağ S, Gürsu M, Şumnu A, Cebeci E, Sevim Y, Uzun S, Aydın Z, Kazancıoğlu R. The Factors Effective on Bone Mineral Density in
Peritoneal Dialysis Patients. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2013. [DOI: 10.29333/ejgm/82214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Parathormone and bone-specific alkaline phosphatase for the follow-up of bone turnover in hemodialysis patients: Is it so simple? Clin Chim Acta 2013; 417:35-8. [DOI: 10.1016/j.cca.2012.12.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 11/08/2012] [Accepted: 12/03/2012] [Indexed: 11/20/2022]
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Klejna K, Naumnik B, Koc-Żórawska E, Myśliwiec M. Effect of Unfractionated and Low-Molecular-Weight Heparin on OPG, sRANKL, and von Willebrand Factor Concentrations During Hemodialysis. Clin Appl Thromb Hemost 2012; 20:433-41. [DOI: 10.1177/1076029612463424] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: Endothelial dysfunction marker, von Willebrand factor (vWF), is physically connected with osteoprotegerin (OPG) in the Weibel-Palade bodies. We aimed to compare the effect of unfractionated (UFH) and low-molecular-weight (LMWH enoxaparin) heparin used as anticoagulants during hemodialysis (HD) on plasma levels and relationships of OPG, soluble receptor activator of nuclear factor κB Ligand (sRANKL), and vWF. Methods: Totally 21 clinically stable chronic HD patients were randomly assigned to either enoxaparin (n = 10) or UFH (n = 11) anticoagulation and followed prospectively for 12 weeks before crossing over to the alternate therapy for further 12 weeks. The OPG, RANKL, and vWF levels were measured at T0, T10, and T180 of HD session after each period of evaluation. Results: The baseline sRANKL level was higher under UFH treatment. Its over-HD level does not behave significantly different under enoxaparin and UFH treatment. Plasma OPG levels expressly changed during both enoxaparin (χ2 analysis of variance [ANOVA] = 31.13, P < .016) and UFH (χ2 ANOVA = 8.26, P = .016) anticoagulation, and its increment at T10 and T180 was significantly different between both the heparins. The main negative predictor of OPG concentration was the total cholesterol level (β = −.51, P = .025). von Willebrand factor concentration remained stable during UFH anticoagulation, whereas constant, no significant increments were noticed, under enoxaparin treatment. After 10 minutes of HD, especially under enoxaparin use, a positive correlation between OPG and vWF increase was noticed ( P = .03, R = .45). Conclusions: Impact of heparin on endothelial cells and simultaneously on OPG/RANK/RANKL axis reinforces the presumption of the pathophysiological linkage between bone mineralization and endothelial dysfunction in end-stage renal disease.
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Affiliation(s)
- Katarzyna Klejna
- Department of Nephrology and Transplantation with Dialysis Unit, Medical University, Bialystok, Poland
| | - Beata Naumnik
- Department of Nephrology and Transplantation with Dialysis Unit, Medical University, Bialystok, Poland
| | - Ewa Koc-Żórawska
- Department of Nephrology and Transplantation with Dialysis Unit, Medical University, Bialystok, Poland
| | - Michał Myśliwiec
- Department of Nephrology and Transplantation with Dialysis Unit, Medical University, Bialystok, Poland
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Wu WT, Lee RP, Wang CH, Fang TC, Lin NT, Chen IH, Hsu BG. The association of serum osteoprotegerin and osteoporosis in postmenopausal hemodialysis patients: a pilot study. J Womens Health (Larchmt) 2012; 19:785-90. [PMID: 20210559 DOI: 10.1089/jwh.2009.1577] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIM Osteoprotegerin (OPG) is a potent inhibitor of osteoclasts and plays an important role in bone metabolism. Relatively high serum levels of OPG have been observed in postmenopausal women with osteoporosis compared with age-matched controls. No data, however, are available on the relationship between low bone density and serum OPG levels in postmenopausal hemodialysis (HD) patients. METHODS The enrolled subjects included 28 postmenopausal HD patients and 28 age-matched postmenopausal women with normal renal function as controls. Bone mineral density (BMD) was measured by dual energy x-ray absorptiometry (DEXA) in both hips. Low BMD was defined as femoral neck T-score <-2.5. Serum OPG levels were measured using a commercial enzyme-linked immunosorbent assay (ELISA) kit. RESULTS Eight of the age-matched postmenopausal controls (28.6%) and 12 of the postmenopausal HD patients (42.9%) had low BMD. There was no statistically significant difference in low BMD between postmenopausal HD patients and age-matched postmenopausal patients (p = 0.263). The serum OPG level was significantly higher in the postmenopausal HD group (p < 0.001). Increased serum OPG (p = 0.017) and decreased serum albumin (p = 0.021) were significantly correlated with low BMD in postmenopausal HD patients. Univariate linear regression analysis showed that serum albumin (r = -0.455, p = 0.015) was negatively correlated, whereas age (r = 0.423, p = 0.025) and the length of time since menopause (r = 0.397, p = 0.036) were positively correlated with the serum OPG level in postmenopausal HD patients. Multivariate forward stepwise linear regression analysis showed that serum OPG (adjusted R(2) = 0.262, p = 0.003) was an independent predictor of low BMD in postmenopausal HD patients and explained 26.2% of the variance. CONCLUSIONS Serum OPG is associated with low BMD in postmenopausal HD patients.
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Affiliation(s)
- Wen-Tien Wu
- Institute of Medicine Science, Tzu Chi University, Hualien, Taiwan
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Abstract
Vitamin D receptor agonists (VDRA) are currently recommended for the treatment of secondary hyperparathyroidism in stage 5 CKD. They are considered to be contraindicated in the presence of low or normal (for a dialysis patient) levels of PTH due to the risk of developing adynamic bone disease, with consequent vascular calcification. However, these recommendations are increasingly at odds with the epidemiological evidence, which consistently shows a large survival advantage for patients treated with low-dose VDRAs, regardless of plasma calcium, phosphate, or PTH. A large number of pleiotropic effects of vitamin D have been described, including inhibition of renin activity, anti-inflammation, and suppression of vascular calcification stimulators and stimulation of vascular calcification inhibitors present in the uremic milieu. Laboratory studies suggest that a normal cellular vitamin D level is necessary for normal cardiomyocyte and vascular smooth muscle function. While pharmacological doses of VDRA can be harmful, the present evidence suggests that the level of 1,25-dihydroxycholecalciferol should also be more physiological in stage 5 CKD, and that widespread use of low-dose VDRA would be beneficial. A randomized controlled trial to test this hypothesis is warranted.
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Affiliation(s)
- James Goya Heaf
- Department of Nephrology, University of Copenhagen Herlev Hospital, Herlev, Denmark.
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OPG/RANK/RANKL signaling system and its significance in nephrology. Folia Histochem Cytobiol 2009; 47:199-206. [DOI: 10.2478/v10042-009-0035-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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OTT SUSANM. Review article: Bone density in patients with chronic kidney disease stages 4-5. Nephrology (Carlton) 2009; 14:395-403. [DOI: 10.1111/j.1440-1797.2009.01159.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Doumouchtsis KK, Kostakis AI, Doumouchtsis SK, Tziamalis MP, Stathakis CP, Diamanti-Kandarakis E, Dimitroulis D, Perrea DN. Associations between osteoprotegerin and femoral neck BMD in hemodialysis patients. J Bone Miner Metab 2008; 26:66-72. [PMID: 18095066 DOI: 10.1007/s00774-007-0785-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2007] [Accepted: 06/21/2007] [Indexed: 11/29/2022]
Abstract
Numerous humoral factors are involved in the development of renal osteodystrophy, causing perturbations in bone mineral density (BMD) in patients with end-stage renal disease (ESRD). The RANKL/OPG cytokine system appears to mediate the effects of many of these factors on bone turnover, contributing to the pathogenesis of renal bone disease. The aim of this study was to evaluate the clinical and biochemical correlations of BMD measurements in patients on chronic hemodialysis. Fifty-four hemodialysis patients underwent measurement of BMD at the proximal femur and the lumbar spine (L2-L4). Intact parathyroid hormone (PTH), osteoprotegerin (OPG), sRANKL, and main bone biochemical markers were also measured in serum samples of all patients. BMD of the femoral neck was negatively correlated with OPG levels (r = 0.333, P = 0.014). OPG levels were significantly different among normal, osteopenic, and osteoporotic tertiles defined according to BMD of the femoral neck. The highest OPG levels were measured in the lowest T-score (osteoporotic) tertile and were higher than in the osteopenic and normal tertiles (P < 0.05). A threshold level for OPG at 21.5 pmol/l enabled the detection of osteoporotic patients with 76.5% sensitivity and 62.2% specificity. BMD values of trabecular bone-rich sites of the skeleton such as lumbar spine (L2-L4), trochanter, and Ward' s triangle were inversely correlated with total ALP levels (P < 0.05). Hemodialysis patients with low BMD of the femoral neck demonstrated higher OPG levels than patients with normal BMD. Those with lumbar spine (L2-L4), trochanteric, and Ward's triangle BMDs below the normal range presented higher total ALP levels. These results suggest that OPG and total ALP may be clinically useful markers in the detection of significant femoral neck and trabecular bone mineral deficit in hemodialysis patients, warranting further investigations.
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Affiliation(s)
- Konstantinos K Doumouchtsis
- Laboratory for Experimental Surgery and Surgical Research, Athens University, 15B Saint Thomas Street, Athens 11527, Greece.
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Cibulka R, Racek J, Pikner R, Rajdl D, Trefil L, Vesela E, Studenovska M, Siroka R. Effect of L-carnitine supplementation on secondary hyperparathyroidism and bone metabolism in hemodialyzed patients. Calcif Tissue Int 2007; 81:99-106. [PMID: 17622482 DOI: 10.1007/s00223-007-9041-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2006] [Accepted: 05/05/2007] [Indexed: 12/23/2022]
Abstract
The aim of our work was to test the influence of L-carnitine supplementation on secondary hyperparathyroidism and bone metabolism in hemodialyzed patients in a randomized study. Eighty-three chronically hemodialyzed patients were observed; 44 were supplemented with L-carnitine (15 mg/kg intravenously after each hemodialysis for 6 months), while 39 took placebo. Levels of free carnitine (CAR), calcium (Ca), inorganic phosphate (P), Ca x P product, parathormone (PTH), bone-specific alkaline phosphatase (b-ALP), osteocalcin (OC), and osteoprotegerin (OPG) were monitored. In comparison with pretreatment values, changes of some selected parameters occurred in the supplemented patients after 6 months (data are expressed as medians; NS, nonsignificant change): PTH, 186.0 vs. 135.5 ng/L (NS); b-ALP, 13.9 vs. 13.2 microg/L (P < 0.05); OC, 78.3 vs. 68.8 microg/L (NS); OPG, 144.0 vs. 182.0 ng/L (P < 0.05). In the controls, there were the following changes: PTH, 148.0 vs. 207.0 ng/L (NS); b-ALP, 15.2 vs. 13.2 microg/L (P < 0.05); OC, 62.7 vs. 79.8 microg/L (P < 0.05); OPG, 140.0 vs. 164.0 ng/L (NS). A significant correlation was found between CAR and OPG changes (r = 0.51, P < 0.001) in the supplemented patients. The supplementation led to a significant increase of serum OPG concentration. Nevertheless, we observed only nonsignificant tendencies to correction of secondary hyperparathyroidism and reduction of bone turnover in hemodialyzed patients supplemented with L-carnitine in contrast to controls. At this point, the use of L-carnitine does not seem to be justified.
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Affiliation(s)
- Roman Cibulka
- Institute of Clinical Biochemistry and Hematology, Charles University Medical Faculty and Faculty Hospital, Alej Svobody 80, CZ-304 60, Pilsen, Czech Republic.
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Ulivieri FM, Marchelli D, Como G, Valente G, Messa P, Raimondi AR, Piodi LP. Increased osteoprotegerin in Italian haemodialysis patients. Osteoporos Int 2006; 17:1822-3; author reply 1824. [PMID: 17019516 DOI: 10.1007/s00198-006-0216-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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