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Stavrinou E, Sarafidis PA, Loutradis C, Memmos E, Faitatzidou D, Giamalis P, Koumaras C, Karagiannis A, Papagianni A. Associations of serum sclerostin and Dickkopf-related protein-1 proteins with future cardiovascular events and mortality in haemodialysis patients: a prospective cohort study. Clin Kidney J 2020; 14:1165-1172. [PMID: 33841862 PMCID: PMC8023195 DOI: 10.1093/ckj/sfaa069] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 04/07/2020] [Indexed: 12/17/2022] Open
Abstract
Background Sclerostin and Dickkopf-related protein-1 (Dkk-1) proteins are inhibitors of the canonical Wnt/β-catenin bone pathway. Sclerostin but not Dkk-1 is associated with increased arterial stiffness. This study examined the prognostic significance of sclerostin and Dkk-1 levels for cardiovascular outcomes and mortality in haemodialysis (HD) patients. Methods Serum sclerostin and Dkk-1 levels were measured with enzyme-linked immunosorbent assay in 80 HD patients that were followed-up for a median of 45 months. Factors that could interfere with the association of sclerostin and Dkk-1 with outcomes [including carotid–femoral pulse wave velocity (PWV), parathyroid hormone (PTH), calcium–phosphate product and others] were assessed at baseline. The primary endpoint was a combination of all-cause death, non-fatal myocardial infarction, non-fatal stroke, coronary revascularization, hospitalization for decompensated heart failure and new-onset atrial fibrillation. Secondary endpoints included cardiovascular and all-cause mortality. Results Cumulative freedom from the primary endpoint was significantly lower for higher tertiles of sclerostin (77.8, 69.2 and 40.7%; Tertiles 1–3, respectively; log-rank P = 0.004). The risk for the primary outcome gradually increased for higher sclerostin tertiles [Tertile 3: hazard ratio (HR) = 3.847, 95% confidence interval (CI) 1.502–9.851]. No significant association was evident between sclerostin and all-cause mortality, whereas higher sclerostin levels presented a trend towards higher risk for cardiovascular mortality. Dkk-1 levels exhibited no association with the risk of the primary or secondary endpoints. In stepwise Cox regression modelled analysis, sclerostin levels were associated with the primary outcome, independently of PTH, calcium–phosphate product, serum albumin, C-reactive protein and PWV levels (HR = 2.921, 95% CI 1.401–6.090; P = 0.004). Conclusions High sclerostin levels are associated with lower cumulative freedom and higher risk for a composite endpoint of cardiovascular events and mortality. Dkk-1 exhibited no association with the future risk of adverse outcomes.
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Affiliation(s)
- Eirini Stavrinou
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Pantelis A Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Charalampos Loutradis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evangelos Memmos
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Danai Faitatzidou
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis Giamalis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Charalampos Koumaras
- Second Propaedeutic Department of Internal Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Asterios Karagiannis
- Second Propaedeutic Department of Internal Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aikaterini Papagianni
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Stavrinou E, Sarafidis PA, Koumaras C, Loutradis C, Giamalis P, Tziomalos K, Karagiannis A, Papagianni A. Increased Sclerostin, but Not Dickkopf-1 Protein, Is Associated with Elevated Pulse Wave Velocity in Hemodialysis Subjects. Kidney Blood Press Res 2019; 44:679-689. [PMID: 31382263 DOI: 10.1159/000501205] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 05/27/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Sclerostin and Dickkopf-1 (Dkk-1) proteins are inhibitors of the canonical Wnt/β-catenin bone pathway. Pilot data suggest that sclerostin may be involved in vascular changes in chronic kidney disease (CKD), but data on the effects of Dkk-1 are scarce. This is the first study investigating simultaneously the associations of sclerostin and Dkk-1 with arterial stiffness in hemodialysis patients. METHODS A total of 80 patients on chronic hemodialysis had carotid-femoral pulse wave velocity (PWV), central blood pressure (BP), and wave reflections evaluated with applanation tonometry (Sphygmocor) on a midweek non-dialysis day. Serum levels of sclerostin and Dkk-1 were measured with ELISA. A large set of demographic, comorbid, laboratory, and drug parameters were used in the analyses. RESULTS Subjects with PWV >9.5 m/s (high arterial stiffness group, n = 40) were older, had higher BMI, higher prevalence of hypertension, diabetes, and coronary heart disease, and higher peripheral systolic BP, central systolic BP, C-reactive protein, and serum sclerostin (p = 0.02), but similar Dkk-1, compared to subjects with low PWV. When dichotomizing the population by sclerostin levels, those with high sclerostin had higher PWV than patients with low sclerostin levels (10.63 ± 2.71 vs. 9.77 ± 3.13, p = 0.048). Increased sclerostin (>200 pg/mL) was significantly associated with increased PWV (>9.5 m/s; HR 2.778, 95% CI 1.123-6.868 per pg/mL increase); this association remained significant after stepwise adjustment for Dkk-1, intact parathyroid hormone, and calcium × phosphate product. In contrast, no association was noted between Dkk-1 and PWV (HR 1.000, 95% CI 0.416-2.403). CONCLUSION Serum sclerostin is associated with PWV independently of routine markers of CKD-MBD in hemodialysis patients. In contrast, Dkk-1 has no association with arterial stiffness and is not pathophysiologically involved in relevant vascular changes.
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Affiliation(s)
- Eirini Stavrinou
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Pantelis A Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece,
| | - Charalampos Koumaras
- Second Propaedeutic Department of Internal Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Charalampos Loutradis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis Giamalis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Tziomalos
- First Propaedeutic Department of Internal Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Asterios Karagiannis
- Second Propaedeutic Department of Internal Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aikaterini Papagianni
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Koumaras C, Tziomalos K, Stavrinou E, Katsiki N, Athyros VG, Mikhailidis DP, Karagiannis A. Effects of renin-angiotensin-aldosterone system inhibitors and beta-blockers on markers of arterial stiffness. ACTA ACUST UNITED AC 2013; 8:74-82. [PMID: 24139833 DOI: 10.1016/j.jash.2013.09.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 08/23/2013] [Accepted: 09/11/2013] [Indexed: 01/29/2023]
Abstract
Antihypertensive agents may, even within the same class, exert variable effects on arterial stiffness variables. Nebivolol could have a better impact than atenolol on arterial stiffness, by increasing the bioavailability of endothelium-derived nitric oxide. Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) increase plasma renin activity (enhancing the production of angiotensin II via non-ACE-related pathways) whereas aliskiren does not, potentially affecting central hemodynamics differently. We compared the effects of two renin-angiotensin-aldosterone system (RAAS) inhibitors (quinapril and aliskiren) and 2 beta-blockers (atenolol and nebivolol) on arterial stiffness variables. Treatment-naïve patients (n = 72; 68.1% males; age, 47.6 ± 10.6 years) with uncomplicated stage I-II essential hypertension were randomly assigned to quinapril, aliskiren, atenolol, or nebivolol for 10 weeks. Central systolic and diastolic blood pressure (BP), central pulse pressure (PP), augmentation index (AIx), and pulse wave velocity (PWV) were measured at baseline, 2, and 10 weeks. The same measurements were performed in 20 normotensive subjects (65.0% males; age, 40.0 ± 8.9 years). Peripheral and central systolic and diastolic BP, peripheral PP, and PWV were significantly and similarly reduced by all agents. However, PWV continued to decline between the second and last visit in patients on quinapril and aliskiren but did not change in those on nebivolol or atenolol. Central PP and AIx decreased in patients on quinapril, aliskiren, and nebivolol but did not change in those taking atenolol. The decrease in central PP and AIx did not differ between patients on quinapril, aliskiren, and nebivolol. Despite similar reductions in peripheral BP, atenolol is less effective than nebivolol and RAAS inhibitors in improving central pulsatile hemodynamics. Aliskiren exerts similar effects on markers of arterial stiffness as quinapril. The clinical relevance of these differences remains to be established.
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Affiliation(s)
- Charalambos Koumaras
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Konstantinos Tziomalos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Eirini Stavrinou
- Department of Nephrology, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Niki Katsiki
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Vasilios G Athyros
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry (Vascular Disease Prevention Clinics), Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, UK.
| | - Asterios Karagiannis
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
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Bilgic A, Sezer S, Ozdemir N, Kurita N, Hosokawa N, Nomura S, Maeda Y, Uchihara H, Fukuhara S, Gascon LD, Karohl C, Smith AL, Wilson RO, Raggi P, Ignace S, Loignon RC, Couture V, Marquis K, Utescu M, Lariviere R, Agharazii M, Zahalkova J, Marsova M, Nikorjakova I, vestak M, amboch K, Bellasi A, Gamboa C, Ferramosca E, Ratti C, Block G, Muntner P, Raggi P, Makino J, Makino K, Ito T, Kato S, Yuzawa Y, Yasuda Y, Tsuruta Y, Itoh A, Maruyama S, Karasavvidou D, Kalaitzidis R, Spanos G, Pappas K, Pappas E, Kountouris S, Tatsioni A, Siamopoulos K, Staffolani E, Galli D, Nicolais R, Magliano G, Forleo GB, Santini L, Romano V, Sgueglia M, Romeo F, Di Daniele N, Freercks R, Swanepoel C, Carrara H, Raggi P, Rayner B, Freercks R, Swanepoel C, Carrara H, Raggi P, Rayner B, Fedak D, Kuzniewski M, Galicka-Latala D, Kusnierz-Cabala B, Dumnicka P, Pasowicz M, Solnica B, Sulowicz W, Kuzniewski M, Fedak D, Kapusta M, Kusnierz-Cabala B, Janda K, Pasowicz M, Solnica B, Sulowicz W, Ozcan M, Calayoglu R, Sengul S, Ensari A, Hazinedaroglu S, Tuzuner A, Nergizoglu G, Erbay B, Keven K, Gross T, Floege J, Leon S, Markus K, Vincent B, Ulrich G, Zitt E, Koenig M, Vychytil A, Auinger M, Wallner M, Lingenhel G, Schilcher G, Lhotta K, Csiky B, Toth G, Sulyok E, Melegh B, Vas T, Wittmann I, Martens-Lobenhoffer J, Awiszus F, Bode-Boger SM, Staffolani E, Nicolais R, Miani N, Galli D, Borzacchi MS, Cipriani S, Sturniolo A, Di Daniele N, Abouseif K, Bichari W, Elewa U, Buimistriuc LD, Badarau S, Stefan A, Leanca E, Covic A, Kimura H, Mukai H, Miura S, Maeda A, Takeda K, Sikole A, Trajceska L, Selim G, Amitov V, Dzekova P, Gelev S, Severova G, Trajceski T, Abe Y, Watanabe M, Ito K, Ogahara S, Nakashima H, Saito T, Oleniuc M, Secara IF, Nistor I, Onofriescu M, Covic A, Papagianni A, Kasimatis E, Stavrinou E, Pliakos K, Spartalis M, Dimitriadis C, Belechri AM, Giamalis P, Economidou D, Efstratiadis G, Memmos D, Chen R, Xing C, Bi G, Ito S, Oyake N, Tanabe K, Shimada T, Capurro F, De Mauri A, Brustia M, Navino C, David P, De Leo M, Usvyat L, Bayh I, Etter M, Lam M, Levin NW, Marcelli D, Raimann JG, Schuh E, Thijssen S, Kotanko P, Sipahioglu M, Unal A, Kocyigit I, Karakurt M, Oguzhan N, Cilan H, Kavuncu F, Tokgoz B, Oymak O, Utas C, Canas L, Galan A, Ferrer E, Filella A, Fernandez M, Bayes B, Bonet J, Bonal J, Romero R, Amore A, Puccinelli MP, Petrillo G, Albiani R, Bonaudo R, Camilla R, Steckiph D, Grandi F, Bracco G, Coppo R, Chen X, Zhu P, Chen Y, Xu Y, Chen N, Tatar E, Kircelli F, Asci G, Carrero JJ, Gungor O, Demirci MS, Ozkahya M, Toz H, Ok E, Buzdugan E, Condor A, Crisan S, Radulescu D, Lucaciu D, Hakemi MS, Nassiri AA, Asadzadeh R, Faizei AM, Molsted S, Andersen JL, Eidemak I, Harrison AP, Rodriguez Gomez MA, Fernandez-Reyes Luis MJ, Molina Ordas A, Heras Benito M, Sanchez Hernandez R, Mortazavi Najafabadi M, Moinzadeh F, Saadatnia SM, Shahidi S, Davarpanah A, Farajzadegan Z, Rodriguez-Reimundes E, Rognant N, Jolivot A, Abdeljaouad A, Pelletier S, Juillard L, Laville M, Fouque D, Santoro A, Zuccala A, Cagnoli L, Bolasco PG, Panzetta O, Mercadal L, Fessy H, London G, Severi S, Domini R, Grandi F, Corsi C. Cardiovascular complications in CKD 5D (2). Clin Kidney J 2011. [DOI: 10.1093/ndtplus/4.s2.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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