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

Luciano Pereira; Luís Mendonça; Juliana Magalhães; Ricardo Neto; Janete Quelhas-Santos; Ana Oliveira; Ana Beco; João Frazão

doi:10.1016/j.nefroe.2023.05.003

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

Nefrologia (Engl Ed). 2023 May 11:S2013-2514(23)00078-0. doi: 10.1016/j.nefroe.2023.05.003. Online ahead of print.

Authors

Luciano Pereira¹, Luís Mendonça², Juliana Magalhães³, Ricardo Neto², Janete Quelhas-Santos⁴, Ana Oliveira⁵, Ana Beco⁵, João Frazão²

Affiliations

¹ Institute 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. Electronic address: lucianoarturpereira@hotmail.com.
² Institute 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.
³ Institute of Investigation and Innovation in Health, University of Porto, Porto, Portugal; INEB - National Institute of Biomedical Engineering, University of Porto, Porto, Portugal.
⁴ Institute of Investigation and Innovation in Health, University of Porto, Porto, Portugal; INEB - National Institute of Biomedical Engineering, University of Porto, Porto, Portugal; School of Medicine of University of Porto, Porto, Portugal.
⁵ Department of Nephrology, São João Hospital Center, Porto, Portugal.

PMID: 37179214
DOI: 10.1016/j.nefroe.2023.05.003

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 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.

Keywords: Alteraciones del metabolismo óseo-mineral en la enfermedad renal crónica; Biopsia ósea; Bone biopsy; Calcificación vascular; Chronic kidney disease-mineral and bone disorder; Diálisis peritoneal; Osteodistrofia renal; Peritoneal dialysis; Renal osteodystrophy; Vascular calcification.