Authors: S Pelletier C B Confavreux J Haesebaert F GuebreEgziabher J Bacchetta MC Carlier L Chardon M Laville R Chapurlat G M London MH LafageProust D Fouque
Publish Date: 2015/04/25
Volume: 26, Issue: 8, Pages: 2165-2174
Abstract
We found for the first time that in maintenance hemodialysis patients higher sclerostin serum level was associated with severe abdominal aortic calcification AAC In addition cortical bone microarchitecture density and thickness assessed by highresolution peripheral quantitative computed tomography HRpQCT at tibia was also independently associated with severe AAC These results suggest that sclerostin may be involved in the association of mineral and bone disorder with vascular calcification in hemodialysis patientsSevere abdominal aortic calcifications are predictive of high cardiovascular mortality in maintenance hemodialysis MHD patients In patients with endstage renal disease a high aortic calcification score was associated with lower bone turnover on bone biopsies Thus we hypothesized that sclerostin a Wnt pathway inhibitor mainly secreted by osteocytes and acting on osteoblasts to reduce bone formation may be associated with vascular calcifications in MHD patientsFiftythree MHD patients aged 53 years 35–63 median Q1–Q3 were included Serum was sampled before the MHD session to assay sclerostin Framingham score was computed and the abdominal aortic calcification AAC score was assessed according to Kauppila method on lateral spine imaging using DEXA Tibia bone status was evaluated by highresolution peripheral quantitative computed tomography HRpQCT Patients were distributed into two groups according to their AAC score patients with mild or without AAC score below 6 versus patients with severe AAC score of 6 and aboveIn multivariate analysis after adjustment on age dialysis duration and diabetes serum sclerostin and cortical thickness were independently associated with severe AAC odds ratio OR = 143 for each 01 ng/mL increase 95 confidence interval CI 110–183 p = 0006 and 016 for 1 SD increase 003–073 p = 0018 respectively A second cardiovascular model adjusted on Framingham score and the above mentioned confounders showed similar resultsElevated sclerostin serum level and poorer tibia cortical bone structure by HRpQCT were positively and independently associated with higher odds of severe AAC in MHD patients Serum sclerostin may become a biomarker of mineral and bone disorder and vascular risk in MHD patientsThis work was supported by a 2009 educational grant from la Société de Néphrologie We thank Anne Jolivot MD Laurent Juillard MD PhD Hospital Edouard Herriot Lyon France Walid Arkouche MD and nephrologists at AURAL Association pour l’Utilisation du Rein Artificiel de la region Lyonnaise Lyon France for the help in patients recruitment and Pawel Szulc Stéphanie Boutroy and Nicolas Vilayphiou INSERM UMR 1033 Edouard Herriot Hospital Lyon France for teaching AAC score measurement on VFA scans and for teaching the use and interpretation of HRpQCT We also thank Annie Varennes MD Michel Richard MD PhD Simone Arnaud and Christine Fadat Department of Biology Edouard Herriot Hospital Lyon France for their help in laboratory measurements
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