Abstract: SA-PO852

Bone Turnover in Patients with Calcific Uremic Arteriolopathy

Session Information

  • Vascular Calcification
    November 04, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Mineral Disease

  • 1205 Vascular Calcification

Authors

  • Nigwekar, Sagar U., Massachusetts General Hospital, Boston, Massachusetts, United States
  • Hymes, Jeffrey L., Fresenius Medical Care, Waltham, Massachusetts, United States
  • Rondeau, Diane M, Fresenius Medical Care, Waltham, Massachusetts, United States
  • Maddux, Franklin W., Fresenius Medical Care, Waltham, Massachusetts, United States
  • Thadhani, Ravi I., Massachusetts General Hospital, Boston, Massachusetts, United States
Background

Calcific uremic arteriolopathy (CUA) is an arteriolar calcification disorder with no effective treatment. Investigation of links between bone and vascular health in ESRD has largely focused on arterial calcifications; however the relationship between bone turnover and CUA is not well studied.

Methods

We examined the prevalence of bone turnover categories at hemodialysis (HD) initiation in patients who subsequently developed CUA. Bone turnover categories were defined by intact parathyroid hormone (iPTH) and alkaline phosphatase (ALK): high turnover if iPTH is >323 pg/mL and ALK>80 U/L; low turnover if iPTH is <103 pg/mL and ALK <25 U/L. We compared the prevalence of bone turnover categories between CUA patients and age, sex, and race matched controls. Univariate and multivariable logistic regression analyses were performed.

Results

We analyzed data from 1,030 CUA cases and 2,060 controls. High bone turnover at HD initiation was present in 8% of patients and low turnover in 9% of patients who subsequently developed CUA. Among controls, the prevalence of high bone turnover was 3% and of low turnover was 4%, both lower than in CUA patients (p<0.001). Both high and low bone turnover at HD initiation were associated with increased odds of subsequent CUA development in univariate and multivariable analyses adjusted for diabetes mellitus, obesity, and warfarin [figure].

Conclusion

The association between bone turnover at HD initiation and subsequent CUA development is U-shaped. Confirmation in future studies that apply bone biopsies will pave the way for targeted therapeutics to prevent/treat CUA (e.g. bisphosphonates, RANKL inhibitors for high turnover and teriparatide for low turnover).

Risk of subsequent CUA development is increased in patients with low and high bone turnover at dialysis initiation

Funding

  • Private Foundation Support