Abstract: SA-PO143

Osteoprotegerin Is a Strong Independent Marker of Cardiovascular Mortality in Patients with CKD Stage 3 to 5

Session Information

Category: Nutrition, Inflammation, and Metabolism

  • 1401 Nutrition, Inflammation, Metabolism

Authors

  • Nascimento, Marcelo M., Hospital de Clinicas, Curitiba, Brazil
  • Marques, Gustavo Lenci, Hospital de Clinicas, Curitiba, Paraná, Brazil
  • Hayashi, Shirley, Royal Institute of Technology (KTH), Huddinge, Sweden
  • Bjällmark, Anna, Royal Institute of Technology (KTH), Huddinge, Sweden
  • Larsson, Matilda, Royal Institute of Technology (KTH), Huddinge, Sweden
  • Riella, Miguel C., Evangelic School of Medicine of Parana,Curitiba,Brazil, Curitiba, Paraná, Brazil
  • Lindholm, Bengt, Karolinska Institutet, Stockholm, Sweden
Background

Osteoprotegerin (OPG) regulates bone mass by inhibiting osteoclast differentiation and activation, and might play a role in vascular calcification. Increased levels of circulating OPG in patients with chronic kidney disease (CKD) have been reported to be associated with both aortic calcification and increased mortality. Here we assessed the mortality predictive role of OPG in CKD stage 3-5 patients followed for up to 5 years.

Methods

We evaluated the relationship between OPG and mortality (general and due to cardiovascular cause) in 143 CKD patients including 36 patients on hemodialysis, 55 patients on peritoneal dialysis, and 52 conservatively treated patients with CKD stages 3-5. Clinical characteristics, markers of mineral metabolism (including fibroblast growth factor-23 [FGF-23]), inflammation (high-sensitivity C-reactive protein [hsCRP] and interleukin-6 [IL-6]), intima-media thickness (IMT) in the common carotid arteries as assessed by ultrasound, and cardiac status by color tissue Doppler echocardiography, were measured at baseline, and correlations with OPG levels were analyzed.

Results

OPG levels were positively associated with IL-6 (r = 0.44, P<0.01), FGF-23 (r = 0.26, P<0.01) and hsCRP (r = 0.27, P<0.01), troponin I (r = 0.55, P<0.01) and IMT (r = 0.39, P<0.01), as well as with higher left ventricular mass. After 60 months follow-up, the survival rate by Kaplan-Meier analysis was significantly worse in those with higher baseline OPG levels for all cause as well as cardiovascular mortality (both Chi-Square: 15.60 p<0.0001). The Cox model for all cause and cardiovascular mortality demonstrated that only OPG (per pg/mL; HR=1.07, 95%CI=1.02-1.13, and HR=4.46, 95%CI=1.4-13.5, respectively) and hsCRP (per mg/dL; HR=1.02, 95%CI=1.01-1.04, and HR=5.71, 95%CI=1.17-27.9, respectively) were independently associated with increased all-cause and cardiovascular risk of death, respectively.

Conclusion

Elevated levels of serum OPG associate with markers of inflammation and mineral metabolism, signs of atherosclerosis and cardiovascular deaths in patients with CKD stage 3-5. OPG is a strong independent predictor of cardiovascular mortality in this patient population.

Funding

  • Commercial Support