Kidney Week

Abstract: PO0405

Bone-Derived Hormones, Mineral Metabolism, Cardiovascular Disease, and Patient Survival in ESRD

Session Information

• Calcified Tissues in Kidney Diseases
  October 22, 2020 | Location: On-Demand
  Abstract Time: 10:00 AM - 12:00 PM

Category: Bone and Mineral Metabolism

• 402 Bone and Mineral Metabolism: Clinical

Authors

• Ferreira, Ana Carina, Hospital Curry Cabral, Lisboa, Lisboa, Portugal

Ana Carina Ferreira,

• Mendes, Marco, Hospital Curry Cabral, Lisboa, Lisboa, Portugal

Marco Mendes,

• Silva, Cecilia, Hospital Curry Cabral, Lisboa, Lisboa, Portugal

Cecilia Silva,

• Cotovio, Patrícia, Hospital Curry Cabral, Lisboa, Lisboa, Portugal

Patrícia Cotovio,

• Aires, Ines, Hospital Curry Cabral, Lisboa, Lisboa, Portugal

Ines Aires,

• Navarro, David, Hospital Curry Cabral, Lisboa, Lisboa, Portugal

David Navarro,

• Pereira, Fernando Caeiro, Hospital Curry Cabral, Lisboa, Lisboa, Portugal

Fernando Caeiro Pereira,

• Salvador, Rute Maria Silva, Nova Medical School, Lisboa, Lisboa, Portugal

Rute Maria Silva Salvador,

• Correia, Bruna F., Nova Medical School, Lisboa, Lisboa, Portugal

Bruna F. Correia,

• Cabral, M. Guadalupe, Nova Medical School, Lisboa, Lisboa, Portugal

M. Guadalupe Cabral,

• Nolasco, Fernando E B, Hospital Curry Cabral, Lisboa, Lisboa, Portugal

Fernando E B Nolasco,

• Ferreira, Manuel A., Hospital Curry Cabral, Lisboa, Lisboa, Portugal

Manuel A. Ferreira,

Background

The aim of this study was to analyse the associations between chronic kidney disease-mineral and bone disorder (CKD-MBD) players [alpha-klotho, fibroblast grow factor (FGF) 23, sclerostin, parathyroid hormone (PTH), bone alkaline phosphatase (bAP), vitamin D (vitD), phosphorus (Pi), Calcium (Ca) and Magnesium (Mg)], and echocardiographic findings [left ventricular mass index (LVMI) measured by Devereux formula, valvular calcifications], vascular calcifications and patients (pts) outcomes.

Methods

We performed a prospective cohort study of a sample of ESRD pts listed for renal transplant. All pts were submitted to renal transplant and were followed for 12 months. Patient and graft survival were recorded. At inclusion, demographic and clinical data were collected, laboratory evaluation, bone biopsy and X-ray of the pelvis and hands (Adragão score) were performed. Associations between variables were performed using Wilcoxon rank sum test and Spearman correlation test. STATA software was used and p < 0.05 was considered statistically significant.

Results

We included 85 pts. Mean age 50.1±12.7 years, 59 men (69.4%), 66 caucasian (77.6%). The median LVMI was 108.5 (92 – 129) g/m², with 32 patients presenting LVH and 19 valvular calcifications. Median Adragão score was 1 (0 – 2). At the end of 12 months, 4 pts died and 5 had graft failure (non-primary function).

Alpha-klotho correlated with bAP (p=0.0006) and marginally with PTH and absence of valvular calcifications (p=0.05). FGF23 correlated with Pi (p<0.001), Ca (p=0.004), PTH (p=0.003), Mg (p=0.002), and inversely with bAP (p=0.003), and presented a marginal association with Adragão score (p=0.06). We didn’t find correlations between FGF23 and alpha-klotho or dialysis vintage or echocardiographic characteristics.
Sclerostin correlated negatively with bAP (p=0.007) and PTH (p=0.04). The 3^rd sclerostin tertile was associated with high scores of vascular calcifications (p=0.02). Lower levels of sclerostin were associated with pt survival at the end of 12 months (p=0.02).

Conclusion

Sclerostin, a bone formation inhibitor, seems to act as a risk factor for vascular calcifications and worse outcomes.