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Kidney Week

Abstract: FR-PO316

Mineral and Bone Biomarkers Associate with Adverse Cardiovascular Outcomes and Mortality Within the German Chronic Kidney Disease (GCKD) Cohort

Session Information

Category: Bone and Mineral Metabolism

  • 502 Bone and Mineral Metabolism: Clinical

Authors

  • Reimer, Katharina Charlotte, University Hospital Aachen, Division of Nephrology and Clinical Immunology, Aachen, Germany
  • Nadal, Jennifer, Institute of Medical Biometry, Informatics and Epidemiology, University Hospital of Bonn, Bonn, Germany
  • Meiselbach, Heike, Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nuernberg, Erlangen, Germany
  • Schultheiss, Ulla T., Institute of Genetic Epidemiology, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
  • Stockmann, Helena, Department of Nephrology and Medical Intensive Care, Charité – Universitätsmedizin Berlin, Berlin, Germany
  • Nauck, Matthias, Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
  • Krane, Vera, Department of Medicine I, Division of Nephrology, University Hospital Wuerzburg, Wuerzburg, Germany
  • Eckardt, Kai-Uwe, Department of Nephrology and Medical Intensive Care, Charité – Universitätsmedizin Berlin, Berlin, Germany
  • Schneider, Markus P., Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nuernberg, Erlangen, Germany
  • Floege, Jürgen, University Hospital Aachen, Division of Nephrology and Clinical Immunology, Aachen, Germany
  • Saritas, Turgay, University Hospital Aachen, Division of Nephrology and Clinical Immunology, Aachen, Germany
Background

Mineral and bone disorders (MBD) in chronic kidney disease (CKD) are tightly linked to cardiovascular disease. This study aimed to compare prognostic information of nine MBD biomarkers to determine those associating best with adverse cardiovascular (CV) outcomes and mortality in pre-dialysis CKD.

Methods

In 5217 participants of the German CKD (GCKD) study, enrolled for glomerular filtration rate (GFR) between 30-60 ml/min/1.73m2 or overt proteinuria, serum osteoprotegerin (OPG), fibroblast growth factor 23 (FGF23), intact parathyroid hormone (iPTH), bone alkaline phosphatase (BAP), cross-linked C-telopeptide of type 1 collagen (CTX1), procollagen 1 intact N-terminal protein (P1NP), phosphate, calcium, and 25-OH vitamin D were measured at baseline. Participants with missing values among these parameters (N = 971) were excluded. Hazard ratios (HRs) for associations of OPG, FGF23, iPTH, BAP, CTX1, P1NP, phosphate, calcium, and 25-OH vitamin D each alone and in combination, with 1) CV death, 2) non-CV death, 3) combined major adverse CV events (non-fatal MACE), and 4) hospitalization for congestive heart failure (CHF) were estimated using Cox regression analyses adjusted for major clinical risk factors for CKD.

Results

During a median follow-up of 6.5 years, 385 non-CV deaths, 173 CV deaths, 643 non-fatal major adverse CV events (MACE) and 367 hospitalizations for congestive heart failure (CHF) were observed among 4246 participants. OPG and FGF23 were associated with all outcomes, with the highest hazard ratios (HRs) for OPG. In the final Cox regression model, adjusted for CV risk factors and all other investigated biomarkers, every standard deviation increase of OPG was associated with non-CV death (HR 1.84, 95%CI 1.41-2.40), CV death (HR 2.33, 95%CI 1.61-3.38), MACE (HR 1.42, 95%CI 1.15-1.76) and hospitalization for CHF (HR 2.13, 95%CI 1.62-2.79).

Conclusion

Out of the nine biomarkers examined, stratification based on serum OPG identified CKD patients best who were at highest risk for any adverse CV outcome and mortality.