Elevated osteoprotegerin is associated with all-cause mortality in CKD stage 4 and 5 patients in addition to vascular calcification
Elevated osteoprotegerin is associated with all-cause mortality in CKD stage 4 and 5 patients in addition to vascular calcification
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DOI：
10.1093/ndt/gfp253
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发表时间：
2009-10-01
影响因子：
6.1
通讯作者：
McIntyre, Chris W.
中科院分区：
文献类型：
--
作者：
Sigrist, Mhairi K.;Levin, Adeera;McIntyre, Chris W.
背景心血管疾病是慢性肾病（CKD）人群的主要死亡原因。血管损伤的机制尚未完全了解。本研究的目的是前瞻性地研究血管损伤的新介质，结合血管钙化（VC），对生存的重要性。共研究了134例受试者[60例血液透析（HD）、28例腹膜透析（PD）和46例CKD 4期]。所有幸存者均完成了40个月的随访。用多层螺旋CT测量股浅动脉的VC。除标准临床生化分析外，还检测了循环骨保护素（OPG）、胎球蛋白A（Fetuin-A）和高敏C反应蛋白（hs-CRP）。经过40个月的随访，31名患者死亡（27名男性和4名女性）。在31名受试者中，31名有明显的VC证据。大部分死亡发生在HD组（48%），36%为PD受试者，16%为CKD受试者。关注的结局是随访结束时的生存率。多因素Logistic回归分析显示男性[OR 8.06（1.34-48.450）P = 0.02]、OPG > 25 pmol/L [OR 5.31（1.35-20.88）P = 0.02]和低白蛋白血症[OR 0.26（0.12-0.56）P < 0.01]与死亡率增加相关。我们以前曾报道，VC和低白蛋白可预测CKD 4期和5期患者在2年随访期内的死亡。这些数据表明，OPG，独立于CRP，也与阴性结果相关。其机制仍有待阐明;然而，它们可能通过除VC之外的机制与血管损伤相关。
Background. Cardiovascular disease is the leading cause of death in the chronic kidney disease (CKD) population. The mechanisms of vascular damage are not fully understood. The objective of this study was to prospectively investigate the importance of novel mediators of vascular damage, in conjunction with vascular calcification (VC), on survival.Methods. A total of 134 subjects [60 haemodialysis (HD), 28 peritoneal dialysis (PD) and 46 CKD stage 4] were studied. All survivors completed 40 months of follow-up. VC was measured using multi-slice spiral CT of the superficial femoral artery. Circulating osteoprotegerin (OPG), Fetuin-A and high sensitivity C-reactive protein (hs-CRP) were measured in addition to standard clinical biochemical analysis.Results. After a 40-month follow-up, 31 patients had died (27 men and 4 women). Of 31 subjects, 31 had evidence of significant VC. The majority of deaths were in the HD group (48%), 36% were PD subjects and 16% were CKD subjects. The outcome of interest was survival at the end of follow-up. Multivariate logistical regression analysis revealed male gender [OR 8.06 (1.34-48.450) P = 0.02], OPG > 25 pmol/L [OR 5.31(1.35-20.88) P = 0.02] and hypoalbuminaemia [OR 0.26 (0.12-0.56) P < 0.01], were associated with increased odds of death.Conclusion. We have previously reported that VC and low albumin predict death in CKD stages 4 and 5 over a 2-year follow-up period. These data show that OPG, independent of CRP, is also associated with a negative outcome. The mechanisms remain to be elucidated; however, it is likely that they are associated with vascular damage through mechanisms in addition to VC.