High parathyroid level, bone loss signal CV risk in patients on dialysis
Elevated parathyroid hormone levels and osteoporosis T-scores predicted progression of coronary artery calcification in patients undergoing dialysis, according to study data published in the Journal of the American Society of Nephrology.
These markers may provide targets for noninvasive tests to predict progression of coronary artery disease in these patients, according to researchers.
In this prospective study, Hartmut H. Malluche, MD, of the University of Kentucky in Lexington, and colleagues enrolled 213 patients with chronic kidney disease undergoing dialysis (CKD-5D); nearly 80% had coronary artery calcification, 50% with Agatston scores greater than 400. At baseline, the following patient blood parameters were measured: serum whole and total parathyroid hormone (PTH), bone-specific alkaline phosphatase, procollagen type 1 N-terminal propeptide, tartrate–resistant acid phosphatase-5b (TRAP5-b), sclerostin, Dickkopf-1, and the novel marker fibroblast growth factor-23. Patients also underwent bone density assessment by DXA and quantitative CT. Coronary artery calcification was measured by multi-slice CT of the heart.
Hartmut H. Malluche
At 1 year, the same measurements were taken for the remaining 122 study participants. Progression of coronary artery calcification (square root volume) was correlated only with baseline TRAP-5b (P = .04) and whole and total PTH levels (P = .02 and P = .02, respectively) and was greater in participants with osteoporosis (7.5 vs. 2.1; P = .001). After adjusting for age, progression of coronary artery calcification was predicted by osteoporosis (P = .002), total PTH above 540 pg/mL (P = .001) and whole PTH greater than 450 pg/mL (P = .003). TRAP-5b did not remain an independent predictor for coronary artery calcification.
“We recommend that clinicians measure PTH to assess not only bone turnover, but also risk of [coronary artery calcification] progression in patients with CKD-5D. This recommendation is easy to implement given PTH measurements are already included in the dialysis bundle payments,” the researchers wrote.
Furthermore, “our results show that osteoporosis diagnosed by DXA is a useful noninvasive tool for predicting [coronary artery calcification] progression with its known associated increased risk for cardiovascular events. This adds a reason for measurement of bone mass in CKD, which has been called for by others.” – by Jill Rollet
Disclosure: The researchers report no relevant financial disclosures.