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NDT Advance Access first published online on May 1, 2008
This version published online on May 13, 2008
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfn242
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© The Author [2008]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Serum osteoprotegerin level, carotid-femoral pulse wave velocity and cardiovascular survival in haemodialysis patients

Gábor Speer1,*, Bertalan Cs. Fekete1,*, Taha El Hadj Othmane1,*, Tamás Szabó2, József Egresits1,3, Erzsébet Fodor2, István Kiss2,3, Alexander G. Logan4, János Nemcsik2, András Szabó1, Zsófia K. Németh1, Miklós Szathmári1 and András Tislér1,2

1 1st Department of Medicine, Semmelweis University Budapest 2 B. Braun Avitum Nephrological Network 3 Division of Angiology and Nephrology, Department of Medicine, St Imre Teaching Hospital, Budapest, Hungary 4 Samuel Lunenfeld Research Institute, University of Toronto, Toronto, Canada

Correspondence and offprint requests to: Gabor Speer, 1st Department of Medicine, Semmelweis University Budapest, 2/a Korányi S. u., Budapest, H-1083, Hungary. Tel: +36-30-9679-144; Fax: +36-1-313-0250; E-mail: speerga{at}bel1.sote.hu



  Abstract

Background. Osteoprotegerin (OPG) is a marker and regulator of arterial calcification, and it is related to cardiovascular survival in haemodialysis patients. The link between OPG and aortic stiffening—a consequence of arterial calcification—has not been previously evaluated in this population, and it is not known whether OPG-related mortality risk is mediated by arterial stiffening.

Methods. At baseline, OPG and aortic pulse wave velocity (PWV) were measured in 98 chronic haemodialysis patients who were followed for a median of 24 months. The relationship between OPG and PWV was assessed by multivariate linear regression. The role of PWV in mediating OPG related cardiovascular mortality was evaluated by including both OPG and PWV in the same survival model.

Results. At baseline mean (standard deviation) PWV was 11.2 (3.3) m/s and median OPG (interquartile range) was 11.1 (7.5–15.9) pmol/L. There was a strong, positive, linear relationship between PWV and lnOPG (P = 0.009, model R2 = 0.540) independent of covariates. During follow-up 23 patients died of cardiovascular causes. In separate univariate survival models both PWV and lnOPG were related to cardiovascular mortality [hazard ratios 1.31 (1.14–1.50) and 8.96 (3.07–26.16), respectively]. When both PWV and lnOPG were entered into the same model, only lnOPG remained significantly associated with cardiovascular mortality [hazard ratio 1.11 (0.93–1.33) and 7.18 (1.89–27.25), respectively).

Conclusion. In haemodialysis patients OPG is strongly related to PWV and OPG related cardiovascular mortality risk is, in part, mediated by increased PWV.

Keywords: cardiovascular mortality; osteoprotegerin; pulse wave velocity; vascular calcification

* These authors contributed equally to this work and are considered first authors.

Received for publication: 30. 1.08
Accepted in revised form: 8. 4.08


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