NDT Advance Access originally published online on July 2, 2009
Nephrology Dialysis Transplantation 2009 24(11):3389-3397; doi:10.1093/ndt/gfp301
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A cut-off value of plasma osteoprotegerin level may predict the presence of coronary artery calcifications in chronic kidney disease patients
1 Laboratoire de Biochimie, CHRU Montpellier, F-34000 France; Univ Montpellier 1, Montpellier, F-34000 France 2 Institut de Recherche et de Formation en Dialyse, CHRU Montpellier, F-34000 France 3 INSERM, U888, Montpellier, F-34093 France; Univ Montpellier 1, Montpellier, F-34000 France 4 Service de Radiologie, CHRU Montpellier, F-34000 France 5 Service de Réanimation Métabolique, CHRU Montpellier, F-34000 France; Univ Montpellier 1, Montpellier, F-34000 France 6 INSERM, U897, Bordeaux, F-33076 France; Univ Bordeaux 2, Bordeaux, F-33076 France 7 Service de Néphrologie-Hémodialyse et Soins Intensifs, CHRU, Montpellier, F-34000 France; Univ Montpellier 1, Montpellier, F-34000 France
Correspondence and offprint requests to: Jean-Paul Cristol; E-mail: jp-cristol{at}chu-montpellier.fr
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Abstract |
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Background. Expression of bone proteins resulting from transdifferentiation of vascular smooth muscle cells into osteoblasts suggests that vascular calcifications are a bioactive process. Osteoprotegerin (OPG) could play a key role in bone-vascular calcification imbalance and could be a marker of vascular calcification extent and progression. The purpose of this study was to evaluate relationships between vascular risk biomarkers (including classic risk factors and OPG) and coronary artery calcification (CAC) extent in chronic kidney disease (CKD) patients and to establish within the markers the appropriate cut-off value to predict CAC.
Methods. A total of 133 non-dialyzed CKD patients at various stages of kidney disease [75 males/58 females, median age: 69.9 (27.4–94.6)] were enrolled, excluding extrarenal replacement therapy patients. All underwent chest multidetector computed tomography for CAC scoring. Blood samples were collected for measurement of vascular risk markers (kidney disease, inflammation, nutrition, calcium phosphate and OPG). A potential relationship between CAC and these biological markers was investigated, and a receiver-operating characteristic (ROC) curve was designed thereafter to identify a cut-off value of involved markers that best predicted the presence of CAC.
Results. After adjustment for age, diabetes, smoking and gender, among biological markers, only low-estimated glomerular filtration rate using Modification of Diet in Renal Disease [OR = 3.63 (1.10–12.02)], high FEPO4 [OR = 3.99 (1.17–13.6)] and high OPG levels [OR = 8.54 (2.14–34.11)] were associated with the presence of CAC. A protective effect of 1.25(OH)2 vitamin D [OR = 0.20 (0.05–0.79)] and LDL cholesterol [OR = 0.27 (0.08–0.94)] on CAC was also observed. ROC curve analysis showed that the OPG best cut-off value predicting CAC was 757.7 pg/mL.
Conclusion. These results suggest that a CAC increase is strongly associated with a plasma OPG increase in CKD patients. The values of OPG >757.7 pg/mL allow us to predict the presence of CAC in these patients.
Keywords: chronic kidney disease; coronary artery calcification; osteoprotegerin
Received for publication: 24.12.08
Accepted in revised form: 27. 5.09