ஜர்னல் ஆஃப் நெப்ராலஜி & தெரபியூட்டிக்ஸ்

Serum Bone Markers and Coronary Artery Calcification in End Stage Renal Failure Patients and Kidney Transplant Recipients

Abstract

Tanja Celic*,Josip Spanjol,Antun Grskovic,Melita Kukuljan,Sanjin Racki,Tomislav Kurelac,Ivana Marić,Dragica Bobinac

Background: Variety of growth factors and cytokines are involved in the process of bone turnover. Evidences are showing that alterations in OPG/RANK/RANKL system form the basis of many metabolic diseases. So, we evaluated the relationship between OPG and RANKL levels, to establish a possible relationship with other bone markers and coronary artery calcification.
Methods: Patients with chronic kidney disease and patients during the first year after transplantation had coronary artery scan and their blood was analyzed for serum bone markers. The following serum markers were measured: OPG, RANKL, BAP, TRAP5b and iPTH.
Results: All measured bone markers values increased with the disease progression and return to normal values during the first year after transplantation. Serum values of OPG, BAP, TRAP5b and iPTH are influenced by gender, age and dialysis duration. There is a significant negative correlation between PTH and OPG, and positive between PTH, BAP and TRAP5b values. No correlation between OPG and sRANKL, or OPG/sRANKL levels with other tested markers was found. In multivariate analysis of CACS revealed that OPG is significantly correlated with calcification in entire study population. Conclusions: This study shows that increased bone turnover markers are present in chronic kidney disease but mainly depending on gender, age and dialysis duration. The effects of those factors are overridden by glucocorticoids effect in transplanted patients. The correlation of OPG with arterial calcification presents it as a possible calcification marker. This is the first study on bone metabolism that covered Chronic Kidney Disease (CKD) patients, both predialysed and hemodialysed, as well as kidney transplant recipients. Results of our study demonstrate that serum levels of all investigated bone markers as well as calcification of coronary arteries are increased during CKD, with highest measured values in HD population.