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Plasma osteoprotegerin, arterial stiffness, and mortality in normoalbuminemic Japanese hemodialysis patients

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Abstract

Summary

A high circulating osteoprotegerin (OPG) level may be a risk factor for vascular calcification and mortality in hemodialysis patients. OPG and pulse wave velocity (PWV) were measured at baseline in 151 normoalbuminemic, long-term (>3 years) Japanese hemodialysis patients who were prospectively followed for 6 years. In long-term normoalbuminemic Japanese hemodialysis patients, OPG levels were strongly linked with both arterial stiffness and worse outcome.

Introduction

A high circulating OPG level is reported to be a risk factor for vascular calcification and mortality in Western chronic kidney disease (CKD) patients but it is not known if this is true for Japanese CKD patients, where a different risk profile may operate.

Methods

OPG and PWV were measured at baseline in 151 normoalbuminemic, long-term (>3 years) Japanese hemodialysis patients (median age 62 years) who were prospectively followed for 6 years.

Results

OPG levels were associated in multivariate analysis with age, dialysis vintage, history of cardiovascular disease (CVD) and parathyroid hormone levels. C-reactive protein levels did not correlate with OPG. Patients with clinical history of CVD had significantly higher OPG levels and OPG levels were positively correlated to PWV, an index of arterial stiffness. These associations were independent of age, sex, dialysis vintage, and diabetes. During the follow-up period, 40 deaths, including 25 cardiovascular deaths, were recorded. In crude analysis, each unit of increase in OPG was associated with increased all-cause (hazard ratios 1.14, 95% confidence interval 1.08–1.20) and CVD mortality (1.14 [1.07–1.21]), which persisted after adjustment for age, sex, dialysis vintage, diabetes, and baseline CVD (1.12 [1.05–1.19] and 1.11 [1.02–1.19], all-cause and CVD mortality, respectively).

Conclusions

In long-term normoalbuminemic Japanese hemodialysis patients, with low prevalence of inflammation, OPG levels were strongly linked with both arterial stiffness and worse outcome.

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Acknowledgments

We would like to thank the patients and personnel involved in the creation of this study at Hakuai Hospital's dialysis unit. Baxter Novum is the result of a grant from Baxter Healthcare to the Karolinska Institutet. JJC is supported by the Loo and Hans Osterman's Foundation and the Swedish Kidney Association.

Conflicts of interest

BL is employed by Baxter Healthcare, Inc. No other author declares a personal or financial conflict of interest.

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Authors and Affiliations

  1. Department of Advanced Nephrology, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi Minami-Ku, Hiroshima, 734-8551, Japan

    A. Nakashima, T. Ueno & N. Yorioka

  2. Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden

    A. Nakashima, J. J. Carrero, A. R. Qureshi & B. Lindholm

  3. Centre for Gender Medicine, Karolinska Institutet, Stockholm, Sweden

    J. J. Carrero

  4. Department of Internal Medicine, Hakuai Clinic, Kure, Japan

    T. Hirai & N. Takasugi

  5. Division of Clinical Pharmacotherapeutics Department Pharmaceutical Science, Hiroshima International University, Kure, Japan

    Y. Taniguchi

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  1. A. Nakashima
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  2. J. J. Carrero
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  9. N. Yorioka
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Correspondence to A. Nakashima.

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Nakashima, A., Carrero, J., Qureshi, A. et al. Plasma osteoprotegerin, arterial stiffness, and mortality in normoalbuminemic Japanese hemodialysis patients. Osteoporos Int 22, 1695–1701 (2011). https://doi.org/10.1007/s00198-010-1377-0

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  • DOI: https://doi.org/10.1007/s00198-010-1377-0

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