Osteoporosis International

, Volume 22, Issue 6, pp 1695–1701

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

  • A. Nakashima
  • J. J. Carrero
  • A. R. Qureshi
  • T. Hirai
  • N. Takasugi
  • T. Ueno
  • Y. Taniguchi
  • B. Lindholm
  • N. Yorioka
Original Article

DOI: 10.1007/s00198-010-1377-0

Cite this article as:
Nakashima, A., Carrero, J., Qureshi, A. et al. Osteoporos Int (2011) 22: 1695. doi:10.1007/s00198-010-1377-0

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.

Keywords

Cardiovascular disease (CVD)Hemodialysis (HD)MortalityOsteoprotegerin (OPG)Pulse wave velocity (PWV)

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2010

Authors and Affiliations

  • A. Nakashima
    • 1
    • 2
  • J. J. Carrero
    • 2
    • 3
  • A. R. Qureshi
    • 2
  • T. Hirai
    • 4
  • N. Takasugi
    • 4
  • T. Ueno
    • 1
  • Y. Taniguchi
    • 5
  • B. Lindholm
    • 2
  • N. Yorioka
    • 1
  1. 1.Department of Advanced Nephrology, Graduate School of Biomedical SciencesHiroshima UniversityHiroshimaJapan
  2. 2.Divisions of Renal Medicine and Baxter Novum, Department of Clinical ScienceIntervention and Technology, Karolinska InstitutetStockholmSweden
  3. 3.Centre for Gender MedicineKarolinska InstitutetStockholmSweden
  4. 4.Department of Internal MedicineHakuai ClinicKureJapan
  5. 5.Division of Clinical Pharmacotherapeutics Department Pharmaceutical ScienceHiroshima International UniversityKureJapan