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Bone mineral density of extremities is associated with coronary calcification and biopsy-verified vascular calcification in living-donor renal transplant recipients

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Abstract

Chronic kidney disease (CKD) mineral and bone disorders (CKD-MBD) may lead to low bone mineral density (BMD) and vascular calcification (VC), but links to the latter are unclear. Here we investigated associations between BMD, coronary artery calcium (CAC) scores, and histological signs of VC in end-stage renal disease (ESRD) patients undergoing living-donor kidney transplantation (LD-Rtx). In 66 ESRD patients (median age 45 years, 68% males), BMD (by dual-energy X-ray absorptiometry, DXA), CAC score (by computed tomography, CT; n = 54), and degree of VC score (graded by histological examination of epigastric artery specimens collected at LD-Rtx; n = 55) were assessed at the time of LD-Rtx. Of the patients, 26% had osteopenia and 7% had osteoporosis. Of those undergoing artery biopsy, 16% had extensive VC, and of those undergoing CT 28% had high CAC score (>100 Agatston units). CAC scores correlated with BMD of legs and pelvis. BMDs of leg and pelvic sub-regions were significantly lower in patients with extensive VC. In multivariate regression analysis adjusted for age and gender, lower BMD of leg sub-region was associated with CAC score >100 AUs and extensive VC, and patients with extensive VC had significantly higher CAC score. Both high CAC and extensive VC were independently predicted by low BMD of legs. Low BMD has the potential to identify ESRD patients at risk of vascular calcification.

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Acknowledgements

We thank the patients who participated in the study. We are grateful to all those who carried out the extensive clinical work (Annika Nilsson, Anki Emmoth, Ulrika Jensen and Åsa Lindé) and laboratory work (Björn Anderstam, Monica Eriksson, and Ann-Christin Bragfors-Helin) in the current study. Zhimin Chen has a scholarship from the China Scholarship Council. Peter Stenvinkel’s research benefited from a Research Grant from Swedish Medical Research Council (VR). The study also benefited from generous support from Martin Rind Foundation (Abdul Rashid Qureshi). Baxter Novum is a result of a Grant from Baxter Healthcare to Karolinska Institutet.

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Authors and Affiliations

  1. Divisions of Renal Medicine and Baxter Novum, Karolinska Institutet, M-99 Karolinska University Hospital, Huddinge, CLINTEC, SE-141 86, Stockholm, Sweden

    Zhimin Chen, Jia Sun, Mathias Haarhaus, Peter Barany, Bengt Lindholm, Annika Wernerson, Peter Stenvinkel & Abdul Rashid Qureshi

  2. Kidney Disease Center, 1st Affiliated Hospital College of Medicine, Zhejiang University, Hangzhou, China

    Zhimin Chen

  3. Transplantation Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden

    Lars Wennberg

  4. Radiology, CLINTEC, Karolinska Institutet, Stockholm, Sweden

    Jonaz Ripsweden & Torkel B. Brismar

  5. Pathology, Drug Safety and Metabolism, AstraZeneca, Mölndal, Sweden

    Magnus Söderberg

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  1. Zhimin Chen
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  2. Jia Sun
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Correspondence to Abdul Rashid Qureshi.

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Dr. Bengt Lindholm is an employee of Baxter Healthcare.

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Chen, Z., Sun, J., Haarhaus, M. et al. Bone mineral density of extremities is associated with coronary calcification and biopsy-verified vascular calcification in living-donor renal transplant recipients. J Bone Miner Metab 35, 536–543 (2017). https://doi.org/10.1007/s00774-016-0788-1

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  • DOI: https://doi.org/10.1007/s00774-016-0788-1

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