#6246 PIVKA II IS A BIOMARKER FOR PREDICTING CORONARY CALCIFICATION IN HEMODIALYSIS PATIENTS WITH DIABETES

Abstract

Abstract Background and Aims Vascular calcification (VC) is a commonly occurring and serious complication in end-stage renal disease (ESRD) patients that increases mortality. Vitamin K deficiency is well known to cause the occurrence of VC through the inactivation of Vitamin K dependent proteins (VKDP). Therefore, a marker that can easily predict the risk of VC due to vitamin K deficiency is needed in clinical practice. In this study, we aim to investigate whether the easily measurable vitamin K absence II (PIVKA-II) can serve as a surrogate marker for predicting coronary artery calcification (CAC) in ESRD patients receiving hemodialysis and what factors influence the prediction of CAC. Method This study is an observational study conducted on end-stage renal disease patients receiving hemodialysis treatment. Patients with liver cirrhosis, HCC, or a history of coronary artery disease with stent placement were excluded, as well as patients with active infectious diseases. CAC score was measured by Non-enhanced computed tomography, and before starting hemodialysis, blood samples were collected to measure PIVKA-II, osteocalcin (OC), and bone-specific alkaline phosphatase (BAP) among other bone markers. PIVKA-II was measured two times with 3 months interval, and the average value was calculated. Additionally, ankle-brachial index (ABI) and DEXA bone densitometry were also performed. Results In this study, 69 dialysis patients participated. Among them, 34 patients had diabetes mellitus (DM). The study compared two groups based on the presence of DM. The results showed that patients with DM had higher Body Mass Index (BMI) (p = 0.01) and a higher frequency of vascular diseases such as coronary artery disease or cerebrovascular disease (p = 0.004). The DM group also had higher LDL cholesterol levels (p = 0.03), but there was no significant difference between the two groups in terms of PIVKA-II, BAP, and Osteocalcin levels (Table 1). When analyzing the factors that had a correlation with the CAC score in all 69 patients, LDL cholesterol (r = -0.37, p = 0.002) and CRP (r = 0.28, p = 0.03) were found to have a significant correlation, but PIVKA-II (p = 0.065, Figure 1A), BAP (p = 0.57), and OC (p = 0.45) did not. In the DM group, there was a statistically significant correlation between CAC score and PIVKA-II (r = 0.283, p = 0.001), but there was no correlation between CAC score (Figure 1B) and CaxP, LDL cholesterol, CRP, BAP, and OC (p = 0.7, p = 0.4, p = 0.3, p = 0.7 and p = 0.4 respectively). Conclusion The results suggest that in patients with diabetes who undergo dialysis, PIVKA-II can be clinically useful as a surrogate marker for predicting CAC associated with vitamin K deficiency. This is because diabetic patients may have more pronounced VKDP inactivation and VC due to vitamin K deficiency, but additional research is needed to fully understand this relationship.