Abstract

BackgroundOsteoprotegerin (OPG) and fibroblast growth factor-23 (FGF23) are recognized as strong risk factors of vascular calcifications in non dialysis chronic kidney disease (ND-CKD) patients. The aim of this study was to investigate the relationships between FGF23, OPG, and coronary artery calcifications (CAC) in this population and to attempt identification of the most powerful biomarker of CAC: FGF23? OPG?Methodology/Principal Findings195 ND-CKD patients (112 males/83 females, 70.8 [27.4–94.6] years) were enrolled in this cross-sectional study. All underwent chest multidetector computed tomography for CAC scoring. Vascular risk markers including FGF23 and OPG were measured. Logistic regression analyses were used to study the potential relationships between CAC and these markers.The fully adjusted-univariate analysis clearly showed high OPG (≥10.71 pmol/L) as the only variable significantly associated with moderate CAC ([100–400[) (OR = 2.73 [1.03;7.26]; p = 0.04). Such association failed to persist for CAC scoring higher than 400. Indeed, severe CAC was only associated with high phosphate fractional excretion (FEPO4) (≥38.71%) (OR = 5.47 [1.76;17.0]; p = 0.003) and high FGF23 (≥173.30 RU/mL) (OR = 5.40 [1.91;15.3]; p = 0.002). In addition, the risk to present severe CAC when FGF23 level was high was not significantly different when OPG was normal or high. Conversely, the risk to present moderate CAC when OPG level was high was not significantly different when FGF23 was normal or high.ConclusionsOur results strongly suggest that OPG is associated to moderate CAC while FGF23 rather represents a biomarker of severe CAC in ND-CKD patients.

Highlights

  • Coronary artery calcifications (CAC) are recognized as a strong predictor of all-cause and cardiovascular mortality in hemodialysis (HD) patients [1]

  • Severe CAC was only associated with high phosphate fractional excretion (FEPO4) ($38.71%) (OR = 5.47 [1.76;17.0]; p = 0.003) and high fibroblast growth factor-23 (FGF23) ($173.30 RU/mL) (OR = 5.40 [1.91;15.3]; p = 0.002)

  • Our results strongly suggest that OPG is associated to moderate CAC while FGF23 rather represents a biomarker of severe CAC in non dialysis chronic kidney disease (ND-chronic kidney disease (CKD)) patients

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Summary

Introduction

Coronary artery calcifications (CAC) are recognized as a strong predictor of all-cause and cardiovascular mortality in hemodialysis (HD) patients [1]. Recent studies provide strong evidence for the risk of death with a high CAC score in chronic kidney disease (CKD) patients before onset of dialysis [2,3]. OPG is a bone regulating protein belonging to the TNF receptor superfamily. RANKL and OPG are produced by bone marrow derived stromal cells and osteoblasts and are regulated by various calcitropic cytokines, hormones, and drugs. Osteoprotegerin (OPG) and fibroblast growth factor-23 (FGF23) are recognized as strong risk factors of vascular calcifications in non dialysis chronic kidney disease (ND-CKD) patients. The aim of this study was to investigate the relationships between FGF23, OPG, and coronary artery calcifications (CAC) in this population and to attempt identification of the most powerful biomarker of CAC: FGF23? OPG?

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