Calcaneal Osteopenia Is a New Marker for Arterial Stiffness in Chronic Hemodialysis Patients

Abstract

Background: A high frequency of simultaneous low estimated bone mineral density (BMD) and atherosclerotic vascular disease is found in chronic dialysis patients. The degree of BMD may be closely related to the severity of atherosclerosis in dialysis patients. The purpose of this study was to determine the association of estimated BMD with severity of atherosclerosis using popular economical non-invasive strategies in chronic dialysis patients. Methods: This cross-sectional design study included 58 subjects receiving maintenance hemodialysis (HD) therapy. The mean age was 68 ± 12 years (range 39–93), 22 subjects were female, and 26 subjects (45%) had diabetic nephropathy. The brachial-ankle pulse wave velocity (baPWV) and estimated BMD, using calcaneal quantitative ultrasound measurements of the osteo-sono index (OSI) were measured in all of the subjects. Results: The mean levels of OSI and baPWV were 2.3 ± 0.3 and 21 ± 5 m/s, respectively. Based on single variable regression analysis, the C-reactive protein concentration correlated with baPWV (r = 0.272, p = 0.039), and the serum albumin concentration was inversely correlated with baPWV (r = –0.318, p = 0.015). In addition, OSI had a strong negative correlation with baPWV (r = –0.470, p = 0.0002). To identify the independent factors correlating with baPWV, multivariate regression analysis was performed using confounding variables which had significant association in univariate analysis. OSI and diabetic nephropathy were found to be significant independent parameters. Conclusion: Calcaneal OSI, a surrogate marker for estimated BMD, has a strong ability to predict the severity of arterial stiffness independent of classical risk factors and markers of inflammation and malnutrition.