Relation of wnt-signaling antagonist sclerostin to valvular calcification and carotid intimal-medial thickness in hemodialysis patients

Abstract

Introduction Sclerostin (Scl) is a Wnt pathway antagonist and is considered to have a role in the bone-vascular axis in patients with chronic kidney disease. However, there is a paucity of data on the relation of circulating serum Scl and valvular calcifications (VCs) in chronic kidney disease and hemodialysis (HD) patients. The present study aimed to evaluate the relationship between serum Scl level and cardiac valve calcification (CVC) as well as carotid intimal-medial thickness (CIMT) in HD patients. Patients and methods This cross-sectional study included 75 HD patients in Mansoura Nephrology and Dialysis Unit. Patients with age older than 75 years, rheumatic valvular disease, cardiomyopathy, prosthetic valves, ischemic heart disease, and carotid artery surgery were excluded. Echocardiogram calcification scores were used to assess the degree of aortic and mitral valve calcification. CIMT was measured using B-mode ultrasonography. Patients’ basic clinical and biochemical data were recorded. Serum Scl level was measured using commercially available enzyme-linked immunosorbent assay kits before HD sessions. Results CIMT (>0.9 mm) was present in 68% of the patients. Double-valve calcification (aortic and mitral) was present in 72% of the patients and 21.3% of the patients had single-valve calcification. Serum Scl level was significantly higher in studied HD patients than normal healthy control (P=0.05). There was a significant negative correlation between serum Scl level and degree of cardiac valve calcification as well as with CIMT. Multiple linear regression analysis revealed that age was the strongest predictor for CIMT in HD patients. Conclusion Cardiac valve calcification and increased CIMT were prevalent in HD patients. Serum Scl level was strongly related to both CVC and CIMT, and it may be considered as one of the calcification modulators in HD patients.