Serum levels of calcification inhibition proteins and coronary artery calcium score: comparison between transplantation and dialysis.
Vascular calcifications in CKD are now linked to serum alterations of both divalent ions and calcification inhibitory proteins. Due to possible biochemical differences between dialysis (D) and transplantation (Tx), we examined the entity and severity of these biochemical modifications and of coronary artery calcium score separately in these two populations. We assayed, besides standard markers of inflammation, divalent ions and serum levels of fetuin, matrix Gla protein (MGP) and osteoprotegerin (OPG), in 51 Tx patients (age 45 +/- 12 years; 30 males, 21 females; previous D duration 4.8 +/- 4.2 years; Tx since 6.6 +/- 5.5 years; Cr 1.8 +/- 0.6 mg/dl) and in 49 D patients (age 49 +/- 14 years; 30 males,19 females; D duration 5.6 +/- 4.8 years). Additionally, coronary calcium score (AS) was evaluated by cardiac multi-slice CT. Compared with D patients, Tx patients had better values of divalent ions and inflammation markers, and lower prevalence (65 vs. 86%; p < 0.02) and severity (AS = 570 +/- 1,637 vs. 1,311 +/- 3,128; p < 0.008) of coronary calcification. In addition, a tendency toward normalization for all of the three calcification inhibitory proteins was evident. In both Tx and D, AS correlated with age and OPG (Tx: r(s) = 0.439, p < 0.001, and r(s) = 0.510, p < 0.0001; D: r(s) = 0.471, p < 0.001, and r(s) = 0.403, p < 0.005, respectively); in D patients, a correlation was present also with D duration (r(s) = 0.435; p < 0.002), other markers of inflammation and, notably, fetuin (r(s) = -0.442; p < 0.002). Regression analysis selected previous time on D in Tx patients (r(m) = 0.400; p < 0.004), and C-reactive protein and OPG in D patients (r(m) = 0.518; p < 0.004) as the most predictive parameters of AS. Discriminant analysis confirmed the major role of age and D duration in the appearance of AS and evidenced male gender as a distinct risk condition. At variance, Tx duration was never associated with AS. In conclusion, as compared to D, renal Tx patients show serum levels of calcification inhibition proteins and of divalent ions closer to normal. As this is associated with a lower prevalence and severity of AS, it is suggested that Tx antagonize the accelerating role of D in the progression of vascular calcification. Assessment of both coronary calcifications and serum levels of calcification inhibitory proteins may be of value to identify those subjects at higher risk of development and progression of vascular lesions, among whom males have the highest rate.
Mazzaferro
Sandro
S
Division of Nephrology, Department of Clinical Science, University of Rome La Sapienza, Rome, Italy. sandro.mazzaferro@uniroma1.it
Pasquali
Marzia
M
Pugliese
Francesco
F
Barresi
Giusi
G
Carbone
Iacopo
I
Francone
Marco
M
Sardella
Daniela
D
Taggi
Franco
F
D015055:1-Carboxyglutamic Acid / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002114:Calcinosis / Q000097:blood* / Q000000981:diagnostic imaging / Q000209:etiology; D002118:Calcium / Q000378:metabolism; D002135:Calcium-Binding Proteins / Q000097:blood*; D003327:Coronary Disease / Q000097:blood* / Q000000981:diagnostic imaging / Q000209:etiology; D004797:Enzyme-Linked Immunosorbent Assay; D016326:Extracellular Matrix Proteins / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000628:therapy; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D053244:Osteoprotegerin / Q000097:blood*; D011379:Prognosis; D006435:Renal Dialysis; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D000509:alpha-Fetoproteins / Q000378:metabolism*; D000097568:Matrix Gla Protein
D015055:1-Carboxyglutamic Acid; D015415:Biomarkers; D002118:Calcium; D002135:Calcium-Binding Proteins; D016326:Extracellular Matrix Proteins; D053244:Osteoprotegerin; D000509:alpha-Fetoproteins; D000097568:Matrix Gla Protein