title: Coronary calcifications in end-stage renal disease patients: a new link between osteoprotegerin, diabetes and body mass index?
abstract: The aim of the study was to assess the factors potentially involved in coronary artery calcifications (CAC) in end-stage renal disease patients. 253 hemodialysis (HD) patients (92 females, 161 males), aged 62.5 +/- 13.5, who had been on HD treatment for at least 6 months, were enrolled in a cross-sectional study. Calcium-phosphate product (Ca x P), body mass index (BMI), fetuin-A, osteoprotegerin (OPG), osteopontin, transforming growth factor-beta1 (TGF-beta1), fibroblast growth factor-23 (FGF-23) and matrix Gla protein (MGP) were considered. CAC was assessed using multislice spiral computed tomography and calcium score was quantified by means of the Agatston score. The median calcium score was 364 Agatston (range 0-7,336). CAC was detected in 228/253 patients (90.1%). Multivariate regression analysis, adjusted for age and for dialysis vintage, showed that TGF-beta1, OPG and days with Ca x P >55 mg/dl are independent predictors of CAC, while MGP was shown to be a protective factor. Surprisingly, results showed that BMI was a protective factor too: the interpolation with cubic spline function revealed a significant reduction in calcium score in patients with a high BMI (>28). However, when diabetes was considered in the regression analysis, only OPG emerged as a predictor of a high CAC score. The interpolation with spline function continued to show a significant reduction in CAC score in nondiabetic and in diabetic patients with the highest BMI quartile. The protective effect of a high BMI on CAC might represent another example of inverse biology in dialysis patients but it needs to be further addressed in larger longitudinal studies.
authors.affiliation: Nephrology Dialysis and Renal Transplantation Unit, S. Orsola University Hospital, University of Bologna, Bologna, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cianciolo
authors.forename: Gaetano
authors.initials: G
authors.lastname: La Manna
authors.forename: Gabriele
authors.initials: G
authors.lastname: Donati
authors.forename: Elisa
authors.initials: E
authors.lastname: Persici
authors.forename: Ada
authors.initials: A
authors.lastname: Dormi
authors.forename: Maria Laura
authors.initials: ML
authors.lastname: Cappuccilli
authors.forename: Serena
authors.initials: S
authors.lastname: Corsini
authors.forename: Rossella
authors.initials: R
authors.lastname: Fattori
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Russo
authors.forename: Valentina
authors.initials: V
authors.lastname: Nastasi
authors.forename: Luigi
authors.initials: L
authors.lastname: Colì
authors.forename: Marylou
authors.initials: M
authors.lastname: Wratten
authors.forename: Sergio
authors.initials: S
authors.lastname: Stefoni
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D002114:Calcinosis / Q000209:etiology*; D002118:Calcium / Q000378:metabolism; D009202:Cardiomyopathies / Q000209:etiology*; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000503:physiopathology*; D005260:Female; D000089703:Fibroblast Growth Factor-23; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D053244:Osteoprotegerin / Q000502:physiology*; D053773:Transforming Growth Factor beta1 / Q000502:physiology
chemical_list: C000717427:FGF23 protein, human; D053244:Osteoprotegerin; D053773:Transforming Growth Factor beta1; D000089703:Fibroblast Growth Factor-23; D002118:Calcium