Vitamin D receptor gene, biochemical bone markers and bone mineral density in Mexican women on dialysis.
BACKGROUND
The influence of the Bsm1 polymorphism of the vitamin D receptor (VDR) gene on mineral and bone disorders in chronic kidney disease (CKD) is still under discussion. The aim of this study was to analyse the relationship between VDR polymorphism, bone mineral density (BMD), biochemical bone markers and clinical factors in women on peritoneal dialysis (PD) and haemodialysis (HD).


METHODS
In a cross-sectional study, 197 women (42 +/- 10 years; 25% with diabetes mellitus (DM); body mass index (BMI) 25.26 +/- 4.77 kg/m(2)) treated by PD (72%) or HD (28%) underwent measurements of BMD (measured at the calcaneus by quantitative ultrasound; expressed as T- and Z-scores) and plasma total calcium (tCa), intact parathyroid hormone 1-84 (iPTH), phosphorus, albumin, glucose, osteoprotegerin (OPG), fetuin-A, intact osteocalcin-49 and N-MID fragment 1-43 aa (N-MID osteocalcin) N-terminal propeptide of type 1 procollagen (PINP) and C-terminal telopeptide-beta aspartic acid (BCL). DNA was extracted from peripheral blood. PCR products were digested with Bsm1 to analyse VDR polymorphism.


RESULTS
The Z-score of BMD was -1.1 +/- 1.03. According to the values of osteopenia (T-score = -1.0), patients with higher BMD were younger, had lower frequency of amenorrhoea and diabetes and had higher serum creatinine and fetuin levels as well as lower levels of PINP. In a stepwise multivariate logistics analysis, osteopenia was associated with presence of genotype BB+Bb (OR = 3.26, P < or = 0.003) and age (OR = 0.95, P = 0.050). According to the B allele, bb: n = 126 (64%) and BB+Bb: n = 71(36%), group bb had significantly higher mean Z-scores (-0.97 +/- 1.0 vs -1.3+/-0.92; P < or = 0.021).


CONCLUSIONS
The high frequency of osteopenia observed in female CKD patients on dialysis is associated with age and genetic predisposition as revealed by its association to the Bsm1 VDR polymorphism.
Avila
Marcela
M
Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, CMN SXXI, Instituto Mexicano del Seguro Social, México City, México. cramav@yahoo.com.mx
Prado
Carmen
C
Ventura
María-de-Jesús
MD
Mora
Carmen
C
Briones
Daniel
D
Valdez
Hilda
H
Hurtado
Maria Elena
ME
Lindholm
Bengt
B
Qureshi
Abdul
A
Castillo-Henkel
Carlos
C
Paniagua
Ramón
R
D000328:Adult; D000367:Age Factors; D015415:Biomarkers / Q000097:blood; D015519:Bone Density / Q000502:physiology*; D001851:Bone Diseases, Metabolic / Q000453:epidemiology / Q000235:genetics; D001842:Bone and Bones / Q000378:metabolism*; D002118:Calcium / Q000097:blood; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D005260:Female; D020022:Genetic Predisposition to Disease / Q000235:genetics; D006801:Humans; D007674:Kidney Diseases / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*; D008800:Mexico; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D010530:Peritoneal Dialysis; D010710:Phosphates / Q000097:blood; D011110:Polymorphism, Genetic / Q000235:genetics; D015995:Prevalence; D018167:Receptors, Calcitriol / Q000235:genetics*; D006435:Renal Dialysis
D015415:Biomarkers; D010281:Parathyroid Hormone; D010710:Phosphates; D018167:Receptors, Calcitriol; D002118:Calcium