title: Plasma osteoprotegerin, arterial stiffness, and mortality in normoalbuminemic Japanese hemodialysis patients.
abstract: A high circulating osteoprotegerin (OPG) level may be a risk factor for vascular calcification and mortality in hemodialysis patients. OPG and pulse wave velocity (PWV) were measured at baseline in 151 normoalbuminemic, long-term (>3 years) Japanese hemodialysis patients who were prospectively followed for 6 years. In long-term normoalbuminemic Japanese hemodialysis patients, OPG levels were strongly linked with both arterial stiffness and worse outcome.
  
  
  BACKGROUND
  A high circulating OPG level is reported to be a risk factor for vascular calcification and mortality in Western chronic kidney disease (CKD) patients but it is not known if this is true for Japanese CKD patients, where a different risk profile may operate.
  
  
  METHODS
  OPG and PWV were measured at baseline in 151 normoalbuminemic, long-term (>3 years) Japanese hemodialysis patients (median age 62 years) who were prospectively followed for 6 years.
  
  
  RESULTS
  OPG levels were associated in multivariate analysis with age, dialysis vintage, history of cardiovascular disease (CVD) and parathyroid hormone levels. C-reactive protein levels did not correlate with OPG. Patients with clinical history of CVD had significantly higher OPG levels and OPG levels were positively correlated to PWV, an index of arterial stiffness. These associations were independent of age, sex, dialysis vintage, and diabetes. During the follow-up period, 40 deaths, including 25 cardiovascular deaths, were recorded. In crude analysis, each unit of increase in OPG was associated with increased all-cause (hazard ratios 1.14, 95% confidence interval 1.08-1.20) and CVD mortality (1.14 [1.07-1.21]), which persisted after adjustment for age, sex, dialysis vintage, diabetes, and baseline CVD (1.12 [1.05-1.19] and 1.11 [1.02-1.19], all-cause and CVD mortality, respectively).
  
  
  CONCLUSIONS
  In long-term normoalbuminemic Japanese hemodialysis patients, with low prevalence of inflammation, OPG levels were strongly linked with both arterial stiffness and worse outcome.
authors.affiliation: Department of Advanced Nephrology, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi Minami-Ku, Hiroshima 734-8551, Japan. ayumu@hiroshima-u.ac.jp
authors.forename: A
authors.initials: A
authors.lastname: Nakashima
authors.forename: J J
authors.initials: JJ
authors.lastname: Carrero
authors.forename: A R
authors.initials: AR
authors.lastname: Qureshi
authors.forename: T
authors.initials: T
authors.lastname: Hirai
authors.forename: N
authors.initials: N
authors.lastname: Takasugi
authors.forename: T
authors.initials: T
authors.lastname: Ueno
authors.forename: Y
authors.initials: Y
authors.lastname: Taniguchi
authors.forename: B
authors.initials: B
authors.lastname: Lindholm
authors.forename: N
authors.initials: N
authors.lastname: Yorioka
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D001783:Blood Flow Velocity / Q000502:physiology; D001916:Brachial Artery / Q000503:physiopathology; D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology / Q000503:physiopathology; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D053244:Osteoprotegerin / Q000097:blood*; D011379:Prognosis; D006435:Renal Dialysis; D012709:Serum Albumin / Q000032:analysis; D059289:Vascular Stiffness / Q000502:physiology*
chemical_list: D015415:Biomarkers; D053244:Osteoprotegerin; D012709:Serum Albumin; C506030:TNFRSF11B protein, human
references.citation: Clin J Am Soc Nephrol. 2009 Dec;4 Suppl 1:S49-55
references.pmid: 19996005
references.citation: Am J Kidney Dis. 2003 Aug;42(2):303-9
references.pmid: 12900812
references.citation: Br Med J. 1973 Dec 15;4(5893):643-6
references.pmid: 4758544
references.citation: Am J Nephrol. 2009;29(3):257-63
references.pmid: 18802328
references.citation: Nephrol Dial Transplant. 2009 Oct;24(10):3157-62
references.pmid: 19491380
references.citation: Cell. 1998 Apr 17;93(2):165-76
references.pmid: 9568710
references.citation: Comput Methods Programs Biomed. 1997 Nov;54(3):201-8
references.pmid: 9421665
references.citation: Am J Kidney Dis. 2002 Mar;39(3):525-32
references.pmid: 11877571
references.citation: J Exp Med. 2000 Aug 21;192(4):463-74
references.pmid: 10952716
references.citation: J Nephrol. 2009 Nov-Dec;22(6):774-82
references.pmid: 19967657
references.citation: J Am Soc Nephrol. 2003 Dec;14(12):3270-7
references.pmid: 14638926
references.citation: Clin Exp Hypertens. 2004 Oct-Nov;26(7-8):689-99
references.pmid: 15702623
references.citation: Arterioscler Thromb Vasc Biol. 2001 Oct;21(10):1610-6
references.pmid: 11597934
references.citation: J Am Soc Nephrol. 2006 Dec;17(12 Suppl 3):S267-73
references.pmid: 17130273
references.citation: Nephrol Dial Transplant. 2008 Oct;23(10):3256-62
references.pmid: 18450827
references.citation: Genes Dev. 1998 May 1;12(9):1260-8
references.pmid: 9573043
references.citation: Cell. 1997 Apr 18;89(2):309-19
references.pmid: 9108485
references.citation: Clin J Am Soc Nephrol. 2009 Jan;4(1):142-51
references.pmid: 19129321
references.citation: Kidney Int. 2005 Apr;67(4):1576-82
references.pmid: 15780114
references.citation: Clin Chem Lab Med. 2009;47(3):339-46
references.pmid: 19676147
references.citation: Clin Chem. 1972 Jun;18(6):499-502
references.pmid: 4337382
references.citation: J Clin Endocrinol Metab. 2003 Aug;88(8):3816-22
references.pmid: 12915674
references.citation: Clin J Am Soc Nephrol. 2009 Dec;4(12):1892-900
references.pmid: 19833908
references.citation: J Am Soc Nephrol. 2006 Jan;17(1):262-70
references.pmid: 16280472
references.citation: Hypertens Res. 2002 May;25(3):359-64
references.pmid: 12135313
references.citation: Arterioscler Thromb Vasc Biol. 1998 Apr;18(4):535-41
references.pmid: 9555858
references.citation: Diabetes Care. 2001 Dec;24(12):2107-14
references.pmid: 11723092
references.citation: Clin Nephrol. 2005 Jul;64(1):64-8
references.pmid: 16047647