title: Osteoprotegerin and mortality in hemodialysis patients with cardiovascular disease.
abstract: BACKGROUND
  Patients treated with hemodialysis (HD) have an increased mortality, mainly caused by cardiovascular disease (CVD). Osteoprotegerin (OPG) is a glycoprotein involved in the regulation of the vascular calcification process. Previous studies have demonstrated that OPG is a prognostic marker of mortality. The aim of this study was to investigate if OPG was a prognostic marker of all-cause mortality in high-risk patients with end-stage renal disease and CVD.
  
  
  METHODS
  We prospectively followed 206 HD patients with CVD. OPG was measured at baseline and the patients were followed for 2 years or until reaching the primary endpoint, i.e., all-cause mortality.
  
  
  RESULTS
  All-cause mortality during follow-up was 44% (90/206). High OPG was associated with increased mortality, using the first tertile as reference, with an unadjusted HR of 1.70 (CI 1.00 - 2.88) for the second tertile and HR of 1.63 (CI 0.96 - 2.78) for the third tertile. In a multivariate Cox-regression analysis age, CRP and OPG in both the second and third tertile were significantly associated with increased mortality In the unadjusted survival analysis, a test for trend of OPG yielded a p-value of 0.08; in the adjusted analyses, the p-value for trend was 0.03.
  
  
  CONCLUSIONS
  In a high-risk population of hemodialysis patients with previously documented cardiovascular disease, a high level of OPG was an independent risk marker of all-cause mortality.
authors.forename: Simon
authors.initials: S
authors.lastname: Winther
authors.forename: Jeppe Hagstrup
authors.initials: JH
authors.lastname: Christensen
authors.forename: Allan
authors.initials: A
authors.lastname: Flyvbjerg
authors.forename: Erik Berg
authors.initials: EB
authors.lastname: Schmidt
authors.forename: Kaj Anker
authors.initials: KA
authors.lastname: Jørgensen
authors.forename: Hanne
authors.initials: H
authors.lastname: Skou-Jørgensen
authors.forename: My
authors.initials: M
authors.lastname: Svensson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood / Q000401:mortality* / Q000628:therapy; D016009:Chi-Square Distribution; D003718:Denmark; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000097:blood / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D053244:Osteoprotegerin / Q000097:blood*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality*; D018570:Risk Assessment; D012307:Risk Factors; D055502:Secondary Prevention; D013997:Time Factors; D016896:Treatment Outcome; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D053244:Osteoprotegerin; C506030:TNFRSF11B protein, human