title: Ankle-brachial index and bone turnover in patients on dialysis.
abstract: An association between atherosclerosis and osteoporosis has been reported in several studies. This association could result from local intraosseous atherosclerosis and ischemia, which is shown by limb osteoporosis in patients with peripheral artery disease (PAD), but also could result from bidirectional communication between the skeleton and blood vessels. Systemic bone disorders and PAD are frequent in ESRD. Here, we investigated the possible interaction of these disorders. For 65 prevalent nondiabetic patients on hemodialysis, we measured ankle-brachial pressure index (ABix) and evaluated mineral and bone disorders with bone histomorphometry. In prevalent patients on hemodialysis, PAD (ABix<0.9 or >1.4/incompressible) was associated with low bone turnover and pronounced osteoblast resistance to parathyroid hormone (PTH), which is indicated by decreased double-labeled surface and osteoblast surface (P<0.001). Higher osteoblast resistance to PTH in patients with PAD was characterized by weaker correlation coefficients (slopes) between serum PTH and double-labeled surface (P=0.02) or osteoblast surface (P=0.03). The correlations between osteoclast number or eroded surface and serum mineral parameters, including PTH, did not differ for subjects with normal ABix and PAD. Common vascular risk factors (dyslipidemia, smoking, and sex) were similar for normal, low, and incompressible ABix. Patients with PAD were older and had high C-reactive protein levels and longer hemodialysis vintage. These results indicate that, in prevalent nondiabetic patients with ESRD, PAD associates with low bone turnover and pronounced osteoblast resistance to PTH.
authors.affiliation: Department of Nephrology, Manhès Hospital, Fleury Mérogis, France; Department of Pharmacology, Georges Pompidou European Hospital, National Institute of Health and Medical Research U970, Paris, France; and glondon@club-internet.fr.
authors.forename: Gérard M
authors.initials: GM
authors.lastname: London
authors.affiliation: Department of Nephrology, Manhès Hospital, Fleury Mérogis, France;
authors.forename: Sylvain J
authors.initials: SJ
authors.lastname: Marchais
authors.affiliation: Department of Pharmacology, Georges Pompidou European Hospital, National Institute of Health and Medical Research U970, Paris, France; and.
authors.forename: Alain P
authors.initials: AP
authors.lastname: Guérin
authors.affiliation: Lariboisiere Hospital, Vigot Petersen Centre, National Institute of Health and Medical Research U606, University Paris 7, Paris, France.
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: de Vernejoul
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D055109:Ankle Brachial Index; D001706:Biopsy; D015519:Bone Density / Q000502:physiology; D001842:Bone and Bones / Q000378:metabolism* / Q000473:pathology; D002097:C-Reactive Protein / Q000378:metabolism; D015897:Comorbidity; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000453:epidemiology / Q000378:metabolism / Q000503:physiopathology*; D010281:Parathyroid Hormone / Q000097:blood; D058729:Peripheral Arterial Disease / Q000453:epidemiology / Q000378:metabolism / Q000503:physiopathology*; D012044:Regression Analysis; D006435:Renal Dialysis; D012189:Retrospective Studies
chemical_list: D010281:Parathyroid Hormone; D002097:C-Reactive Protein
keywords: arteries; arteriosclerosis; end stage kidney disease; hemodialysis; hyperparathyroidism; parathyroid hormone