title: Peritoneal dialysis per se is a risk factor for sclerostin-associated adynamic bone disease.
abstract: Chronic kidney disease--mineral bone disorder (CKD-MBD) is a complex syndrome influenced by various factors, such as age, CKD etiology, uremic toxins, and dialysis modality. Although extensively studied in hemodialysis (HD) patients, only a few studies exist for peritoneal dialysis (PD) patients. Since most of these older studies contain no bone biopsy data, we studied the pattern of renal osteodystrophy in 41 prevalent PD patients. The most common presentation was adynamic bone disease (49%). There was a significant inverse association between serum sclerostin (a Wnt/β-catenin pathway inhibitor that decreases osteoblast action and bone formation) and the bone formation rate. Bone alkaline phosphatase had the best sensitivity and specificity to detect both high- and low-turnover diseases. The comparison between nondiabetic PD and HD patients, matched by age, gender, parathyroid hormone level, and length of dialysis, revealed low 25-hydroxyvitamin D levels, worse bone mineralization, and low bone turnover in the nondiabetic PD group. Thus, adynamic bone disease was the most frequent type of renal osteodystrophy in PD patients. Sclerostin seems to participate in the pathophysiology of adynamic bone disease and bone alkaline phosphatase was the best serum marker of bone turnover in these patients.
authors.affiliation: 1] Department of Internal Medicine, Nephrology Division, Universidade de São Paulo, São Paulo, Brazil [2] Department of Integrated Medicine, Universidade Federal do Rio Grande do Norte, Natal, Brazil.
authors.forename: Rodrigo A
authors.initials: RA
authors.lastname: de Oliveira
authors.affiliation: School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil.
authors.forename: Fellype C
authors.initials: FC
authors.lastname: Barreto
authors.affiliation: Department of Internal Medicine, Nephrology Division, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Monique
authors.initials: M
authors.lastname: Mendes
authors.affiliation: Department of Internal Medicine, Nephrology Division, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Luciene M
authors.initials: LM
authors.lastname: dos Reis
authors.affiliation: Department of Internal Medicine, Nephrology Division, Universidade Estadual Paulista, Botucatu, Brazil.
authors.forename: João Henrique
authors.initials: JH
authors.lastname: Castro
authors.affiliation: Department of Internal Medicine, Nephrology Division, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Zita Maria L
authors.initials: ZM
authors.lastname: Britto
authors.affiliation: Department of Internal Medicine, Nephrology Division, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Igor D B
authors.initials: ID
authors.lastname: Marques
authors.affiliation: Department of Internal Medicine, Nephrology Division, Universidade Federal de São Paulo, São Paulo, Brazil.
authors.forename: Aluizio B
authors.initials: AB
authors.lastname: Carvalho
authors.affiliation: 1] Department of Internal Medicine, Nephrology Division, Universidade de São Paulo, São Paulo, Brazil [2] Medicine Master Degree Program, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil.
authors.forename: Rosa M
authors.initials: RM
authors.lastname: Moysés
authors.affiliation: Department of Internal Medicine, Nephrology Division, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Vanda
authors.initials: V
authors.lastname: Jorgetti
mesh_terms: D048868:Adaptor Proteins, Signal Transducing; D000328:Adult; D015415:Biomarkers / Q000097:blood*; D019485:Bone Morphogenetic Proteins / Q000097:blood*; D016723:Bone Remodeling; D001842:Bone and Bones / Q000473:pathology; D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000097:blood / Q000473:pathology / Q000503:physiopathology*; D003430:Cross-Sectional Studies; D005260:Female; D005819:Genetic Markers; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis; D012307:Risk Factors; D061205:Vascular Calcification
chemical_list: D048868:Adaptor Proteins, Signal Transducing; D015415:Biomarkers; D019485:Bone Morphogenetic Proteins; D005819:Genetic Markers; C422903:SOST protein, human