title: Important abnormalities of bone mineral metabolism are present in patients with coronary artery disease with a mild decrease of the estimated glomerular filtration rate.
abstract: Chronic kidney disease (CKD)-mineral and bone disorder (MBD) is characterized by increased circulating levels of parathormone (PTH) and fibroblast growth factor 23 (FGF23), bone disease, and vascular calcification, and is associated with adverse outcomes. We studied the prevalence of mineral metabolism disorders, and the potential relationship between decreased estimated glomerular filtration rate (eGFR) and CKD-MBD in coronary artery disease patients in a cross-sectional study of 704 outpatients 7.5 ± 3.0 months after an acute coronary syndrome. The mean eGFR (CKD Epidemiology Collaboration formula) was 75.8 ± 19.1 ml/min/1.73 m(2). Our patients showed lower calcidiol plasma levels than a healthy cohort from the same geographical area. In the case of men, this finding was present despite similar creatinine levels in both groups and older age of the healthy subjects. Most patients (75.6 %) had an eGFR below 90 ml/min/1.73 m(2) (eGFR categories G2-G5), with 55.3 % of patients exhibiting values of 60-89 ml/min/1.73 m(2) (G2). PTH (r = -0.3329, p < 0.0001) and FGF23 (r = -0.3641, p < 0.0001) levels inversely correlated with eGFR, whereas calcidiol levels and serum phosphate levels did not. Overall, PTH levels were above normal in 34.9 % of patients. This proportion increased from 19.4 % in G1 category patients, to 33.7 % in G2 category patients and 56.6 % in G3-G5 category patients (p < 0.001). In multivariate analysis, eGFR and calcidiol levels were the main independent determinants of serum PTH. The mean FGF23 levels were 69.9 (54.6-96.2) relative units (RU)/ml, and 33.2 % of patients had FGF23 levels above 85.5 RU/ml (18.4 % in G1 category patients, 30.0 % in G2 category patients, and 59.2 % in G3-G5 category patients; p < 0.001). In multivariate analysis, eGFR was the main predictor of FGF23 levels. Increased phosphate levels were present in 0.7 % of the whole sample: 0 % in G1 category patients, 0.3 % in G2 category patients, and 2.8 % in G3-G5 category patients (p = 0.011). Almost 90 % of patients had calcidiol insufficiency without significant differences among the different degrees of eGFR. In conclusion, in patients with coronary artery disease there is a large prevalence of increased FGF23 and PTH levels. These findings have an independent relationship with decreased eGFR, and are evident at an eGFR of 60-89 ml/min/1.73 m(2). Then, mild decreases in eGFR must be taken in consideration by the clinician because they are associated with progressive abnormalities of mineral metabolism.
authors: Division of Nephrology and Hypertension, IIS-Fundación Jiménez Díaz and Autónoma University, Madrid, Spain.
authors: Emilio
authors: E
authors: González-Parra
authors: Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain.
authors: Álvaro
authors: Á
authors: Aceña
authors: Renal and Vascular Research Laboratory, IIS-Fundación Jiménez Díaz and Autónoma University, Madrid, Spain.
authors: Óscar
authors: Ó
authors: Lorenzo
authors: Department of Cardiology, Hospital Universitario de Móstoles, Madrid, Spain.
authors: Nieves
authors: N
authors: Tarín
authors: Laboratory of Nephrology and Mineral Metabolism, Hospital Gómez-Ulla, Madrid, Spain.
authors: María Luisa
authors: ML
authors: González-Casaus
authors: Department of Cardiology, Hospital de Fuenlabrada and Rey Juan Carlos University, Fuenlabrada, Spain.
authors: Carmen
authors: C
authors: Cristóbal
authors: Department of Cardiology, Hospital Universitario Fundación Alcorcón, Madrid, Spain.
authors: Ana
authors: A
authors: Huelmos
authors: Department of Epidemiology, IIS-Fundación Jiménez Díaz, Madrid, Spain.
authors: Ignacio
authors: I
authors: Mahíllo-Fernández
authors: Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain.
authors: Ana María
authors: AM
authors: Pello
authors: Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain.
authors: Rocío
authors: R
authors: Carda
authors: Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain.
authors: Ignacio
authors: I
authors: Hernández-González
authors: Department of Cardiology, Hospital de Fuenlabrada and Rey Juan Carlos University, Fuenlabrada, Spain.
authors: Joaquín
authors: J
authors: Alonso
authors: Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
authors: Fernando
authors: F
authors: Rodríguez-Artalejo
authors: Rey Juan Carlos University, Alcorcón, Spain.
authors: Lorenzo
authors: L
authors: López-Bescós
authors: Division of Nephrology and Hypertension, IIS-Fundación Jiménez Díaz and Autónoma University, Madrid, Spain.
authors: Alberto
authors: A
authors: Ortiz
authors: Division of Nephrology and Hypertension, IIS-Fundación Jiménez Díaz and Autónoma University, Madrid, Spain.|Renal, Vascular and Diabetes Research Laboratory, IIS-Fundación Jiménez Díaz, Autónoma University, and CIBERDEM, Madrid, Spain.
authors: Jesús
authors: J
authors: Egido
authors: Department of Cardiology and Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz and Autónoma University, 28040, Madrid, Spain. jtunon@secardiologia.es.
authors: José
authors: J
authors: Tuñón
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002112:Calcifediol / Q000097:blood; D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000097:blood / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology*; D003324:Coronary Artery Disease / Q000150:complications*; D003430:Cross-Sectional Studies; D005260:Female; D000089703:Fibroblast Growth Factor-23; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged
chemical_list: C000717427:FGF23 protein, human; D000089703:Fibroblast Growth Factor-23; D002112:Calcifediol
keywords: Coronary artery disease; Fibroblast growth factor 23; Glomerular filtration rate; Parathormone; Vitamin D