title: Vertebral bone density associates with coronary artery calcification and is an independent predictor of poor outcome in end-stage renal disease patients.
abstract: Chronic kidney disease-mineral bone disorder (CKD-MBD) is a major complication of end-stage renal disease (ESRD). Reduced bone mineral density (BMD) is associated with vascular calcification. Here we investigated associations between vertebral bone density (VBD) and coronary artery calcification (CAC), quantified by cardiac computed tomography (CT), and BMD quantified by dual-energy X-ray absorptiometry (DXA), and their relations with mortality.
  
  
  
  In 231 ESRD patients (median age 56years, 63% males) comprising incident dialysis patients, prevalent peritoneal dialysis patients and recipients of living donor kidney transplant, VBD (Hounsfield units, HUs) and CAC scores (Agatston units, AUs) were quantified by cardiac CT, and, in 143 of the patients, BMD was measured by DXA of total body. Metabolic and inflammation biomarkers potentially linked to CKD-MBD were also analysed.
  
  
  
  Patients with low tertile of VBD were older and had more often cardiovascular disease (CVD), and higher HbA1c (non-diabetics), interleukin-6 and CAC score. Low VBD was independently associated with higher CAC score (>100 AUs) after adjustment for age, gender, diabetes, CVD, inflammation and cohorts. In Cox proportional hazards analysis, low VBD was independently associated with all-cause mortality after adjustment for age, gender, diabetes, CVD, inflammation and subjective global assessment (SGA). The root mean-squared error of prediction (RMSE) showed a good degree of association between VBD and BMD evaluated from DXA. In receiver-operator characteristics curve (ROC) analysis, lower VBD was more strongly associated with higher CAC score and all-cause mortality than BMD evaluated from DXA.
  
  
  
  While assessments of BMD by DXA and CT showed good degree of agreement, associations of high CAC, and mortality, with low VBD were stronger than those based on low BMD by DXA. The strong independent associations of low VBD with high CAC score and increased mortality risk suggest that VBD may serve as an important prognosticator in ESRD patients.
authors: Division of Renal Medicine and Baxter Novum, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Kidney Disease Center, 1st Affiliated Hospital College of Medicine, Zhejiang University, Hangzhou, China.
authors: Zhimin
authors: Z
authors: Chen
authors: Division of Renal Medicine and Baxter Novum, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
authors: Abdul Rashid
authors: AR
authors: Qureshi
authors: Division of Medical Imaging and Technology, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Radiology, Karolinska University Hospital, Huddinge, Sweden.
authors: Jonaz
authors: J
authors: Ripsweden
authors: Division of Transplantation Surgery, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
authors: Lars
authors: L
authors: Wennberg
authors: Division of Renal Medicine and Baxter Novum, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
authors: Olof
authors: O
authors: Heimburger
authors: Division of Renal Medicine and Baxter Novum, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
authors: Bengt
authors: B
authors: Lindholm
authors: Division of Renal Medicine and Baxter Novum, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
authors: Peter
authors: P
authors: Barany
authors: Division of Renal Medicine and Baxter Novum, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
authors: Mathias
authors: M
authors: Haarhaus
authors: Division of Medical Imaging and Technology, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Radiology, Karolinska University Hospital, Huddinge, Sweden.
authors: Torkel B
authors: TB
authors: Brismar
authors: Division of Renal Medicine and Baxter Novum, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden. Electronic address: peter.stenvinkel@ki.se.
authors: Peter
authors: P
authors: Stenvinkel
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods; D000328:Adult; D000368:Aged; D015519:Bone Density / Q000502:physiology; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000000981:diagnostic imaging* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016037:Single-Blind Method; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D061205:Vascular Calcification / Q000000981:diagnostic imaging* / Q000453:epidemiology
keywords: Coronary artery calcification; DXA; End-stage renal disease; Vertebral bone density