Abstract: PO0590
Progression of Renal Osteodystrophy and Vascular Calcifications in Patients with CKD Stage II-IV
Session Information
- Vascular Disease, Nephrolithiasis, and Mineral Metabolism: Clinical
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Bone and Mineral Metabolism
- 402 Bone and Mineral Metabolism: Clinical
Authors
- Mohamed, Amr El-Husseini, University of Kentucky Medical Center, Lexington, Kentucky, United States
- Abdalbary, Mohamed Mamdouh, University of Kentucky Medical Center, Lexington, Kentucky, United States
- Issa, Mohamed, University of Kentucky Medical Center, Lexington, Kentucky, United States
- Winkler, Michael, University of Kentucky Medical Center, Lexington, Kentucky, United States
- Lima, Florence, University of Kentucky Medical Center, Lexington, Kentucky, United States
- Faugere, Marie-Claude M., University of Kentucky Medical Center, Lexington, Kentucky, United States
- Srour, Habib, University of Kentucky Medical Center, Lexington, Kentucky, United States
- Malluche, Hartmut H., University of Kentucky Medical Center, Lexington, Kentucky, United States
Background
Vascular calcifications (VC) are associated with renal osteodystrophy (ROD) but limited data are available on ROD and VC with progression of CKD.
Methods
23 pts with CKD II-IV underwent iliac crest bone biopsies for bone histomorphometry, Dual-photon absorptiometry (DXA) of hip and spine for bone mineral density (BMD), and MSCT of the aorta (AOC) and coronaries (CAC) for assessment of VCs. Tests were done at baseline and after 2-3 years of observation with continuation of the same clinical management following KDIGO guidelines.
Results
Pts age was 60 ± 12 y with 56% female, 70% white, 26% black, 4% Asian, 57% DM II, 96% HTN, 9% CKD II, 74% CKD III, and 17% CKD IV. Results are shown in Table 1. There was an increase in VCs. GFR declined in 12 and was stable in 11 pts. Pts with declining GFR had greater increases in AOC and more loss in hip BMD. AOC correlated better than CAC with BMD. At baseline there was low bone turnover (LTO) in 87% of pts, and bone volume (BV) was low in 22%. LTO decreased to 78% and low BV was increased to 45% of pts at end of study. Defective mineralization was not observed at any time.
Conclusion
LTO and low BV are seen in early stages of CKD. With progression of CKD, turnover increases and low BV is more frequently seen. VCs are also seen early in CKD, AOCs progress faster than CACs and there is a relationship between VCs and bone loss.
Table 1
| Baseline | After 2-3 years | P | |
| GFR(mL/min/1.73m2) | 41.1±12.8 | 38.9±11.9 | 0.03 |
| TH BMD(g/cm2) | 1.01±0.17 | 0.99±0.18 | 0.03 |
| FN BMD(g/cm2) | 0.94±0.15 | 0.93±0.17 | <0.01 |
| Coronary calcifications | |||
| - Agatston Score | 119(0-3410) | 132(0-4392) | 0.06 |
| - SqrtVolume | 9.06(0-52.0) | 10.6(0-58.3) | 0.04 |
| Aortic Calcifications | |||
| - Agatston Score | 130(0-5076) | 263(0-6054) | <0.01 |
| - SqrtVolume | 11.0(0-63.8) | 15.7(0-70.9) | <0.01 |
| BFR(mm3/mm2/yr) | 0.66(0.09-1.78) | 0.98(0.40-2.01) | <0.01 |
| ACF(Number/yr) | 0.25(0.04-0.76) | 0.41 (0.17-0.79) | <0.01 |
| AR(µm/d) | 0.30(0.09-1.76) | 0.41(0.15-16.4) | 0.02 |
| MLT(days) | 22.2(1.96-134) | 16.4(0.21-56.1) | 0.01 |
Data given as Mean ± SD or Median(range). TH: Total hip, FN: Femoral Neck, SqrtVolume: Square Root of Volume, BFR: Bone Formation Rate, ACF: Activation frequency, AR: Apposition Rate, MLT: Mineralization Lag Time.
Funding
- NIDDK Support