Kidney Week

Abstract: TH-PO154

Fluorine F 18 Sodium-Fluoride Positron Emission Tomography to Study Renal Osteodystrophy and Aortic Microcalcification in Patients with CKD: A Pilot Study

Session Information

• CKD-MBD: Clinical
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Bone and Mineral Metabolism

• 502 Bone and Mineral Metabolism: Clinical

Authors

• Shokrekhuda, Aspan Meherzad, Montefiore Medical Center, New York, New York, United States

Aspan Meherzad Shokrekhuda, MD

• Stratford, Rylen, Montefiore Medical Center, New York, New York, United States

Rylen Stratford, DO

• Mowrey, Wenzhu, Albert Einstein College of Medicine, Bronx, New York, United States

Wenzhu Mowrey, PhD

• Song, Na, Montefiore Medical Center, New York, New York, United States

Na Song, MSc, PhD

• Zhang, Kexin, Albert Einstein College of Medicine, Bronx, New York, United States

Kexin Zhang, MS

• Saini, Sara, Albert Einstein College of Medicine, Bronx, New York, United States

Sara Saini, MA

• Didea, Mario T., Montefiore Medical Center, New York, New York, United States

Mario T. Didea, MS

• Duah, Gabriel K., Montefiore Medical Center, New York, New York, United States

Gabriel K. Duah, MPH

• Sibinga, Nicholas, Albert Einstein College of Medicine, Bronx, New York, United States

Nicholas Sibinga, MD

• Levsky, Jeffrey M., Montefiore Medical Center, New York, New York, United States

Jeffrey M. Levsky, MD, PhD

• Travin, Mark, Montefiore Medical Center, New York, New York, United States

Mark Travin, MD

• Chen, Wei, Albert Einstein College of Medicine, Bronx, New York, United States

Wei Chen, MD, MS, FASN

Background

Recent advances in positron emission tomography (PET) may accelerate the adoption of ¹⁸Fluorine-sodium fluoride (¹⁸F-NaF) PET as a clinical diagnostic tool for renal osteodystrophy and arterial micro- or early calcification in CKD. Herein, we aimed to define the optimal timing of ¹⁸F-NaF PET imaging and show its feasibility in patients with moderate CKD.

Methods

In 7 patients with CKD 3b-4 and 3 healthy controls, we acquired a 30-min dynamic scan followed by 3 static scans 15 min after the injection of ¹⁸F-NaF. ECG-gated CT was done to detect macro- or advanced calcification in coronary arteries (CAC). ¹⁸F-NaF uptake was quantified for regions over bilateral kidneys, lumbar spine, and lumbar aorta using tissue-to-background ratios (TBRs), which were calculated by dividing standardized uptake values (SUVs) of the regions by the SUV of reference blood pool. The Mann-Whitney U tests were used for group comparisons.

Results

Median (IQR) eGFR_Cys-Cr for CKD patients (age: 54-80) and controls (age: 57-69) was 40 (32-43) and 95 (64-103) ml/min/1.73m², respectively. CKD patients had a significantly slower renal clearance of ¹⁸F-NaF than controls (median biological half-life: 20 vs. 8 min, p=0.02). Time to reach optimal TBRs at lumbar spine was similar (43 vs. 44 min, p>0.99). Among CKD patients (n=7), there was a trend toward significance in correlation between mean TBR in lumbar spine at 60-min and intact PTH levels (spearman r=0.75, p=0.07). Median (IQR) Agaston CAC score was 473 (30-559), and among those with CAC (n=8), peak TBR in lumbar aorta at 60-min was positively correlated with CAC score (spearman r=0.79, p=0.048).

Conclusion

We report for the first time the renal clearance kinetics of ¹⁸F-NaF and define the optimal time for its PET imaging in people with moderate CKD. We also demonstrated the feasibility of using ¹⁸F-NaF PET as a promising diagnostic tool for evaluating both renal osteodystrophy and aortic micro-calcification.

Funding

• NIDDK Support