Abstract: TH-PO158
Presence and Progression of Changes in Bone Mass, Bone Quality, and Vascular Calcifications in Patients with Moderate to Advanced Reduction in Kidney Function
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
- Malluche, Hartmut H., University of Kentucky College of Medicine, Lexington, Kentucky, United States
- Qiao, Qi, University of Kentucky Department of Internal Medicine, Lexington, Kentucky, United States
- Chen, Jin, University of Kentucky Department of Internal Medicine, Lexington, Kentucky, United States
- Issa, Mohamed, University of Kentucky Department of Radiology, Lexington, Kentucky, United States
- Lima, Florence, University of Kentucky College of Medicine, Lexington, Kentucky, United States
Background
CKD patients have serum, bone and vascular abnormalities presenting as CKD-Mineral and Bone Disorder (MBD). This study sought to identify the parameters with the greatest relative impact on progression of CKD-MBD.
Methods
This prospective study measured the impact of 262 parameters including serum markers, clinical variables and bone parameters on vascular calcifications and bone quality and quantity at baseline and after 2-3 years. These impacts were assessed using machine learning, a subset of artificial intelligence analyses.
Results
Baseline kidney function values ranged from an estimated glomerular filtration rate (eGFR) 18–70 ml/min, it declined in 52% of subjects by at least 3.3% annually during the study. Machine learning analyses was able to detect relationships between annual changes in eGFR as low as 1% annually with decreases in hip bone mineral quantity, bone mineral crystallinity and a serum resorption marker (TRAP-5b). Arterial calcifications were associated with collagen crosslinking heterogeneity, serum phosphorus level, diuretic use and atorvastatin treatment. Baseline collagen crosslinking heterogeneity was an important factor impacting progression of coronary, but not aortic calcification. Baseline serum phosphorus was a factor associated with progression of arterial calcification (Fig. 1). Median serum phosphorus levels starting as low as 4.0 mg/dl impacted progression of arterial calcification.
Conclusion
Identification of these parameters enhances our understanding of the breadth of abnormalities before dialysis requirements. Attention to these abnormalities in mild to moderate loss of kidney function should improve the management and quality of life for patients with CKD.
Figure 1. Baseline serum phosphorous concentrations for coronary (left panel) and aortic arteries (right panel) evaluated in subjects with and without progression of calcification.
Funding
- NIDDK Support