Division of Metabolism and Endocrinology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 62247, Taiwan.
Division of Nephrology, Buddhist Tzu-Chi General Hospital, Hualien 97004, Taiwan.
Int J Environ Res Public Health. 2020 Feb 14;17(4):1230. doi: 10.3390/ijerph17041230.
Sclerostin and dickkopf-1 (DKK1) played a role in the development of cardiovascular diseases and arterial stiffness in chronic kidney disease (CKD) patients but with controversial results of patients in end-stage renal disease (ESRD) including hemodialysis (HD) and peritoneal dialysis (PD). This study aimed to examine the association between the mode of dialysis or the values of sclerostin or DKK1 and carotid-femoral pulse wave velocity (cfPWV) in ESRD patients. There were 122 HD and 72 PD patients enrolled in this study. By a validated tonometry system, cfPWV was measured and then segregated patients into values of >10 m/s as the high central arterial stiffness (AS) group and values ≤ 10 m/s as the control group. Serum levels of sclerostin and DKK1 were measured using a commercial enzyme-linked immunosorbent assay kit. Possible risk factors for the development of AS were analyzed by logistic regression analysis. There were 21 (29.2%) of PD and 53 (43.4%) of HD in the high AS group. Compared to patients in the control group, those in the high AS group were older, had more comorbidities, had higher systolic blood pressure, and had higher serum levels of fasting glucose, C-reactive protein, and sclerostin. Levels of sclerostin (adjusted OR 1.012, 95% CI. 1.006-1.017, = 0.0001) was found to be an independent predictor of high AS in ESRD patients by multivariate logistic regression analysis. Furthermore, receiver operating characteristic curve analysis showed the optimal cut-off values of sclerostin for predicting AS was 208.64 pmol/L (Area under the curve 0.673, 95% CI: 0.603-0.739, < 0.001). This study showed that serum levels of sclerostin, but not DKK1 or mode of dialysis, to be a predictor for high central AS in ESRD patients.
骨硬化蛋白和 Dickkopf-1(DKK1)在慢性肾脏病(CKD)患者的心血管疾病和动脉僵硬的发展中发挥作用,但在终末期肾病(ESRD)患者,包括血液透析(HD)和腹膜透析(PD)患者中的结果存在争议。本研究旨在探讨透析方式或骨硬化蛋白或 DKK1 值与 ESRD 患者颈动脉-股动脉脉搏波速度(cfPWV)之间的关系。本研究纳入了 122 例 HD 患者和 72 例 PD 患者。通过验证的张力测量系统测量 cfPWV,然后将患者分为 cfPWV>10m/s 的高中心动脉僵硬(AS)组和 cfPWV≤10m/s 的对照组。使用商业酶联免疫吸附测定试剂盒测量血清骨硬化蛋白和 DKK1 水平。采用逻辑回归分析探讨 AS 发生的可能危险因素。高 AS 组中 PD 患者有 21 例(29.2%),HD 患者有 53 例(43.4%)。与对照组患者相比,高 AS 组患者年龄较大,合并症较多,收缩压较高,空腹血糖、C 反应蛋白和骨硬化蛋白水平较高。多变量逻辑回归分析显示,血清骨硬化蛋白水平(调整 OR 1.012,95%CI.1.006-1.017,=0.0001)是 ESRD 患者高 AS 的独立预测因素。此外,受试者工作特征曲线分析显示,预测 AS 的骨硬化蛋白最佳截断值为 208.64pmol/L(曲线下面积 0.673,95%CI:0.603-0.739,<0.001)。本研究表明,血清骨硬化蛋白水平,而不是 DKK1 或透析方式,是 ESRD 患者高中心 AS 的预测因素。