Kidney Center, Department of Medicine, Turku University Hospital, PL 52, Kiinamyllynkatu 4-8, 20521, Turku, Finland.
Turku PET Centre, University of Turku, Kiinamyllynkatu 4-8, 20521, Turku, Finland.
BMC Nephrol. 2022 Jan 3;23(1):12. doi: 10.1186/s12882-021-02652-z.
Development of vascular calcification is accelerated in patients with end-stage renal disease. In addition to traditional risk factors of cardiovascular disease (CVD) abnormal bone and mineral metabolism together with many other factors contribute to the excess cardiovascular burden in patients on dialysis. Aortic calcification score and coronary calcification score are predictive of CVD and mortality. The aim of this study was to evaluate the possible relationship between arterial calcification and bone metabolism.
Thirty two patients on dialysis were included. All patients underwent a bone biopsy to assess bone histomorphometry and a F-NaF PET scan. Fluoride activity was measured in the lumbar spine (L1 - L4) and at the anterior iliac crest. Arterial calcification scores were assessed by computerized tomography for quantification of coronary artery calcification score and lateral lumbar radiography for aortic calcification score.
This study group showed high prevalence of arterial calcification and 59% had verified CVD. Both CAC and AAC were significantly higher in patients with verified CVD. Only 22% had low turnover bone disease. There was a weak association between fluoride activity, which reflects bone turnover, measured in the lumbar spine, and CAC and between PTH and CAC. There was also a weak association between erosion surfaces and AAC. No significant association was found between calcification score and any other parameter measured.
The results in this study highlight the complexity, when evaluating the link between bone remodeling and vascular calcification in patients with multiple comorbidities and extensive atherosclerosis. Several studies suggest an impact of bone turnover on development of arterial calcification and there is some evidence of reduced progression of vascular calcification with improvement in bone status. The present study indicates an association between vascular calcification and bone turnover, even though many parameters of bone turnover failed to show significance. In the presence of multiple other factors contributing to the development of calcification, the impact of bone remodeling might be diminished.
The study is registered in ClinicalTrials.gov protocol registration and result system, ID is NCT02967042 . Date of registration is 17/11/2016.
血管钙化在终末期肾病患者中加速发展。除了心血管疾病（CVD）的传统危险因素外，异常的骨骼和矿物质代谢以及许多其他因素共同导致透析患者的心血管负担过重。主动脉钙化评分和冠状动脉钙化评分可预测 CVD 和死亡率。本研究旨在评估动脉钙化与骨代谢之间的可能关系。
纳入 32 名透析患者。所有患者均接受骨活检以评估骨组织形态计量学和 F-NaF PET 扫描。氟化物活性在腰椎（L1-L4）和髂前嵴进行测量。通过计算机断层扫描评估动脉钙化评分，以定量冠状动脉钙化评分，通过侧位腰椎 X 线摄影评估主动脉钙化评分。
本研究组显示出动脉钙化的高患病率，59%的患者有确诊的 CVD。有确诊 CVD 的患者 CAC 和 AAC 均显著升高。仅有 22%的患者患有低转换骨疾病。腰椎氟化物活性与 CAC 之间存在弱相关性，反映了骨转换，而 PTH 与 CAC 之间也存在弱相关性。侵蚀表面与 AAC 之间也存在弱相关性。钙化评分与任何其他测量参数之间均无显著相关性。
本研究结果强调了在患有多种合并症和广泛动脉粥样硬化的患者中，评估骨重塑与血管钙化之间的联系的复杂性。有几项研究表明骨转换对动脉钙化的发展有影响，并且有一些证据表明骨状态的改善可减缓血管钙化的进展。本研究表明血管钙化与骨转换之间存在关联，尽管许多骨转换参数均未显示出显著意义。在存在多种其他促成钙化发展的因素的情况下，骨重塑的影响可能会减弱。
该研究在 ClinicalTrials.gov 方案注册和结果系统中注册，ID 为 NCT02967042。注册日期为 2016 年 11 月 17 日。
