Akab Samah M, Abozeid Hanaa Elsayed, Elazab Seham A, Elazab Sherien Abdallh Fathy, ElBazzar Noran, Youness Eman Refaat, Shahba Mohamed Ahmed, Orban Hisham A, Abdallah Hanaa Reyad, Zaki Moushira
Department of Internal Medicine, Faculty of Medicine (Girls), Al-Azhar University, Cairo, Egypt.
Department of Rheumatology and Rehabilitation, Faculty of Medicine (Girls), Al-Azhar University, Cairo, Egypt.
BMC Nephrol. 2025 Apr 18;26(1):197. doi: 10.1186/s12882-025-04099-y.
BACKGROUND: Chronic kidney disease (CKD) patients are prone to osteoporosis (OP) and they had significant oxidative stress. The relationship between oxidative stress (OS) and bone mineral density (BMD) in CKD is not entirely clear. The investigation of this relation is of pronounced importance in decreasing the occurrence of osteoporosis among CKD cases. OBJECTIVES: To evaluate the association between BMD and OS in CKD patients. METHODS: We performed a case-control study, including 150 adults with CKD (stage 1-5 according to Kidney Disease Improving Global Outcomes (KDIGO) classification, 2024) and 150 healthy controls. CKD patients were further subdivided to 3 subgroups based on estimated glomerular filtration rate: stage 1-2, stage 3-4 and stage 5. BMD at the lumbar spine (LS), femur neck (FN), and distal radius (DR) were measured using DEXA. Vitamin D and OS biomarkers including; 8-Hydroxy-2'-deoxyguanosine (8-OHdG) and Malondialdehyde (MDA) were measured. Paraoxonase1 (PON1) as a biomarker of antioxidant response was assessed. Statistical analysis was performed using the appropriate tests. RESULTS: The CKD cases showed lower BMD T-Scores than healthy controls. Moreover, LS, DR, and FN BMDs were significantly different between CKD stages. Post hoc analyses showed higher LS, DR, and FN T-Scores in Stage I-II vs. Stage III-IV and Stage V. However, no significant differences were noted between stage III-IV and stage V for all sites. Significant increase in OS biomarkers (8-OHdG and MDA) while decreasing antioxidant activity (PON-1) with CKD severity were observed. There was a significant positive correlation between PON1and BMD while 8-OHdG and MDA had a negative correlation with BMD. We also observed significant positive correlations between 8-OHdG and MDA with alkaline phosphatase and phosphorus, while these markers had significant negative correlations with vitamin D and calcium. PON1 had a significantly positive correlation with vitamin D & calcium. CONCLUSION: CKD patients suffer of OS. OS positively correlated with CKD severity. There is a negative relation between OS and BMD in CKD. OS might participate in the occurrence of OP in CKD.
背景：慢性肾脏病（CKD）患者易患骨质疏松症（OP），且存在明显的氧化应激。CKD中氧化应激（OS）与骨密度（BMD）之间的关系尚不完全清楚。研究这种关系对于降低CKD患者骨质疏松症的发生率具有重要意义。 目的：评估CKD患者BMD与OS之间的关联。 方法：我们进行了一项病例对照研究，包括150例成年CKD患者（根据2024年改善全球肾脏病预后组织（KDIGO）分类为1-5期）和150例健康对照者。CKD患者根据估计的肾小球滤过率进一步分为3个亚组：1-2期、3-4期和5期。使用双能X线吸收法（DEXA）测量腰椎（LS）、股骨颈（FN）和桡骨远端（DR）的骨密度。检测维生素D和OS生物标志物，包括8-羟基-2'-脱氧鸟苷（8-OHdG）和丙二醛（MDA）。评估对氧磷酶1（PON1）作为抗氧化反应的生物标志物。使用适当的检验进行统计分析。 结果：CKD病例的BMD T值低于健康对照者。此外，CKD各期之间的LS、DR和FN骨密度有显著差异。事后分析显示，I-II期的LS、DR和FN T值高于III-IV期和V期。然而，所有部位的III-IV期和V期之间未观察到显著差异。随着CKD严重程度的增加，OS生物标志物（8-OHdG和MDA）显著增加，而抗氧化活性（PON-1）降低。PON1与BMD呈显著正相关，而8-OHdG和MDA与BMD呈负相关。我们还观察到8-OHdG和MDA与碱性磷酸酶和磷之间存在显著正相关，而这些标志物与维生素D和钙存在显著负相关。PON1与维生素D和钙呈显著正相关。 结论：CKD患者存在氧化应激。氧化应激与CKD严重程度呈正相关。CKD中氧化应激与骨密度呈负相关。氧化应激可能参与CKD患者骨质疏松症的发生。
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