Dataset Information

Biomarkers of vascular calcification and mortality in patients with ESRD.

ABSTRACT:

Background

Vascular calcification is common among patients undergoing dialysis and is associated with mortality. Factors such as osteoprotegerin (OPG), osteopontin (OPN), bone morphogenic protein-7 (BMP-7), and fetuin-A are involved in vascular calcification.

Design, setting, participants, & measurements

OPG, OPN, BMP-7, and fetuin-A were measured in blood samples from 602 incident dialysis patients recruited from United States dialysis centers between 1995 and 1998 as part of the Choices for Healthy Outcomes In Caring for ESRD Study. Their association with all-cause and cardiovascular mortality were assessed using Cox proportional hazards models adjusted for demographic characteristics, comorbidity, serum phosphate, and calcium. An interaction with diabetes was tested because of its known association with vascular calcification. Predictive accuracy of selected biomarkers was explored by C-statistics in nested models with training and validation subcohorts.

Results

Higher OPG and lower fetuin-A levels were associated with higher mortality over up to 13 years of follow-up (median, 3.4 years). The adjusted hazard ratios (HR) for highest versus lowest tertile were 1.49 (95% confidence interval [95% CI], 1.08 to 2.06) for OPG and 0.69 (95% CI, 0.52 to 0.92) for fetuin-A. In stratified models, the highest tertile of OPG was associated with higher mortality among patients without diabetes (HR, 2.42; 95% CI, 1.35 to 4.34), but not patients with diabetes (HR, 1.26; 95% CI, 0.82 to 1.93; P for interaction=0.001). In terms of cardiovascular mortality, higher fetuin-A was associated with lower risk (HR, 0.85 per 0.1 g/L: 95% CI, 0.75 to 0.96). In patients without diabetes, higher OPG was associated with greater risk (HR for highest versus lowest tertile, 2.91; 95% CI, 1.06 to 7.99), but not in patients with diabetes or overall. OPN and BMP-7 were not independently associated with outcomes overall. The addition of OPG and fetuin-A did not significantly improve predictive accuracy of mortality.

Conclusions

OPG and fetuin-A may be risk factors for all-cause and cardiovascular mortality in patients undergoing dialysis, but do not improve risk prediction.

SUBMITTER: Scialla JJ

PROVIDER: S-EPMC3974354 | biostudies-literature | 2014 Apr

REPOSITORIES: biostudies-literature

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Publications

Biomarkers of vascular calcification and mortality in patients with ESRD.

Scialla Julia J JJ Kao W H Linda WH Crainiceanu Ciprian C Sozio Stephen M SM Oberai Pooja C PC Shafi Tariq T Coresh Josef J Powe Neil R NR Plantinga Laura C LC Jaar Bernard G BG Parekh Rulan S RS

Clinical journal of the American Society of Nephrology : CJASN 20140123 4

<h4>Background</h4>Vascular calcification is common among patients undergoing dialysis and is associated with mortality. Factors such as osteoprotegerin (OPG), osteopontin (OPN), bone morphogenic protein-7 (BMP-7), and fetuin-A are involved in vascular calcification.<h4>Design, setting, participants, & measurements</h4>OPG, OPN, BMP-7, and fetuin-A were measured in blood samples from 602 incident dialysis patients recruited from United States dialysis centers between 1995 and 1998 as part of the ...[more]

PMID: 24458076

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Dataset Information

Biomarkers of vascular calcification and mortality in patients with ESRD.

Background

Design, setting, participants, & measurements

Results

Conclusions

Publications

Biomarkers of vascular calcification and mortality in patients with ESRD.

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