Serum calcification propensity predicts all-cause mortality in predialysis CKD

Smith, Edward R.; Ford, Martin L.; Tomlinson, Laurie A.; Bodenham, Emma; McMahon, Lawrence P.; Farese, Stefan; Rajkumar, Chakravarthi; Holt, Stephen G.; Pasch, Andreas (2014). Serum calcification propensity predicts all-cause mortality in predialysis CKD. Journal of the American Society of Nephrology, 25(2), pp. 339-348. Lippincott Williams & Wilkins 10.1681/ASN.2013060635

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Medial arterial calcification is accelerated in patients with CKD and strongly associated with increased arterial rigidity and cardiovascular mortality. Recently, a novel in vitro blood test that provides an overall measure of calcification propensity by monitoring the maturation time (T50) of calciprotein particles in serum was described. We used this test to measure serum T50 in a prospective cohort of 184 patients with stages 3 and 4 CKD, with a median of 5.3 years of follow-up. At baseline, the major determinants of serum calcification propensity included higher serum phosphate, ionized calcium, increased bone osteoclastic activity, and lower free fetuin-A, plasma pyrophosphate, and albumin concentrations, which accounted for 49% of the variation in this parameter. Increased serum calcification propensity at baseline independently associated with aortic pulse wave velocity in the complete cohort and progressive aortic stiffening over 30 months in a subgroup of 93 patients. After adjustment for demographic, renal, cardiovascular, and biochemical covariates, including serum phosphate, risk of death among patients in the lowest T50 tertile was more than two times the risk among patients in the highest T50 tertile (adjusted hazard ratio, 2.2; 95% confidence interval, 1.1 to 5.4; P=0.04). This effect was lost, however, after additional adjustment for aortic stiffness, suggesting a shared causal pathway. Longitudinally, serum calcification propensity measurements remained temporally stable (intraclass correlation=0.81). These results suggest that serum T50 may be helpful as a biomarker in designing methods to improve defenses against vascular calcification.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Dermatology, Urology, Rheumatology, Nephrology, Osteoporosis (DURN) > Clinic of Nephrology and Hypertension

UniBE Contributor:

Pasch, Andreas

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1046-6673

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Andreas Pasch

Date Deposited:

10 Oct 2014 10:42

Last Modified:

05 Dec 2022 14:34

Publisher DOI:

10.1681/ASN.2013060635

PubMed ID:

24179171

BORIS DOI:

10.7892/boris.52991

URI:

https://boris.unibe.ch/id/eprint/52991

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