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The Link Between Bone and Cardiovascular Disease in Chronic Kidney Disease
Evidence from Haemodialysis Patients with in 83% of the patients using multiple-slice CT and in 58% of the patients
Bone Histomorphometry using plain radiographs. There was an association between low bone
A report
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compared bone histomorphometric characteristics with turnover and a high degree of arterial calcification and stiffness in
arterial calcification score in 58 white non-diabetic patients on haemodialysis patients. A lower bone mass was also associated with
haemodialysis for at least 12 months. The presence of calcification was more coronary calcifications. These findings suggested a contributory role
evaluated, as previously described,
7
in four main arterial regions: of low bone volume and turnover to vascular calcifications in
common carotid arteries, abdominal aorta, iliofemoral axis and legs. dialysis patients.
A binary notation was given as being present (1) or absent (0) for each
territory. The final score was calculated by adding the scores of
each arterial region, ranging from 0 (no identifiable calcium in any of the
There is recent evidence supporting a
regions) to 4 (calcification in all four territories). Anterior iliac crest bone
possible role for bone metabolism
biopsies were performed after double tetracycline labelling.The authors
reported that patients with the highest calcification scores (3 and 4)
alterations related to chronic kidney
were characterised by lower intact PTH levels, low osteoclast numbers,
disease in the development and
smaller osteoblastic and double tetracycline-labelled surfaces and a high
progression of cardiovascular
percentage of aluminum-stained surfaces compared with the patients
with the lower calcification scores of 1 or 2.
7
These data suggested that calcifications in this population.
the presence of low bone activity and adynamic bone disease is an
important risk factor for the development of arterial calcification in
patients with chronic kidney disease stage V on haemodialysis. Conclusion
Hyperparathyroidism assessed by serum intact PTH levels and bone The presence of arterial calcifications in chronic kidney disease stage V
histomorphometry are inversely proportional to arterial calcification. haemodialysis patients is an independent predictor of subsequent
cardiovascular morbidity and mortality. Hyperphosphataemia and
elevated calcium–phosphorus product are associated with
The presence of arterial calcifications
cardiovascular calcification. The use of excessive amounts of calcium-
containing phosphate binders has been associated with progression of
in chronic kidney disease stage V
vascular calcification in haemodialysis patients and an increase in
haemodialysis patients is an mortality in patients new to dialysis.
independent predictor of subsequent
There is recent evidence supporting a possible role for bone metabolism
cardiovascular morbidity and mortality.
alterations related to chronic kidney disease in the development and
progression of cardiovascular calcifications in this population. Low bone
mineral density, evaluated by quantitative CT, has been inversely
In another study,
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histomorphometric parameters of bone volume and correlated with coronary artery calcification score. The presence of low
turnover were correlated with arterial calcifications and arterial stiffness. serum levels of intact PTH, an accepted surrogate marker for bone
Forty haemodialysis patients underwent bone biopsies from the iliac crest turnover, has been associated with arterial media calcification.
after tetracycline double-labelling. Vascular calcification was assessed by
Agatston score, volume score and calcium mass in the coronary, iliac and Studies performed in dialysis patients submitted to bone biopsies with
thoracic aorta, using multiple-slice CT and simple vascular calcification histomorphometric evaluation suggested a possible contributory role
score in plain radiographs. Arterial stiffening was evaluated by of low bone volume and turnover for the development and
carotid–femoral pulse wave velocity. Vascular calcifications were detected progression of vascular calcifications. ■
1. Blacher J, Guérin AP, Pannier B, et al., Arterial calcifications, hemodialysis, J Am Soc Nephrol, 2004;15:2208–18. 13. Hak AE, Pols HA, van Hemert AM, et al., Progression
Arterial stiffness, and cardiovascular risk in end-stage renal 7. Guerin A, London G, Marchais S, Metivier F, Arterial of aortic calcification is associated with metacarpal
disease, Hypertension, 2001;38:938–42. stiffening and vascular calcifications in end-stage renal bone loss during menopause: a population-based
2. London GM, Guérin AP, Marchais SJ, et al., Arterial media disease, Nephrol Dial Transplant, 2000;15:1014–21. longitudinal study, Arterioscler Thromb Vasc Biol,
calcification in end-stage renal disease: impact on all-cause 8. Goodman WG, Goldin J, Kuizon BD, et al., Coronary-artery 2000;20:1926–31.
and cardiovascular mortality, Nephol Dial Transplant, calcification in young adults with end-stage renal disease 14. Braun J, Oldendorf M, Moshage W, et al., Electron beam
2003;18:1731–40. who are undergoing dialysis, N Engl J Med, computed tomography in the evaluation of cardiac
3. Adragão T, Pires A, Lucas C, et al., A simple vascular 2000;342:1478–83. calcifications in chronic dialysis patients, Am J Kidney Dis,
calcification score predicts cardiovascular risk in 9. Chertow GM, Burke SK, Raggi P, Treat to Goal Working 1996;27:394–401.
haemodialysis patients, Nephrol Dial Transplant, Group. Sevelamer attenuates the progression of coronary and 15. London GM, Guérin AP, Marchais SJ, et al., Arterial media
2004;19:1480–88. aortic calcification in hemodialysis patients, Kidney Int, calcification in end-stage renal disease: impact on all-cause
4. Raggi P, Boulay A, Chasan-Taber S, et al., Cardiac 2002;62:245–52. and cardiovascular mortality, Nephol Dial Transplant,
calcification in adult hemodialysis patients. A link between 10. Block GA, Spiegel DM, Ehrlich J, et al., Effects of sevelamer 2003;18:1731–40.
end-stage renal disease and cardiovascular disease?, J Am and calcium on coronary artery calcification in patients new 16. London GM, Marty C, Marchais SJ, et al., Arterial
Coll Cardiol, 2002;39:695–701. to hemodialysis, Kidney Int, 2005;68:1815–24. Calcification and bone histomorphometry in end-
5. Block G, Hulbert-Shearon T, Levin N, Port F, Association of 11. Spiegel DM, Raggi P, Metha R, et al., Coronary and aortic stage renal disease, J Am Soc Nephrol, 2004;15:
serum phosphorus and calcium x phosphate product with calcification in patients new to dialysis, Hemodialysis Int, 1943–51.
mortality risk in chronic hemodialysis patients: a national 2004;8:265–72. 17. Adragão T, Ferreira A, Frazão JM, et al., Vascular
study, Am J Kidney Dis, 1998;31:607–17. 12. Block GA, Raggi P, Bellasi A, et al., Mortality effect of calcifications and bone turnover in hemodialysis patients,
6. Block GA, Klassen PS, Lazarus JM, et al., Mineral coronary calcification and phosphate binder choice in incident Nephrol Dial Transplant, 2006;21:(Suppl. 4): iv292.
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EUROPEAN RENAL DISEASE 2007 17
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