Winther, Simon8; Christensen, Jeppe Hagstrup1; Flyvbjerg, Allan9; Schmidt, Erik Berg1; Jørgensen, Kaj Anker10; Skou-Jørgensen, Hanne11; Svensson, My12
1 Department of Clinical Medicine, The Faculty of Medicine, Aalborg University, VBN2 The Faculty of Medicine, Aalborg University, VBN3 Aalborg University Hospital, The Faculty of Medicine, Aalborg University, VBN4 Klinik Medicin, The Faculty of Medicine, Aalborg University, VBN5 Nyremedicin (Nefrologi), The Faculty of Medicine, Aalborg University, VBN6 Klinik Hjerte-Lunge, The Faculty of Medicine, Aalborg University, VBN7 Hjertemedicin (Kardiologi), The Faculty of Medicine, Aalborg University, VBN8 Institut for Klinisk Medicin - Hjertemedicinsk Afdeling B, SKS9 Dekanatet, Health10 The Faculty of Social Sciences, Aalborg University, VBN11 unknown12 Nyremedicinsk Afdeling, Medicinsk Center, Aalborg Sygehus Syd
Abstract BACKGROUND: Patients treated with hemodialysis (HD) have an increased mortality, mainly caused by cardiovascular disease (CVD). Osteoprotegerin (OPG) is a glycoprotein involved in the regulation of the vascular calcification process. Previous studies have demonstrated that OPG is a prognostic marker of mortality. The aim of this study was to investigate if OPG was a prognostic marker of all-cause mortality in high-risk patients with end-stage renal disease and CVD. METHODS: We prospectively followed 206 HD patients with CVD. OPG was measured at baseline and the patients were followed for 2 years or until reaching the primary endpoint, i.e., all-cause mortality. RESULTS: All-cause mortality during follow-up was 44% (90/206). High OPG was associated with increased mortality, using the first tertile as reference, with an unadjusted HR of 1.70 (CI 1.00 - 2.88) for the second tertile and HR of 1.63 (CI 0.96 - 2.78) for the third tertile. In a multivariate Cox-regression analysis age, CRP and OPG in both the second and third tertile were significantly associated with increased mortality In the unadjusted survival analysis, a test for trend of OPG yielded a p-value of 0.08; in the adjusted analyses, the p-value for trend was 0.03. CONCLUSIONS: In a high-risk population of hemodialysis patients with previously documented cardiovascular disease, a high level of OPG was an independent risk marker of all-cause mortality.
Clinical Nephrology, 2013, Vol 80, Issue 9, p. 161-167