Using the ratio of serum osteoprotegerin ligand to osteoprotegerin to evaluate renal osteodystrophy in dialysis patients

Abstract

Osteoclast function is important in the development of renal osteodystrophy (ROD). Osteoclast activity is modulated by the osteoprotegerin ligand-osteoprotegerin (OPGL/OPG) system. In the present study, we checked levels of serum OPG and soluble OPGL in dialyzed patients and correlated those levels with routinely measured parameters of bone metabolism. The study was carried out in 39 patients on hemodialysis (HD) and 29 on peritoneal dialysis (PD). The control group included 13 healthy volunteers. Patients on HD had lower OPGL (p = 0.027) and higher OPG (p = 0.000) levels than control subjects did [OPGL: 0.6 pmol/L (median) and 0.0 - 10.0 pmolL (range) vs. 1.9 pmo1/L (median) and 0.0 - 10.5 pmol/L (range); OPG: 7.7 pmol/L (median) and 0.9 - 16.5 pmol/L (range) vs. 2.2 pmol/L (median) and 1.0- 3.9 pmol/L (range)]. Patients on PD differed from controls only in OPG level [4.0 pmol/L (median) and 2.1 - 13.4 pmol/L (range), p = 0.043]. Patients on HD and on PD both had a lower OPGL/OPG ratio than did the control subjects [HD: 0.09 (median) and 0.00 - 1.45 (range), p = 0.000; PD: 0.35 (median) and 0.00 - 3.89 (range), p = 0.018; controls: 1.07 (median) and 0.00 - 5.14 (range)]. Patients on HD did not differ from patients on PD in levels of OPGL and OPGL/OPG, but they had a higher OPG level (p = 0.001). Patients on HD also showed significantly higher total alkaline phosphatase (ALP) activity and higher inorganic phosphate (iP), but lower total calcium and blood pH. In PD patients, OPGL and OPG both correlated with pH (OPGL positively and OPG negatively). In HD patients, OPGL showed a positive correlation with ALP and a negative correlation with calcium; OPG correlated positively with iP In 36 patients on HD (92.3%) and 15 patients on PD (51.7%), OPG was elevated above the normal value. Differences in serum OPG and OPGL/OPG ratio between groups of dialyzed patients and of control subjects indicate that ROD is more advanced in HD patients than in PD patients. Higher serum OPG and lower serum OPGL in the HD group is probably an effect of higher osteoclast activity. In about 50% of PD patients, osteoclast function is also disturbed, as indicated by elevated OPG levels.