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Multicenter Study
. 2022 Apr 8;12(4):551.
doi: 10.3390/biom12040551.

Osteoprotegerin Is a Better Predictor for Cardiovascular and All-Cause Mortality than Vascular Calcifications in a Multicenter Cohort of Patients on Peritoneal Dialysis

Marcela Ávila  1 , Ma Del Carmen Prado  1 , Renata Romero  1 , Ricardo Córdova  2 , Ma Del Carmen Rigo  1 , Miguel Trejo  1 , Carmen Mora  1 , Ramón Paniagua  1 , For The Mexican Nephrology Collaborative Study Group
Affiliations
Multicenter Study

Osteoprotegerin Is a Better Predictor for Cardiovascular and All-Cause Mortality than Vascular Calcifications in a Multicenter Cohort of Patients on Peritoneal Dialysis

Marcela Ávila et al. Biomolecules. .

Abstract

The purpose of this study was to compare vascular calcification (VC), serum osteoprotegerin (OPG) levels, and other biochemical markers to determine their value as available predictors of all-cause and cardiovascular (CV) mortality in patients on peritoneal dialysis (PD). A total of 197 patients were recruited from seven dialysis centers in Mexico City. VC was assessed with multi-slice computed tomography, measured using the calcification score (CaSc). OPG, albumin, calcium, hsC-reactive protein, phosphorous, osteocalcin, total alkaline phosphatase, and intact parathormone were also analyzed. Follow-up and mortality analyses were assessed using the Cox regression model. The mean age was 43.9 ± 12.9 years, 64% were males, and 53% were diabetics. The median OPG was 11.28 (IQR: 7.6−17.4 pmol/L), and 42% of cases had cardiovascular calcifications. The median VC was 424 (IQR:101−886). During follow-up (23 ± 7 months), there were 34 deaths, and 44% were cardiovascular in origin. In multivariable analysis, OPG was a significant predictor for all-cause (HR 1.08; p < 0.002) and CV mortality (HR 1.09; p < 0.013), and performed better than VC (HR 1.00; p < 0.62 for all-cause mortality and HR 1.00; p < 0.16 for CV mortality). For each mg/dL of albumin-corrected calcium, there was an increased risk for CV mortality, and each g/dL of albumin decreased the risk factor for all-cause mortality. OPG levels above 14.37 and 13.57 pmol/L showed the highest predictive value for all-cause and CV mortality in incident PD patients and performed better than VC.

Keywords: cardiovascular mortality; diabetes mellitus; osteoprotegerin; peritoneal dialysis; risk factor; vascular calcification.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Scheme 1
Scheme 1
Vascular calcification of a patient with high levels of OPG. (A) Sagittal view of calcification (CaSc) at the level of L3. (B) Axial view of calcification (CaSc) at the level of L3.
Figure 1
Figure 1
Study flow chart.
Figure 2
Figure 2
(a) ROC curve of OPG for all-cause mortality (AUC 0.72, CI 95%: 0.627–0.821), cut-off point for OPG = 14.37 pmol/L, p < 0.001; with 72.4% sensitivity and a specificity of 62.5%. (b) ROC curve of OPG for CV mortality (AUC: 0.70; CI 95%: 0.552–0.845), cut-off point for OPG = 13.57 pmol/L, p < 0.011, with a sensitivity of 77.3% and a specificity of 64.8%.
Figure 3
Figure 3
(a) All-cause survival analysis (Cox regression) according to the cut-off point for osteoprotegerin (14.37 pmol/L), p < 0.001. (b) Cardiovascular survival analysis (Cox regression) according to the cut-off point for osteoprotegerin (13.57 pmol/L), p < 0.006.
See this image and copyright information in PMC

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