Impact of vascular calcifications on the risk of fractures in patients with chronic kidney disease

Abstract

Background: The decline in kidney function adversely affects mineral and bone disease, leading to decreased bone mass, increased fractures, and vascular calcifications (VC), particularly in advanced CKD stage 5. This study aimed to identify VC markers to eventually develop personalized therapeutic and preventive strategies in Argentina, where data is limited.

Methods: A prospective, observational study included 101 patients on dialysis or pre-dialysis, eligible for kidney transplant at the Private University Hospital of Córdoba from June 2019 to December 2020. Clinical, laboratory, and imaging assessments were conducted, measuring bone mineral density (BMD), pulse wave velocity (PWV), and VC presence. Patients were grouped based on VC status for comparative analysis.

Results: VC was found in 28 % of patients, correlating significantly with age, BMI, time on dialysis, deceased donor type, and PWV (p < 0.01). PTH showed a direct correlation with total alkaline phosphatase (ALP), bone-specific alkaline phosphatase, P1NP, osteocalcin, and telopeptides. ALP was significantly higher in the VC group (median = 149.5, range [62-964] vs. median = 106, range [28-449]; p < 0.01). Patients without VC had higher serum albumin levels (OR = 0.16; p = 0.002; CI = 0.05-0.52). Fracture prevalence was 32.1 % in the VC group compared to 13.1 % without VC (p < 0.02), with logistic regression showing VC increased fracture risk threefold (OR = 3.09; p = 0.01; CI = 1.22-7.83).

Conclusion: This study highlights the high prevalence of VC and increased fracture risk in CKD stage 5 patients. ALP is a potential serum marker for bone metabolism, while lower serum albumin levels suggest chronic inflammation may contribute to VC development.

Keywords: Chronic kidney disease; Fractures; Mineral and bone metabolism; Vascular calcifications.