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 bonemass, increased fractures, and vascular calcifications (VC), particularly in advanced CKD stage 5. This studyaimed to identify VC markers to eventually develop personalized therapeutic and preventive strategies inArgentina, where data is limited.Methods: A prospective, observational study included 101 patients on dialysis or pre-dialysis, eligible for kidneytransplant at the Private University Hospital of C´ordoba 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, deceaseddonor type, and PWV (p < 0.01). PTH showed a direct correlation with total alkaline phosphatase (ALP), bonespecificalkaline 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 higherserum albumin levels (OR = 0.16; p = 0.002; CI = 0.05–0.52). Fracture prevalence was 32.1 % in the VC groupcompared 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 chronicinflammation may contribute to VC development.