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Published ahead of print on January 21, 2009
Clin J Am Soc Nephrol 4: 450-455, 2009
© 2009 American Society of Nephrology
doi: 10.2215/CJN.01870408
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Mineral Metabolism and Bone Disease

Low Bone Volume—A Risk Factor for Coronary Calcifications in Hemodialysis Patients

Teresa Adragao*, Johann Herberth{dagger}, Marie-Claude Monier-Faugere{dagger}, Adam J. Branscum{ddagger}, Anibal Ferreira§, Joao M. Frazao||, Jose Dias Curto, and Hartmut H. Malluche{dagger}

* Nephrology Department, Santa Cruz Hospital, Lisbon, Portugal; {dagger} Division of Nephrology, Bone, and Mineral Metabolism and {ddagger} Department of Biostatistics, Statistics, and Epidemiology, University of Kentucky, Lexington, Kentucky; § Nephrology Department, Curry Cabral Hospital, Lisbon, Portugal; || Nephrology Department, Hospital de S. João, Medical School and Nephrology Research and Development Unit, University of Porto, Porto, Portugal; and ISCTE, Business School, Lisbon, Portugal

Correspondence: Dr. Hartmut H. Malluche, FACP, Division of Nephrology, Bone, and Mineral Metabolism, Room MN 564, University of Kentucky Medical Center, 800 Rose Street, Lexington, Kentucky, 40536-0084. Phone: 859-323-5048 ext. 221; Fax: 859-257-1052; E-mail: hhmall{at}uky.edu

Background and objectives: There is increasing evidence that altered bone metabolism is associated with cardiovascular calcifications in patients with stage 5 chronic kidney disease on hemodialysis (HD). This study was conducted to evaluate the association between bone volume, turnover, and coronary calcifications in HD patients.

Design, setting, participants, & measurements: In a cross-sectional study, bone biopsies and multislice computed tomography were performed in 38 HD patients. Bone volume/total volume, activation frequency, and bone formation rate/bone surface were determined by histomorphometry and coronary calcifications were quantified by Agatston scores.

Results: Prevalence of low bone turnover was 50% and of low bone volume was 16%. Among the studied traditional cardiovascular risk factors, only age was found to be associated with coronary calcifications. Lower bone volume was a significant risk factor for coronary calcifications during early years of HD, whereas this effect was not observed in patients with dialysis duration >6 yr. Histomorphometric parameters of bone turnover were not associated with coronary calcifications.

Conclusions: Low bone volume is associated with increased coronary calcifications in patients on HD.


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Clin. J. Am. Soc. Nephrol. 2009 4: 254-257. [Full Text] [PDF]



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G. M. London
Bone-Vascular Axis in Chronic Kidney Disease: A Reality?
Clin. J. Am. Soc. Nephrol., February 1, 2009; 4(2): 254 - 257.
[Full Text] [PDF]


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