Histomorphometric diagnostics of renal osteopathy in chronic dialysis patients at high risk of cardiovascular disease

• Published in: International urology and nephrology Vol. 47; no. 7; pp. 1195 - 1201
• Main Authors: Žamboch, K., Krejčí, K., Škarda, J., Tichý, M., Überall, I., Skýpalová, P., Langová, K., Stejskal, D., Švesták, M., Zahálková, J., Ščudla, V., Zadražil, J.
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01-07-2015; Springer Nature B.V
• Subjects: Aged; Biomarkers - metabolism; Bone and Bones - pathology; Bone Density; Calcitriol - metabolism; Calcium - metabolism; Cardiovascular Diseases - epidemiology; Chronic Kidney Disease-Mineral and Bone Disorder - blood; Chronic Kidney Disease-Mineral and Bone Disorder - diagnosis; Czech Republic; Female; Humans; Kidney - metabolism; Male; Medicine; Medicine & Public Health; Nephrology; Nephrology - Original Paper; Osteocalcin - blood; Osteoprotegerin - blood; Parathyroid Hormone - metabolism; Pilot Projects; Prospective Studies; RANK Ligand - blood; Renal Dialysis - methods; Renal Insufficiency, Chronic - diagnosis; Renal Insufficiency, Chronic - metabolism; Renal Insufficiency, Chronic - therapy; Reproducibility of Results; Risk Factors; Urology; Calcium and phosphate metabolism; Mineral and bone disorder; Cardiovascular risk; Histomorphometric bone analysis
• ISSN: 0301-1623; 1573-2584
• DOI: 10.1007/s11255-015-0989-x

Summary
Chronic kidney disease–mineral and bone disorder (CKD–MBD) ranks among clinically and pathogenetically significant complications in patients with CKD. Numerous factors are involved in its development, and histomorphometric analysis of the bone tissue is still necessary for accurate diagnosis.
Methods
The open, pilot, prospective study aimed at performing a comprehensive histomorphometric bone analysis in 26 dialysis patients and assessing the relationships of different types of CKD–MBD to selected parameters of calcium and phosphate metabolism, densitometry, activity of parathyroid glands, presence of diabetes mellitus, and duration of dialysis treatment.
Results
Comparison of the histomorphometric characteristics demonstrated statistically significant correlations between the volume of bone trabeculae and s-procollagen 1 (.754) as well as s-calcitonin (.856). Similarly, there was a positive correlation between the size of tetracycline lines and volume of bone trabeculae (.705) and a strong negative correlation with the thickness of trabeculae (−.442). When assessing the serum levels of s-osteoprotegerin and serum RANKL, there was a correlation with osteoid thickness and bone trabeculae thickness. In case of s-osteoprotegerin, a statistical power was demonstrated in relation to osteoid thickness (.880); in case of s-RANKL, a statistical power was demonstrated in relation to the thickness of trabeculae (.830). When assessing the influence of dialysis duration, relationships to the volume of trabecular bone (.665) and volume of bone trabeculae (.949) were demonstrated. Finally, a relationship between s-1,25-hydroxyvitamin D and s-osteoprotegerin was observed (.739); also the relationships demonstrated were significantly lower volume of bone trabeculae in men (
p
 = 0.067) and lower values of s-osteocalcin and s-procollagen 1 in diabetic patients (
p
 = 0.014).
Conclusion
The results provide new noninvasive possibilities of CKD–MBD detection that are based on selected serum parameters of bone metabolism. Presented are possibilities of noninvasive assessment of different types of CKD–MBD using serum osteomarkers in relation to comprehensive CKD–MBD histomorphometry.