High Serum Sclerostin Levels Are Associated with a Better Outcome in Haemodialysis Patients

Abstract

Background: Sclerostin is an osteocyte hormone that decreases osteoblastogenesis. Sclerostin may play a key role in osteoporosis and also in vascular calcification (VC). In chronic kidney disease and haemodialysis (HD) patients, serum sclerostin levels are high. Aim: To assess the correlation of serum sclerostin levels with VC, bone mineral density (BMD), and survival rate in HD patients. Methods: A cross-sectional study was conducted in prevalent HD patients to correlate serum sclerostin tertiles with the Kauppila aortic calcification score, BMD scores and survival rate. Results: We studied 207 patients who had a mean serum sclerostin level of 1.9 ± 0.7 ng/ml. Compared to patients in the 1st tertile of serum sclerostin levels (0.6-1.53 ng/ml), patients in the 3rd tertile (2.2-4.6 ng/ml) were significantly older (73.7 ± 12 vs. 64.7 ± 18 years), more frequently of the male gender (74 vs. 48%), had lower serum bone-specific alkaline phosphatases values (14 ± 9 vs. 20.4 ± 13 µg/l), were less frequently treated with alfacalcidol, displayed lower aortic calcification scores (9.5 ± 5 vs. 12.5 ± 7/24) and had higher BMD scores. Furthermore, patients of the 3rd tertile displayed a lower mortality rate compared to tertile 1 using multivariable adjusted Cox model (hazard ratio 0.5, 95% CI 0.25-0.93, p = 0.03). The main factors associated with VC score were age, diabetes, cardiovascular disease, CRP level and Warfarin use. Conclusion: Our study of HD patients shows that higher serum sclerostin levels are associated with higher BMD, lower aortic calcification scores, and a better survival rate.

A Prospective Cohort Study Showing No Association Between Serum Sclerostin Level and Mortality in Maintenance Hemodialysis Patients

“…Some showed that serum sclerostin levels had no association with all-cause mortality [21][22][23], and two showed a significant negative association with all-cause mortality [24,25]. A recent quantitative meta-analysis concluded that no significant association existed between sclerostin levels and either all-cause mortality or CVD mortality [26].…”

Assessment of Sclerostin and Interleukin 6 Levels and Selected Anthropometric Parameters in Patients Receiving Hemodialysis Replacement Therapy—Pilot Study

“…The results of this research project may suggest that CKD and RRT disturb the assessed parameters. Sato et al and Jean et al observed a positive correlation between SCL levels and BMI values in hemodialyzed patients [11,38]. Pelletier et al demonstrated a positive correlation between SCL levels and BMI values in a group of nonhemodialyzed CKD patients [38].…”

“…Increased sclerostin levels (SCL) are first observed at stage III CKD. In patients with end-stage renal disease, sclerostin concentrations are several-fold higher than those in subjects with normal renal function [7][8][9][10][11][12]. Bone metabolism disorders may result in blood vessel calcifications, atherosclerosis, or myocardial ischemia [13].…”

Serum sclerostin and adverse outcomes in elderly patients with stable coronary artery disease undergoing percutaneous coronary intervention

“…Recent data have demonstrated that circulating sclerostin levels are positively correlated with better survival in patients undergoing hemodialysis [9]. Nevertheless, other studies have shown that higher serum sclerostin levels increase all-cause mortality in patients with chronic kidney disease (CKD) [10].…”