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

Abstract

Background/Aims: Potential relationships between serum sclerostin levels and the levels of bone metabolic markers in maintenance hemodialysis (MHD) patients have yet to be evaluated. This study sought to determine whether serum sclerostin levels are associated with mortality in MHD patients. Methods: We measured serum sclerostin levels in a Japanese MHD cohort, classified the patients into tertiles according to these levels, and followed their course for a 42-month period. Results: The cohort consisted of 389 MHD patients and there were 75 deaths. Kaplan-Meier analyses showed that the tertile of serum sclerostin was not associated with mortality risk. Cox analyses showed that there were no significant associations between serum sclerostin level and mortality. Conclusion: Serum sclerostin level was not an independent predictor of mortality in MHD patients after adjustment for several confounders. However, whether clinical interventions to modulate serum sclerostin levels in MHD patients would improve their survival remains to be determined.

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

“…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]. A positive correlation between SCL levels and BMI values was also observed in other disorders [39,40].…”

“…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].…”

“…However, no explanation of the mechanism behind increased SCL production has been provided yet. It has been suggested that it may result from hyperphosphatemia, osteocytic resistance to the effects of PTH, impaired binding of SCL by its specific receptors, or increased extraskeletal production [34,[36][37][38][39][40][41][42]. Calcium and phosphorus metabolism disorders in the course of CKD are known to result in calcification of blood vessels [33].…”

Sclerostin is an independent risk factor for all-cause mortality in kidney transplant recipients

“…So far, nine studies have analyzed the relationship between sclerostin and all-cause mortality in dialysis patients, five showed that sclerostin is associated with all-cause mortality [ 23 – 25 , 32 , 33 ], and four of them show no association [ 28 – 31 ]. Four of these studies also analyzed the relationship between sclerostin and cardiovascular mortality, three studies saw an association of sclerostin with cardiovascular mortality [ 23 , 25 , 28 ], but one study did not find this association [ 29 ]. Our study is the first to study the association of sclerostin with all-cause mortality in transplanted patients and clearly showed that sclerostin is an independent all-cause mortality risk factor in this population.…”

Could Serum Sclerostin Help in Early Assessment and Treatment of Chronic Kidney Disease – Mineral and Bone Disorder?

“…Several observational studies reported significant and independent positive correlation between serum phosphate, FGF23, and sclerostin concentrations and negative relationship with PTH. Hence, sclerostin may be a possible candidate to aggravate PTH resistance in CKD which could cause and/or aggravate adynamic bone disease (ABD) as well [10]. Patients with ABD associated with low PTH usually tends to have severe vascular calcification.…”