Association of mineral and bone biomarkers with adverse cardiovascular outcomes and mortality in the German Chronic Kidney Disease (GCKD) cohort

Reimer KC, Nadal J, Meiselbach H, Schmid M, Schultheiss UT, Kotsis F, Stockmann H, Friedrich N, Nauck M, Krane V, Eckardt KU, Schneider M, Kramann R, Floege J, Saritas T, Schiffer M, Prokosch HU, Bärthlein B, Beck A, Reis A, Ekici AB, Becker S, Alberth-Schmidt U, Weigel A, Marschall S, Schefler E, Walz G, Köttgen A, Meder S, Mitsch E, Reinhard U, Schaeffner E, Baid-Agrawal S, Theisen K, Schmidt-Ott K, Zeier M, Sommerer C, Aykac M, Wolf G, Paul R, Börner-Klein A, Bauer B, Raschenberger J, Kollerits B, Forer L, Schönherr S, Weissensteiner H, Oefner P, Gronwald W (2023)

Publication Type: Journal article

Publication year: 2023

Journal

Book Volume: 11

Article Number: 52

Journal Issue: 1

DOI: 10.1038/s41413-023-00291-8

Abstract

Mineral and bone disorder (MBD) in chronic kidney disease (CKD) is tightly linked to cardiovascular disease (CVD). In this study, we aimed to compare the prognostic value of nine MBD biomarkers to determine those associated best with adverse cardiovascular (CV) outcomes and mortality. In 5 217 participants of the German CKD (GCKD) study enrolled with an estimated glomerular filtration rate (eGFR) between 30–60 mL·min⁻¹ per 1.73 m² or overt proteinuria, serum osteoprotegerin (OPG), C-terminal fibroblast growth factor-23 (FGF23), intact parathyroid hormone (iPTH), bone alkaline phosphatase (BAP), cross-linked C-telopeptide of type 1 collagen (CTX1), procollagen 1 intact N-terminal propeptide (P1NP), phosphate, calcium, and 25-OH vitamin D were measured at baseline. Participants with missing values among these parameters (n = 971) were excluded, leaving a total of 4 246 participants for analysis. During a median follow-up of 6.5 years, 387 non-CV deaths, 173 CV deaths, 645 nonfatal major adverse CV events (MACEs) and 368 hospitalizations for congestive heart failure (CHF) were observed. OPG and FGF23 were associated with all outcomes, with the highest hazard ratios (HRs) for OPG. In the final Cox regression model, adjusted for CV risk factors, including kidney function and all other investigated biomarkers, each standard deviation increase in OPG was associated with non-CV death (HR 1.76, 95% CI: 1.35–2.30), CV death (HR 2.18, 95% CI: 1.50–3.16), MACE (HR 1.38, 95% CI: 1.12–1.71) and hospitalization for CHF (HR 2.05, 95% CI: 1.56–2.69). Out of the nine biomarkers examined, stratification based on serum OPG best identified the CKD patients who were at the highest risk for any adverse CV outcome and mortality.

Authors with CRIS profile

Involved external institutions

Charité - Universitätsmedizin Berlin Germany (DE) Universitätsklinikum Aachen (UKA) Germany (DE) Universitätsklinikum Bonn Germany (DE) Universitätsklinikum Freiburg Germany (DE) Universitätsmedizin Greifswald / Universitätsklinikum Greifswald Germany (DE) Universitätsklinikum Würzburg Germany (DE) Albert-Ludwigs-Universität Freiburg Germany (DE) Medizinische Hochschule Hannover (MHH) / Hannover Medical School Germany (DE) Ruprecht-Karls-Universität Heidelberg Germany (DE) Friedrich-Schiller-Universität Jena Germany (DE) Julius-Maximilians-Universität Würzburg Germany (DE) Medizinische Universität Innsbruck Austria (AT) Universität Regensburg Germany (DE)

How to cite

APA:

Reimer, K.C., Nadal, J., Meiselbach, H., Schmid, M., Schultheiss, U.T., Kotsis, F.,... Gronwald, W. (2023). Association of mineral and bone biomarkers with adverse cardiovascular outcomes and mortality in the German Chronic Kidney Disease (GCKD) cohort. Bone Research, 11(1). https://doi.org/10.1038/s41413-023-00291-8

MLA:

Reimer, Katharina Charlotte, et al. "Association of mineral and bone biomarkers with adverse cardiovascular outcomes and mortality in the German Chronic Kidney Disease (GCKD) cohort." Bone Research 11.1 (2023).

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