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Objective: The objective of this study is to investigate the association between the serum sclerostin, the coronary artery calcification (CAC), and patient outcomes in maintenance dialysis patients. Methods: We performed a prospective cohort study of 65 maintenance dialysis patients in 2014, including 39 patients on peritoneal dialysis and 26 on hemodialysis, and followed up for 5 years. Parameters of mineral metabolism including bone-specific alkaline phosphatase, fibroblast growth factor 23, sclerostin, and other biochemical factors were determined at the baseline. Meanwhile, the CAC score was analyzed by cardiac computed tomography. Results: Serum sclerostin in hemodialysis patients was significantly higher than that in peritoneal dialysis patients (632.35 ± 369.18 vs. 228.85 ± 188.92, p < 0.001). The patients with CAC were older, receiving hemodialysis, lower Kt/V, and had longer dialysis vintage, as well as higher levels of serum 25-(OH)-vit D and sclerostin. In multivariate logistic regression analysis, older age and lower Kt/V were risk factors for CAC. The area under the receiver operating characteristic curves for prediction of CAC by sclerostin was 0.74 (95% confidence interval 0.605–0.878, p = 0.03), and the cutoff value of sclerostin is 217.55 pg/mL with the sensitivity 0.829 and specificity 0.619. After 5 years of follow-up, 51 patients survived. The patients in the survival group had significantly lower age, sclerostin levels, and low CAC scores than the nonsurvival group. Old age (≥60 years, p < 0.001) and high CAC score (≥50 Agatston unit, p = 0.031) were significant risk factors for the patient survival. Conclusions: Sclerostin is significantly elevated in dialysis patients with CAC. But sclerostin is not a risk factor for CAC. After 5 years of follow-up, patients in the survival group are younger and have lower sclerostin levels and CAC scores. But sclerostin levels are not independent risk factors for high mortality in dialysis patients. [ABSTRACT FROM AUTHOR]

Purpose: Accurate preoperative parathyroid localization is important for successful parathyroidectomy (PTX). The aim of our study was to investigate whether SPECT/CT has enhanced effect in preoperative localization of parathyroids. Methods: In our retrospective cohort study, we evaluated the effects of technetium-99m methoxyisobutylisonitrile-single-photon emission computed tomography/computed tomography (99mTc-MIBI SPECT/CT) on preoperative parathyroid localization for 645 secondary hyperparathyroidism (SHPT) patients. Among them, 569 successful PTX patients were divided into group A (received 99mTc-MIBI scintigraphy, n = 175) and group B (received 99mTc-MIBI scintigraphy and SPECT/CT imaging, n = 394). Sensitivity, specificity, and consistency of two imaging methods in preoperative localization of parathyroids were compared. Results: Overall sensitivity and consistency were higher in group B, while there was no difference in specificity between the two groups. In group A, the sensitivity of 99mTc-MIBI was 50.00%, 77.11%, 61.76%, and 76.54% in the right upper gland (RU), right lower gland (RL), left upper gland (LU), and left lower gland (LL) subgroups, while the consistency was 52.00%, 76.57%, 61.71%, and 75.43%, respectively. In group B, the sensitivity of 99mTc-MIBI with SPECT/CT was 69.39%, 90.03%, 78.07%, and 84.27%, and the consistency was 69.54%, 88.32%, 78.43%, and 84.26%, respectively. The sensitivity and consistency in lower glands were higher than in upper glands in both groups. Sensitivity for eutopic parathyroid was higher in group B, while there was no difference for ectopic parathyroid. Conclusions:99mTc-MIBI SPECT/CT can increase the sensitivity and consistency of preoperative localization of eutopic parathyroid glands, and it can accurately locate ectopic parathyroid without sensitivity improvement. [ABSTRACT FROM AUTHOR]

Aims: We demonstrated a relationship between transforming growth factor-beta(1) (TGF-beta(1)) and production of bone matrix in vascular smooth muscle cells (VSMCs) induced by a high-phosphate environment., Methods: Rat VSMCs were incubated in a high-phosphate (2.5 or 3.5 mM) or TGF-beta(1) (2 or 5 ng/ml) environment. TGF-beta(1) monoclonal neutralization antibody (50 microg/ml) was added to inhibit the TGF-beta(1) signal in high-phosphate medium. Production of TGF-beta(1) was analyzed by Western blot and real-time PCR. Core binding factor a1 (Cbfa1), osteopontin (OP), collagen type I (Col I) and osteocalcin (OC) was investigated by Western blot and immunofluorescence staining. Mineral deposition was assessed by von Kossa staining and o-cresolphthalein complexone method., Results: VSMCs transformation induced by high phosphate occurs via an autocrine loop of TGF-beta(1). First, high phosphate stimulated the production of TGF-beta(1) in VSMCs. Second, TGF-beta(1) could induce increased expression of osteoblast-specific transcription factor Cbfa1 and osteogenic molecule in VSMCs. Third, the TGF-beta(1) neutralization antibody largely attenuated the upregulation of Cbfa1 and bone matrix in high-phosphate-stimulated cells. However, neutralization of TGF-beta(1) could not inhibit high-phosphate-induced VSMCs calcification, indicating that TGF-beta(1) was not necessary for the deposition of calcium., Conclusion: TGF-beta(1) plays a crucial role in bone matrix production but not calcium deposition in VSMCs induced by a high-phosphate environment, and the blockade of TGF-beta(1) signaling may thus be a therapeutic strategy for use with vascular disease in a high-phosphate environment., (Copyright 2010 S. Karger AG, Basel.)

Aim: Vascular access is the lifeline of haemodialysis patients and radial-cephalic fistula is the preferred type of access. We investigated vascular calcification in uraemia radial arteries and compared it with clinical parameters., Methods: Artery specimens from 30 end-stage renal disease patients were collected, examined calcification by von Kossa and Alizarin red staining. Expression of alpha-smooth muscle actin (alpha-SMA) and the main component of bone matrix, osteopontin (OP) were detected by immunohistochemistry., Results: In uraemia vessels, calcification was mainly located in the medial layer. Nineteen (63.33%) patients had no evidence of calcification, six (20%) had mild/moderate calcification and five (16.66%) had severe calcification. Upregulation of OP and diminished expression of alpha-SMA occurred in the medial layer, especially in the area of severe calcification. The calcification score, decreased expression of alpha-SMA and upregulation of OP were positively correlated with older age, serum calcium, serum phosphorus and calcium x phosphorus product (P < 0.01)., Conclusion: Vascular calcification in uraemia radial arteries is mainly located in the media layer. The risk factors appear to be older age, an elevated serum level of phosphorus, calcium and calcium x phosphorus product.