Osteoprotegerin predicts cardiovascular events in patients treated with haemodialysis

Ping-Hsun Wu, Rie Io Glerup, My Hanna Sofia Svensson, Niclas Eriksson, Jeppe Hagstrup Christensen, Torbjörn Linde, Östen Ljunggren, Bengt Fellström*

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review


Background. Disturbances in bone mineral metabolism are associated with increased mortality and cardiovascular events (CVEs). However, the association between bone-associated protein biomarkers, mortality and CVEs independent of cytokine activation remains unknown. This study aimed to investigate bone-associated protein biomarkers and the association with inflammatory cytokines and cardiovascular (CV) outcomes. Methods. This prospective study enrolled haemodialysis patients in Denmark between December 2010 and March 2011. Using a proximity extension proteomics assay, nine bone-associated proteins were examined: cathepsin D (CTSD), cathepsin L1 (CTSL1), dickkopf-related protein 1, fibroblast growth factor 23, leptin, osteoprotegerin (OPG), receptor activator of nuclear factor kappa-B ligand, TNF-related apoptosis-inducing ligand (TRAIL) and TRAIL receptor 2 (TRAIL-R2). The importance of the bone-associated protein markers was evaluated by a random forest (RF) algorithm. The association between bone-associated proteins with all-cause death, CV death and CVEs was analysed in multivariable Cox models adjusted for age, gender, comorbidities, laboratory data and dialysis duration. Results. We enrolled 331 patients [63.7% men; mean age, 65 years (standard deviation 14.6)] in a prospective cohort study with 5 years of follow-up. When adjusting for confounders, CTSL1 remained associated with all-cause death and four biomarkers were associated with CVEs. However, the association between bone markers and the outcomes was attenuated after adjusting for inflammatory proteins and only OPG remained associated with CVEs in the adjusted model. Evaluating the importance of bone markers by RF, OPG was the most important marker related to CVEs. OPG also improved the prediction of CVEs in integrated discrimination improvement and net reclassification improvement analyses. Conclusions. OPG, a well-known bone biomarker, was associated with CVEs independent of cytokine activity. In contrast, the association between CVEs and the remaining three bone-associated proteins (TRAIL-R2, CTSD and CTSL1) was affected by cytokine inflammation activity.

Original languageEnglish
JournalNephrology, Dialysis, Transplantation
Issue number6
Pages (from-to)1162–1170
Number of pages9
Publication statusPublished - 25 May 2022

Bibliographical note

© The Author(s) 2021. Published by Oxford University Press on behalf of ERA-EDTA.


  • bone markers
  • cardiovascular disease
  • haemodialysis
  • inflammation
  • mortality


Dive into the research topics of 'Osteoprotegerin predicts cardiovascular events in patients treated with haemodialysis'. Together they form a unique fingerprint.

Cite this