Assessing Bone–Vascular Axis Using 18F-NaF PET and Serum Biomarkers in Hemodialysis Patients

 

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Assessing Bone–Vascular Axis Using 18F-NaF PET and Serum Biomarkers in Hemodialysis Patients

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Peter
Kotanko
Hasib Absar hasib.absar@rriny.com Fresenius Medical Care Clinical research New York United States - Renal Research Institute Laboratory New York United States
Mark Kakembo Mark.Kakembo@rriny.com Fresenius Medical Care Clinical research New York United States - Renal Research Institute Laboratory New York United States
Zijun Dong Zijun.Dong@rriny.com Fresenius Medical Care Clinical research New York United States - Renal Research Institute Clinical research New York United States
Lin-Chun Wang Lin-Chun.Wang@rriny.com Fresenius Medical Care Clinical research New York United States - Renal Research Institute Clinical research New York United States
Xiaoling Wang Xiaoling.Wang@rriny.com Fresenius Medical Care Clinical research New York United States - Renal Research Institute Laboratory New York United States
Lela Tisdale Lela.Tisdale@rriny.com Fresenius Medical Care Clinical research New York United States - Renal Research Institute Clinical research New York United States
Sarah Ren Sarah.ren@nyu.edu Renal Research Institute Clinical research New York United States -
Lemuel Rivera Fuentes rivera.lem@gmail.com Renal Research Institute Clinical research New York United States -
Stephan Thijssen quarantine@arved.com Fresenius Medical Care Clinical research New York United States - Renal Research Institute Clinical research New York United States
Silvina P. Dutruel spd9005@med.cornell.edu Weill Cornell Medicine Clinical Radiology New York United States -
Nadja Grobe Nadja.Grobe@rriny.com Fresenius Medical Care Clinical research New York United States - Renal Research Institute Laboratory New York United States
Peter Kotanko peter.kotanko@mssm.edu Renal Research Institute Clinical research New York United States * Icahn School of Medicine at Mount Sinai Medicine and Nephrology New York United States
Jonathan Dyke jpd2001@med.cornell.edu Weill Cornell Medicine Physics Research in Radiology New York United States -
 
 

Vascular mineralization (VM) is a prevalent cardiovascular complication in hemodialysis (HD) patients, affecting up to 80–90%. VM is an actively regulated process of tissue biomineralization (“bone-vascular axis”). ¹⁸F-sodium fluoride (¹⁸F-NaF) positron emission tomography (PET) of blood vessels can quantitate ongoing VM. However, the relationship between PET-derived VM activity and circulating serum bone biomarkers in HD patients remains poorly defined.

We enrolled seven HD patients (3 F/4 M, age 65±4.5 years). Five patients underwent baseline and follow-up 18F-NaF PET/CT imaging of the thoracic aorta. VM rate was quantified by aortic K_Patlak (Ki_Aortic_VM). A higher Ki_Aortic_VM indicates a higher VM rate. Serum bone turnover markers, including bone-specific alkaline phosphatase (BAP), tartrate-resistant acid phosphatase 5b (TRAP-5b), parathyroid hormone (PTH), and soluble α-klotho, were measured using validated commercial ELISAs. Simple linear regression examined associations between the mean Ki_Aortic_VM and the mean of the biomarker measurements.

Serum BAP was moderately correlated with Ki_Aortic_VM (R² = 0.61, p = 0.065), suggesting that greater osteoblastic activity was associated with higher VM rates. TRAP-5b showed a similar positive trend (R² = 0.52, p = 0.10), consistent with increased osteoclast activity paralleling VM. In contrast, PTH and α-Klotho levels were not correlated with VM rates (Figure 1). 

Concordant increases in BAP and TRAP-5b support the concept of coupled bone turnover linked to VM in HD patients, whereas systemic PTH and α-Klotho levels did not reflect local VM activity. Before considering BAP and TRAP-5b as serum biomarkers reporting VM, our results need to be corroborated in a larger cohort. 

Kewords