Prevalence of Vertebral Fractures, Vascular Calcifications, and Mortality in Warfarin Treated Hemodialysis Patients

Author(s): Maria Fusaro, Giovanni Tripepi, Marianna Noale, Mario Plebani, Martina Zaninotto, Antonio Piccoli, Agostino Naso, Davide Miozzo, Sandro Giannini, Marco Avolio, Annalisa Foschi, Maria Antonietta Rizzo, Maurizio Gallieni, The Vertebral Fractures and Vascular Calcifications Study Group.

Journal Name: Current Vascular Pharmacology

Volume 13 , Issue 2 , 2015

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Abstract:

Warfarin inhibits vitamin-K dependent proteins involved in bone mineralization and the prevention of vascular calcification (bone Gla protein BGP, matrix Gla protein MGP). In this multicenter, cross-sectional study with 3-year follow-up, data from 387 patients on hemodialysis for ≥1 year at 18 dialysis units were analyzed. Patients on warfarin treatment for > 1 year (11.9% of the population) were compared with the remaining cohort for vertebral fractures, vascular calcifications and mortality. Vertebral fractures and vascular calcifications were sought in L-L vertebral X-rays (D5 to L4).

Compared with controls, warfarin-treated male patients had more vertebral fractures (77.8 vs. 57.7%, p<0.04), but not females (42.1% vs. 48.4%, p=0.6); total BGP was significantly reduced (82.35 vs. 202 μg/L, p<0.0001), with lower levels in treated men (69.5 vs. women 117.0 μg/L, p=0.03). In multivariate logistic regression analyses, the use of warfarin was associated with increased odds of aortic (OR 2.58, p<0.001) and iliac calcifications (OR 2.86, p<0.001); identified confounders were age, atrial fibrillation, angina, PPI use and total BGP. Seventy-seven patients died during a 2.7±0.5 year follow-up. In univariate Cox regression analysis, patients on warfarin had a higher risk of all-cause mortality (HR 2.42, 95% CI 1.42-4.16, p=0.001) when compared with those untreated and data adjustment for confounders attenuated but confirmed the significant warfarin-mortality link (HR: 1.97, 95% CI: 1.02-3.84, P=0.046).

In hemodialysis patients, additional studies are warranted to verify the risk/benefit ratio of warfarin, which appears to be associated with significant morbidity and increased mortality.

Keywords: Hemodialysis, matrix Gla protein, mortality, osteocalcin, vascular calcifications, vertebral fractures, warfarin.

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Article Details

VOLUME: 13
ISSUE: 2
Year: 2015
Page: [248 - 258]
Pages: 11
DOI: 10.2174/15701611113119990146
Price: $58

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