Relationship of serum periostin with bone mineral density in maintenance hemodialysis patients

Objective To investigate the relationship between serum periostin (POSTN) level and bone mineral density in patients undergoing maintenance hemodialysis (MHD).

Methods Ninety-five patients who had received MHD treatment for more than 3 months in the Hemodialysis Center of Qingdao Municipal Hospital from October 2022 to October 2023 were enrolled as experimental group. Meanwhile, 50 healthy individuals undergoing health examinations in the Physical Examination Center of the same hospital during the same period were selected as the control group. Clinical data such as gender and age were collected for both groups. Fasting venous blood samples were collected before dialysis to measure parathyroid hormone (PTH), alkaline phosphatase (ALP), urea nitrogen, serum creatinine, serum calcium, serum phosphorus, and other indicators. Serum POSTN levels in MHD patients and healthy individuals were determined using enzyme-linked immunosorbent assay (ELISA). The correlation between serum POSTN levels and bone mineral density in MHD patients was explored. Univariate and multivariate binary Logistic regression analyses were performed to identify risk factors for low bone mineral density in MHD patients and assess the clinical value of serum POSTN level in predicting low bone mineral density in these patients.

Results The serum POSTN level in the experimental group were significantly higher than those in the control group (P < 0.05). These patients were divided into two groups based on T-values: normal bone mass group(47 cases, T value >-1.0) and low bone mineral density (48 cases, T value≤-1.0). The low bone mineral density group had significantly higher serum POSTN levels, dialysis vintage, PTH, ALP, serum phosphorus, β₂-microglobulin levels, and a higher proportion of females compared to the normal bone mass group (P < 0.05). Pearson correlation analysis revealed negative correlations of bone mineral density T values with serum POSTN, dialysis vintage, C-reactive protein, PTH, ALP, serum phosphorus, and β₂-microglobulin in MHD patients (r=-0.695, -0.688, -0.246, -0.528, -0.216, -0.309, -0.293; P < 0.05). Multivariate binary Logistic regression analysis showed that after adjusting for confounding factors such as dialysis vintage, PTH, and ALP, high serum POSTN level was an independent risk factor for low bone mineral density in MHD patients. The receiver operating characteristic (ROC) curve indicated that the area under the curve (AUC) for serum POSTN level in predicting low bone mineral density in MHD patients was 0.901, with a cut-off value of 29.66 ng/L.

Conclusion MHD patients have higher serum POSTN levels than healthy individuals, and this marker is associated with low bone mineral density in MHD patients.