Mineral and bone disorder (MBD) in chronic kidney disease (CKD) is tightly linked to cardiovascular disease (CVD). In this study, we aimed to compare the prognostic value of nine MBD biomarkers to determine those associated best with adverse cardiovascular (CV) outcomes and mortality. In 5 217 participants of the German CKD (GCKD) study enrolled with an estimated glomerular filtration rate (eGFR) between 30–60 mL·min⁻¹ per 1.73 m² or overt proteinuria, serum osteoprotegerin (OPG), C-terminal fibroblast growth factor-23 (FGF23), intact parathyroid hormone (iPTH), bone alkaline phosphatase (BAP), cross-linked C-telopeptide of type 1 collagen (CTX1), procollagen 1 intact N-terminal propeptide (P1NP), phosphate, calcium, and 25-OH vitamin D were measured at baseline. Participants with missing values among these parameters (n = 971) were excluded, leaving a total of 4 246 participants for analysis. During a median follow-up of 6.5 years, 387 non-CV deaths, 173 CV deaths, 645 nonfatal major adverse CV events (MACEs) and 368 hospitalizations for congestive heart failure (CHF) were observed. OPG and FGF23 were associated with all outcomes, with the highest hazard ratios (HRs) for OPG. In the final Cox regression model, adjusted for CV risk factors, including kidney function and all other investigated biomarkers, each standard deviation increase in OPG was associated with non-CV death (HR 1.76, 95% CI: 1.35–2.30), CV death (HR 2.18, 95% CI: 1.50–3.16), MACE (HR 1.38, 95% CI: 1.12–1.71) and hospitalization for CHF (HR 2.05, 95% CI: 1.56–2.69). Out of the nine biomarkers examined, stratification based on serum OPG best identified the CKD patients who were at the highest risk for any adverse CV outcome and mortality.

慢性肾脏病 (CKD) 中的矿物质和骨骼紊乱 (MBD) 与心血管疾病 (CVD) 密切相关。在这项研究中，我们的目的是比较九种 MBD 生物标志物的预后价值，以确定与不良心血管 (CV) 结局和死亡率最相关的标志物。在德国 CKD (GCKD) 研究的 5 217 名参与者中，估计肾小球滤过率 (eGFR) 介于 30–60 mL·min ^-1每 1.73 m ²或明显蛋白尿、血清骨保护素 (OPG)、C 末端成纤维细胞生长因子 23 (FGF23)、完整甲状旁腺激素 (iPTH)、骨碱性磷酸酶 (BAP)、1 型胶原交联 C 端肽 (CTX1)、前胶原 1 完整 N 端前肽 (P1NP)、磷酸盐、钙、和 25-OH 维生素 D 在基线时进行测量。这些参数中存在缺失值的参与者 ( n  = 971) 被排除在外，总共留下 4 246 名参与者进行分析。在中位随访 6.5 年期间，观察到 387 例非心血管死亡、173 例心血管死亡、645 例非致命性主要不良心血管事件 (MACE) 和 368 例因充血性心力衰竭 (CHF) 住院。OPG 和 FGF23 与所有结果相关，其中 OPG 的风险比 (HR) 最高。在最终的 Cox 回归模型中，根据 CV 风险因素（包括肾功能和所有其他研究的生物标志物）进行调整，OPG 的每个标准差增加都与非 CV 死亡（HR 1.76，95% CI：1.35–2.30）、CV 死亡相关。 （HR 2.18，95% CI：1.50–3.16）、MACE（HR 1.38，95% CI：1.12–1.71）和因 CHF 住院（HR 2.05，95% CI：1.56–2.69）。在检查的九种生物标志物中，基于血清 OPG 的分层可以最好地识别出任何不良心血管结果和死亡风险最高的 CKD 患者。