Serum myostatin levels are associated with abdominal aortic calcification in dialysis patients
Su Mi Lee1 , Seong Eun Kim1 , Ji Young Lee2 , Hyo Jin Jeong3 , Young Ki Son1 , Won Suk An1
1Department of Internal Medicine, Dong-A University College of Medicine, Busan, Republic of Korea
2Department of Internal Medicine, Busan Veterans Hospital, Busan, Republic of Korea
3Department of Internal Medicine, Dong-Eui Medical Center, Busan, Republic of Korea
Correspondence to: Won Suk An
Department of Internal Medicine, Dong-A University College of Medicine, 32 Daesingongwon-ro, Seo-gu, Busan 49201, Republic of Korea. E-mail: anws@dau.ac.kr
*Su Mi Lee and Seong Eun Kim contributed equally to this work.

Edited by Young-Ki Lee, Hallym University, Seoul, Republic of Korea
Received: February 17, 2019; Revised: July 1, 2019; Accepted: July 3, 2019; Published online: September 20, 2019.
© The Korean Society of Nephrology. All rights reserved.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: Serum myostatin levels are increased according to renal function decline and myostatin may be a main mediator of chronic kidney disease–related sarcopenia. A previous study reported that serum myostatin level was negatively associated with abdominal aortic calcification (AAC) in older males. The aim of this study was to assess the association between serum myostatin level and AAC among dialysis patients of both sexes. In addition, we analyzed the relationship between serum myostatin level, muscle mass, and bone mineral density (BMD).
Methods: In this cross-sectional study, we evaluated AAC in the lateral lumbar spine using plain radiography and BMD in 71 patients undergoing dialysis. We classified patients into two groups according to the median value of myostatin as follows: those with high myostatin levels (≥ 5.0 ng/mL) and those with low myostatin levels (< 5.0 ng/mL).
Results: The proportion of patients with an AAC score of five points or more was higher among those with low myostatin levels. Myostatin level was negatively associated with AAC scores on plain radiography and had a positive association with skeletal muscle mass and T-scores for BMD measured at the total hip and femur neck. Lower myostatin levels were independently associated with higher AAC scores following adjustment for age, sex, diabetes mellitus, dialysis vintage, dialysis modality, and osteoprotegerin level.
Conclusion: Lower serum myostatin levels were associated with higher AAC scores, lower muscle mass, and lower BMD in dialysis patients. Further, prospective studies and those with larger cohorts are necessary to validate these findings.
Keywords: Bone density, Dialysis, Muscle, Myostatin, Vascular calcification


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