Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026
Serum activin A and bone metabolism in patients undergoing hemodialysis.
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Nakagawa Yosuke, Takahashi Hiroo, Takahashi Yuichiro, Hyodo Toru, Hida Miho, Suga Takao, Kakuta Takatoshi, Tomita Yusuke, Nakamura Michio, Komaba Hirotaka
Аннотация
UNLABELLED: Activin A, which promotes osteoclast differentiation, increases with declining kidney function, but its role in bone metabolism in kidney failure remains unclear. We found that higher activin A levels were associated with increased bone turnover markers, independent of parathyroid hormone levels.
PURPOSE: Activin A, produced by various cells including bone marrow stromal cells, immune cells, and osteoblasts, is thought to promote osteoclast differentiation. Serum activin A levels rise with declining kidney function, but its role in bone metabolism in kidney failure remains incompletely understood.
METHODS: Serum activin A levels were measured in 35 healthy individuals and 654 patients undergoing maintenance hemodialysis. Associations of serum activin A with tartrate-resistant acid phosphatase isoform 5b (TRACP5b), bone-specific alkaline phosphatase (BALP), and metacarpal bone mineral density were assessed using both unadjusted and multivariable-adjusted linear regression analyses. Serum activin A levels were also compared between patients with and without a history of fracture, and between those who developed incident fractures during follow-up and those who did not.
RESULTS: The median serum activin A level in hemodialysis patients was 733 pg/mL (interquartile range (IQR), 591-912), approximately 2.6-fold higher than that of healthy controls (277 pg/mL; IQR, 216-289; P < 0.001). Patients with higher activin A levels had longer dialysis durations, a higher prevalence of polycystic kidney disease, and higher serum phosphorus and alkaline phosphatase levels. Higher activin A levels were significantly associated with increased TRACP5b levels independently of intact parathyroid hormone levels, with a similar trend observed for BALP. Serum activin A levels were not associated with metacarpal bone mineral density, history of fracture, or incident fractures.
CONCLUSION: These findings suggest that in patients with kidney failure, elevated activin A may contribute to high bone turnover, although its ability to predict fracture risk appears limited. Further studies are warranted to investigate its potential as a therapeutic target.
PURPOSE: Activin A, produced by various cells including bone marrow stromal cells, immune cells, and osteoblasts, is thought to promote osteoclast differentiation. Serum activin A levels rise with declining kidney function, but its role in bone metabolism in kidney failure remains incompletely understood.
METHODS: Serum activin A levels were measured in 35 healthy individuals and 654 patients undergoing maintenance hemodialysis. Associations of serum activin A with tartrate-resistant acid phosphatase isoform 5b (TRACP5b), bone-specific alkaline phosphatase (BALP), and metacarpal bone mineral density were assessed using both unadjusted and multivariable-adjusted linear regression analyses. Serum activin A levels were also compared between patients with and without a history of fracture, and between those who developed incident fractures during follow-up and those who did not.
RESULTS: The median serum activin A level in hemodialysis patients was 733 pg/mL (interquartile range (IQR), 591-912), approximately 2.6-fold higher than that of healthy controls (277 pg/mL; IQR, 216-289; P < 0.001). Patients with higher activin A levels had longer dialysis durations, a higher prevalence of polycystic kidney disease, and higher serum phosphorus and alkaline phosphatase levels. Higher activin A levels were significantly associated with increased TRACP5b levels independently of intact parathyroid hormone levels, with a similar trend observed for BALP. Serum activin A levels were not associated with metacarpal bone mineral density, history of fracture, or incident fractures.
CONCLUSION: These findings suggest that in patients with kidney failure, elevated activin A may contribute to high bone turnover, although its ability to predict fracture risk appears limited. Further studies are warranted to investigate its potential as a therapeutic target.