A prospective pilot study assessing osteoblastic changes of vascular calcifications in chronic kidney disease subjects on hemodialysis using 18F-NaF sodium fluoride positron emission tomography PET.
| Publication Type | Academic Article |
| Authors | Dyke J, Absar H, Kakembo M, Dong Z, Wang L, Wang X, Ren S, Cobb B, Dutruel S, Grobe N, Kotanko P |
| Journal | BMC Nephrol |
| Volume | 27 |
| Issue | 1 |
| Date Published | 02/07/2026 |
| ISSN | 1471-2369 |
| Abstract | BACKGROUND: Vascular calcification (VC) is a highly prevalent cardiovascular complication in maintenance hemodialysis (HD), affecting up to 80%–90% of subjects. It represents an actively regulated process of tissue biomineralization via the “bone-vascular axis”. VC contributes to morbidity and mortality in dialysis subjects causing arterial stiffening which may lead to cardiovascular events. This prospective observational pilot study assessed whether changes in osteoblastic turnover in aortic and cardiac VCs could be quantified by ¹⁸F-Sodium Fluoride Positron Emission Tomography / Computed Tomography (18F-NaF PET/CT) in a serial manner. ¹⁸F-NaF PET provides a quantitative measure of ongoing vascular mineralization in calcifications of both the heart and aorta. METHODS: Seven subjects (three females, four males, age 65 ± 4.5 years) treated with HD were enrolled. Five subjects underwent baseline and follow-up 18F-NaF PET/CT imaging at 9.9 ± 1.8 months. All subjects (n = 7) received coronary artery calcification (CAC) scoring with CT. Vascular mineralization rate (Ki) in 18F-NaF PET was estimated using the Patlak method in regions of aortic and cardiac calcifications as well as thoracic spine. RESULTS: VCs were visually apparent in all subjects in both cardiac and aortic regions on both CT and PET. Ki-Patlak in the aortic VCs increased in all subjects over time (13.0% ± 4.9%; p = 0.005) indicating an increasing rate of aortic mineralization. Increased Ki-Patlak was also seen in cardiac VCs in 4 of 5 subjects (p = 0.198). Ki-Patlak in thoracic spine did not change during follow-up time (p = 0.953). The cardiac Agatston Calcification Score (ACS) ranged from moderate (n = 5) and severe (n = 1) to extensive (n = 1) showing the presence of atherosclerotic disease. The Agatston Calcification Score measured specifically in the aorta typically exceeded that in the heart and ranged from severe (n = 1) to extensive (n = 6). Changes in ACS were not significant during follow-up. CONCLUSION: 18F-NaF PET/CT showed the ability to quantify changes in cardiac and aortic vascular calcifications in subjects receiving HD and may present a method to monitor changes in 18F-NaF uptake as a function of time. |
| DOI | 10.1186/s12882-026-04810-7 |
| PubMed ID | 41654789 |
| PubMed Central ID | PMC13049791 |