Denosumab Recovers Aortic Arch Calcification During Long-Term Hemodialysis

INTRODUCTION: Aortic arch calcification (AoAC) is related closely to mortality risk in patients undergoing maintenance dialysis. Recent experimentally obtained data suggest that osteoprotegerin/receptor activator for nuclear factor κB ligand signal transmission plays a role in de novo chondrogenic transition of vascular cells leading to calcification that is unrelated to bone metabolism. This study investigated the long-term effects of denosumab, an osteoprotegerin mimic peptide, on AoAC. METHODS: This study examined 58 patients with an 8 year vintage of dialysis at 1 center for observational study during 2009 to 2020. Denosumab was administered to 28 patients every 6 months. Blood chemical data were used. AoAC proportions were measured using a simple but computed tomography–equivalent computer-based chest X-ray analysis (calcified pieces of areas around the aorta). RESULTS: Blood chemical data of the control and denosumab groups that did not differ at the start showed differences of mineral metabolism after 30 months of observation. Remarkably, the AoAC proportion increased from 29.4% to 46.25% in the control group but decreased significantly from 25.0% to 20.0% (P < 0.01) in the denosumab group. Denosumab effects on decalcification were not observed 12 months after initiation. CONCLUSION: We conclude that long-term use of denosumab is effective to reverse or treat AoAC in patients undergoing hemodialysis.