Denosumab Decreases Epicardial Adipose Tissue Attenuation in Dialysis Patients with Secondary Hyperparathyroidism and Low Bone Mass

Introduction: Denosumab preceding elective surgery is an alternative option when parathyroidectomy is not immediately possible. Denosumab (an osteoprotegerin mimic) may play a role in the cardiovascular system, which is reflected in the features of epicardial adipose tissue (EAT) and coronary artery calcification (CAC). Methods: We investigated the effects of denosumab on EAT attenuation (EAT_at) and CAC in dialysis patients with secondary hyperparathyroidism (SHPT). This cohort study included patients on dialysis with SHPT. The baseline characteristics of dialysis patients and propensity score-matched non-dialysis patients were compared. Computed tomography scans of the dialysis patients (dialysis group with denosumab, n = 24; dialysis group without denosumab, n = 21) were obtained at baseline and at 6 months of follow-up. Results: At baseline, the dialysis group patients had a higher EAT_at-median (−71.00 H ± 10.38 vs. −81.60 H ± 6.03; p < 0.001) and CAC (1,223 A [248.50–3,315] vs. 7 A [0–182.5]; p < 0.001) than the non-dialysis group. At follow-up, the dialysis group without denosumab showed an increase in Agatston score (1,319.50 A [238.00–2,587.50] to 1,552.00 A [335.50–2,952.50]; p = 0.001) without changes in EAT_at-median (−71.33 H ± 11.72 to −70.86 H ± 12.67; p = 0.15). The dialysis group with denosumab showed no change in Agatston score (1,132.2 A [252.25–3,260.5] to 1,199.50 A [324.25–2,995]; p = 0.19) but a significant decrease of EAT_at-median (−70.71 H ± 9.30 to −74.33 H ± 10.28; p = 0.01). Conclusions: Denosumab may reverse EAT_at and retard CAC progression in dialysis patients with SHPT.