Sclerostin: a new biomarker of CKD-MBD

Int Urol Nephrol. 2020 Jan;52(1):107-113. doi: 10.1007/s11255-019-02290-3. Epub 2019 Oct 14.


The causes of the increased cardiovascular risk associated with kidney diseases partly reside in the chronic kidney disease-mineral bone disorder (CKD-MBD) syndrome. Three cardiovascular risk factors [hyperphosphatemia, vascular calcification, and elevated fibroblast growth factor 23 (FGF23)] levels have been discovered within the CKD-MBD over the last decades. In addition, sclerostin is recently presented as a new bone and vascular disease biomarker. This 22-kDa glycoprotein, secreted mainly by osteocytes, is a soluble inhibitor of the canonical Wnt pathway that has a pivotal role in bone biology and turnover. CKD patients are reported with higher levels of sclerostin, and levels decrease during dialysis. Sclerostin is associated with vascular calcification and CV risk in CKD, although data are still controversial. The question whether serum sclerostin has protective or deleterious role in CKD-MBD pathophysiology, and therefore in cardiovascular risk and overall mortality, is still open and needs to be answered. The standardization of assays and the establishment of a clear cut-off values when sclerostin starts to switch from physiological to pathophysiological role have to be another important step. Further research is needed also to define its relationship with other CKD-MBD biomarkers for future diagnostic and therapeutic strategies.

Keywords: Bone turnover 3; Cardiovascular mortality 5; Chronic kidney disease 2; Sclerostin 1; Vascular calcification 4.

Publication types

  • Review

MeSH terms

  • Adaptor Proteins, Signal Transducing / blood*
  • Biomarkers / blood
  • Cardiovascular Diseases / blood
  • Cardiovascular Diseases / etiology
  • Chronic Kidney Disease-Mineral and Bone Disorder / blood*
  • Chronic Kidney Disease-Mineral and Bone Disorder / complications
  • Chronic Kidney Disease-Mineral and Bone Disorder / diagnosis*
  • Fibroblast Growth Factor-23
  • Humans


  • Adaptor Proteins, Signal Transducing
  • Biomarkers
  • FGF23 protein, human
  • SOST protein, human
  • Fibroblast Growth Factor-23