Bone mineral density, its predictors, and outcomes in peritoneal dialysis patients.

The objective of the present work was to assess bone mineral density (BMD) and its predictors in peritoneal dialysis (PD) patients, to check the history of those patients 4 years after the assessment, and to relate thoses outcome to BMD. We used dual-energy X-ray absorptiometry to measure BMD in 26 patients at the femoral neck (FN), and we related those measurements to demographic, nutrition, and laboratory data. Four years after the assessments, the outcomes of those patients were checked and related to BMD. In the study patients, the mean FN BMD was 0.842 +/- 0.137 g/cm2. Serum albumin, lean body mass, alkaline phosphatase (ALP), and treatment with acetylsalicylic acid were significant predictors for BMD in the first multivariate model. A second model included blood pH, serum phosphorus, serum creatinine, and age as significant BMD predictors. Hemoglobin or hematocrit could have replaced phosphorus as a BMD predictor The prevalences of abnormal values for BMD predictors in the study patients were phosphorus > 4.5 mg/dL, 69.2%; pH < 7.36, 53.8%; albumin < 3.5 g/dL, 46.1%; ALP > 104 IU/L, 23.1%; and hemoglobin < 11.0 g/ dL, 23.1%. In 8 patients, a successful renal transplantation occurred at 8.5 +/- 9.3 months; 9 patients died at 25.9 +/- 12.5 months; and 9 patients continued dialysis for a further 50.4 +/- 1.7 months. The highest BMD was found in the patients who underwent renal transplantation (0.962 +/- 0.110 g/cm2); the lowest BMD was found in the patients who died (0.737 +/- 0.100 g/ cm2, p = 0.001). In PD patients, low BMD indicates worse outcome. High prevalences of predictors for low BMD (age, poor nutrition status, metabolic acidosis, high phosphorus, anemia) also contribute to worse outcome in PD patients.