BACKGROUND: Reduced bone mineral density (BMD) is common in end-stage renal disease (ESRD) patients and predicts outcomes. The chronic kidney disease-mineral bone disorder contributes to low BMD in ESRD; however, the impact of classical risk factors for osteoporosis in the general population, such as body weight and fat mass, remains less well defined in ESRD subjects. METHODS: BMD, body composition (dual-energy X-ray absorptiometry), nutritional status (subjective global assessment), hand grip strength and multiple biomarkers were investigated in 361 patients (218 males; 60.4%) starting on dialysis. The relations between BMD, body composition and biomarkers were analyzed at baseline, and the impact of BMD on mortality was analyzed prospectively. RESULTS: In univariate analysis, T-score correlated with fat mass (r = 0.308, p<0.001), lean body mass (r = 0.278, p<0.001), leptin (r = 0.124, p = 0.028) as well as the anabolic marker insulin-like growth factor-1 (IGF-1; r = 0.301, p<0.001), and its binding proteins IGFBP-1 (r = -0.342, p<0.001) and IGFBP-3 (0.231, p<0.001). BMD T-score was independently associated with age, total fat mass, intact parathyroid hormone and presence of wasting. During 5 years of follow-up, 87 deaths were recorded. Each unit of increase of T-score was associated with decreased all-cause mortality, which persisted after multivariate adjustment (hazard ratio = 0.824, 95% confidence interval, 0.681-0.996). CONCLUSIONS: BMD is associated with body composition, especially total fat mass, nutritional status and mortality risk in ESRD patients.
BACKGROUND: Reduced bone mineral density (BMD) is common in end-stage renal disease (ESRD) patients and predicts outcomes. The chronic kidney disease-mineral bone disorder contributes to low BMD in ESRD; however, the impact of classical risk factors for osteoporosis in the general population, such as body weight and fat mass, remains less well defined in ESRD subjects. METHODS:BMD, body composition (dual-energy X-ray absorptiometry), nutritional status (subjective global assessment), hand grip strength and multiple biomarkers were investigated in 361 patients (218 males; 60.4%) starting on dialysis. The relations between BMD, body composition and biomarkers were analyzed at baseline, and the impact of BMD on mortality was analyzed prospectively. RESULTS: In univariate analysis, T-score correlated with fat mass (r = 0.308, p<0.001), lean body mass (r = 0.278, p<0.001), leptin (r = 0.124, p = 0.028) as well as the anabolic marker insulin-like growth factor-1 (IGF-1; r = 0.301, p<0.001), and its binding proteins IGFBP-1 (r = -0.342, p<0.001) and IGFBP-3 (0.231, p<0.001). BMD T-score was independently associated with age, total fat mass, intact parathyroid hormone and presence of wasting. During 5 years of follow-up, 87 deaths were recorded. Each unit of increase of T-score was associated with decreased all-cause mortality, which persisted after multivariate adjustment (hazard ratio = 0.824, 95% confidence interval, 0.681-0.996). CONCLUSIONS:BMD is associated with body composition, especially total fat mass, nutritional status and mortality risk in ESRDpatients.
Authors: Ken Iseri; Abdul Rashid Qureshi; Jonaz Ripsweden; Olof Heimbürger; Peter Barany; Ingrid B Bergström; Peter Stenvinkel; Torkel B Brismar; Bengt Lindholm Journal: J Bone Miner Metab Date: 2020-09-04 Impact factor: 2.626
Authors: Baris Afsar; Alan A Sag; Cinar Oztosun; Masanari Kuwabara; Mario Cozzolino; Adrian Covic; Mehmet Kanbay Journal: J Nephrol Date: 2019-04-27 Impact factor: 3.902
Authors: Leon Lenchik; Thomas C Register; Fang-Chi Hsu; Jianzhao Xu; S Carrie Smith; J Jeffrey Carr; Barry I Freedman; Donald W Bowden Journal: J Clin Densitom Date: 2017-12-01 Impact factor: 2.617
Authors: Peggy M Cawthon; Sheena Patel; Susan K Ewing; Li-Yung Lui; Jane A Cauley; Jennifer G Lyons; Lisa Fredman; Deborah M Kado; Andrew R Hoffman; Nancy E Lane; Kristine E Ensrud; Steven R Cummings; Eric S Orwoll Journal: JBMR Plus Date: 2017-07-10