Shunsuke Yamada1, Masatomo Taniguchi2, Masanori Tokumoto3, Ryota Yoshitomi4, Hisako Yoshida5, Narihito Tatsumoto1, Hideki Hirakata2, Satoru Fujimi2, Takanari Kitazono1, Kazuhiko Tsuruya6. 1. Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. 2. Fukuoka Renal Clinic, Fukuoka, Japan. 3. Department of Internal Medicine, Fukuoka Dental College, Fukuoka, Japan. 4. Yoshitomi Medical Clinic, Fukuoka, Japan. 5. Clinical Research Center, Saga University Hospital, Saga, Japan. 6. Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. Electronic address: tsuruya@intmed2.med.kyushu-u.ac.jp.
Abstract
BACKGROUND: Hemodialysis patients are at increased risk for bone fracture and sarcopenia. There is close interplay between skeletal muscle and bone. However, it is still unclear whether lower skeletal muscle mass increases the risk for bone fracture. STUDY DESIGN: Cross-sectional study and prospective longitudinal cohort study. SETTING & PARTICIPANTS: An independent cohort of 78 hemodialysis patients in the cross-sectional study and 3,030 prevalent patients undergoing maintenance hemodialysis prospectively followed up for 4 years. PREDICTOR: Skeletal muscle mass measured by bioelectrical impedance analysis (BIA) and modified creatinine index, an estimate of skeletal muscle mass based on age, sex, Kt/V for urea, and serum creatinine level. OUTCOMES: Bone fracture at any site. RESULTS: In the cross-sectional study, modified creatinine index was significantly correlated with skeletal muscle mass measured by BIA. During a median follow-up of 3.9 years, 140 patients had bone fracture. When patients were divided into sex-specific quartiles based on modified creatinine index, risk for bone fracture estimated by a Fine-Gray proportional subdistribution hazards model with all-cause death as a competing risk was significantly higher in the lower modified creatinine index quartiles (Q1 and Q2) compared to the highest modified creatinine index quartile (Q4) as the reference value in both sexes (multivariable-adjusted HRs for men were 7.81 [95% CI, 2.63-23.26], 5.48 [95% CI, 2.08-14.40], 2.24 [95% CI, 0.72-7.00], and 1.00 [P for trend < 0.001], and for women were 4.44 [95% CI, 1.50-13.11], 2.33 [95% CI, 0.86-6.31], 1.96 [95% CI, 0.82-4.65], and 1.00 [P for trend = 0.007] for Q1, Q2, Q3, and Q4, respectively). LIMITATIONS: One-time assessment of modified creatinine index; no data for residual kidney function and fracture sites and causes. CONCLUSIONS: Modified creatinine index was correlated with skeletal muscle mass measured by BIA. Lower modified creatinine index was associated with increased risk for bone fracture in male and female hemodialysis patients.
BACKGROUND: Hemodialysis patients are at increased risk for bone fracture and sarcopenia. There is close interplay between skeletal muscle and bone. However, it is still unclear whether lower skeletal muscle mass increases the risk for bone fracture. STUDY DESIGN: Cross-sectional study and prospective longitudinal cohort study. SETTING & PARTICIPANTS: An independent cohort of 78 hemodialysis patients in the cross-sectional study and 3,030 prevalent patients undergoing maintenance hemodialysis prospectively followed up for 4 years. PREDICTOR: Skeletal muscle mass measured by bioelectrical impedance analysis (BIA) and modified creatinine index, an estimate of skeletal muscle mass based on age, sex, Kt/V for urea, and serum creatinine level. OUTCOMES: Bone fracture at any site. RESULTS: In the cross-sectional study, modified creatinine index was significantly correlated with skeletal muscle mass measured by BIA. During a median follow-up of 3.9 years, 140 patients had bone fracture. When patients were divided into sex-specific quartiles based on modified creatinine index, risk for bone fracture estimated by a Fine-Gray proportional subdistribution hazards model with all-cause death as a competing risk was significantly higher in the lower modified creatinine index quartiles (Q1 and Q2) compared to the highest modified creatinine index quartile (Q4) as the reference value in both sexes (multivariable-adjusted HRs for men were 7.81 [95% CI, 2.63-23.26], 5.48 [95% CI, 2.08-14.40], 2.24 [95% CI, 0.72-7.00], and 1.00 [P for trend < 0.001], and for women were 4.44 [95% CI, 1.50-13.11], 2.33 [95% CI, 0.86-6.31], 1.96 [95% CI, 0.82-4.65], and 1.00 [P for trend = 0.007] for Q1, Q2, Q3, and Q4, respectively). LIMITATIONS: One-time assessment of modified creatinine index; no data for residual kidney function and fracture sites and causes. CONCLUSIONS: Modified creatinine index was correlated with skeletal muscle mass measured by BIA. Lower modified creatinine index was associated with increased risk for bone fracture in male and female hemodialysis patients.
Authors: Kyung Bok Lee; Jung Gon Lee; Beom Joon Kim; Jun Yup Kim; Keon Joo Lee; Moon Ku Han; Jong Moo Park; Kyusik Kang; Yong Jin Cho; Hong Kyun Park; Keun Sik Hong; Tai Hwan Park; Soo Joo Lee; Mi Sun Oh; Kyung Ho Yu; Byung Chul Lee; Jae Kwan Cha; Dae Hyun Kim; Joon Tae Kim; Jun Lee; Jeong Ho Hong; Sung Il Sohn; Dong Eog Kim; Jay Chol Choi; Min Ju Yeo; Wook Joo Kim; Jae Eun Chae; Ji Sung Lee; Juneyoung Lee; Hee Joon Bae Journal: J Korean Med Sci Date: 2019-06-10 Impact factor: 2.153
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