A Gaipov1,2, O Cseprekal3, P K Potukuchi1, K Kabulbayev4, A Remport3, Z Mathe3, M Talwar5,6, V Balaraman5,6, T Fülöp7,8, J D Eason5,6, I Mucsi9, C P Kovesdy1,10, M Z Molnar11,12,13,14. 1. Department of Medicine, Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, USA. 2. Department of Extracorporeal Hemocorrection, National Scientific Medical Center, Astana, Kazakhstan. 3. Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary. 4. Department of Nephrology, Kazakh National Medical University, Almaty, Kazakhstan. 5. Methodist Transplant Epidemiology Research Group, Methodist University Hospital Transplant Institute, 1211 Union Ave., Memphis, TN, 38104, USA. 6. Department of Surgery, Division of Transplant Surgery, University of Tennessee Health Science Center, Memphis, TN, USA. 7. Medical Services, Ralph H. Johnson VA Medical Center, Charleston, SC, USA. 8. Department of Medicine, Division of Nephrology, Medical University of South Carolina, Charleston, SC, USA. 9. Department of Medicine, Division of Nephrology and Multiorgan Transplant Program, University Health Network, University of Toronto, Toronto, Canada. 10. Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, TN, USA. 11. Department of Medicine, Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, USA. mzmolnar@uthsc.edu. 12. Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary. mzmolnar@uthsc.edu. 13. Methodist Transplant Epidemiology Research Group, Methodist University Hospital Transplant Institute, 1211 Union Ave., Memphis, TN, 38104, USA. mzmolnar@uthsc.edu. 14. Department of Surgery, Division of Transplant Surgery, University of Tennessee Health Science Center, Memphis, TN, USA. mzmolnar@uthsc.edu.
Abstract
Chronic inflammation and protein energy wasting (PEW) syndrome are common in kidney transplant recipients (KTR). The presence of inflammation and PEW syndrome can directly affect bone resorption and bone formation, leading to bone loss and fractures. We showed PEW is independently associated with new clinically detected bone fractures in prevalent KTR. INTRODUCTION: Kidney transplant recipients (KTR) have a 4-fold higher risk of fracture compared to the general population. Chronic inflammation and PEW syndrome are common in KTR and are associated with poor outcomes. We hypothesized that the Malnutrition-Inflammation Score (MIS), a validated measure of PEW, is associated with higher risk of bone fractures in KTR. METHODS: This prospective cohort study included 839 prevalent KTR from a Central European academic center. MIS, a semiquantitative instrument of PEW, was calculated at the study entry. Self-reported history of fractures was recorded during the 2-year follow-up period. The association between MIS and bone fractures was examined in logistic regression analyses with adjustment for age, gender, eGFR, smoking habits, history of pre-transplant bone fractures, and acute rejection. RESULTS: Mean age was 51 ± 13 years, and 56% of patients were males with median (interquartile range) transplant vintage 69 (38-112) months, estimated glomerular filtration rate 55 ± 21 ml/min/1.73 m2, and calculated MIS 3 (2-4) at enrollment. Fifty-five (7%) patients experienced self-reported bone fractures during the 2-year follow-up period. Higher MIS score showed linear association with increased risk of fracture. Each one-point higher MIS was associated with 23% higher risk of bone fractures (odds ratio (OR) and 95% CI 1.23, 1.12-1.34), which remained significant after multivariable adjustments (OR 1.17, 95% CI 1.06-1.29). CONCLUSION: The MIS is independently associated with new clinically detected bone fractures in prevalent KTR.
Chronic inflammation and protein energy wasting (PEW) syndrome are common in kidney transplant recipients (KTR). The presence of inflammation and PEW syndrome can directly affect bone resorption and bone formation, leading to bone loss and fractures. We showed PEW is independently associated with new clinically detected bone fractures in prevalent KTR. INTRODUCTION: Kidney transplant recipients (KTR) have a 4-fold higher risk of fracture compared to the general population. Chronic inflammation and PEW syndrome are common in KTR and are associated with poor outcomes. We hypothesized that the Malnutrition-Inflammation Score (MIS), a validated measure of PEW, is associated with higher risk of bone fractures in KTR. METHODS: This prospective cohort study included 839 prevalent KTR from a Central European academic center. MIS, a semiquantitative instrument of PEW, was calculated at the study entry. Self-reported history of fractures was recorded during the 2-year follow-up period. The association between MIS and bone fractures was examined in logistic regression analyses with adjustment for age, gender, eGFR, smoking habits, history of pre-transplant bone fractures, and acute rejection. RESULTS: Mean age was 51 ± 13 years, and 56% of patients were males with median (interquartile range) transplant vintage 69 (38-112) months, estimated glomerular filtration rate 55 ± 21 ml/min/1.73 m2, and calculated MIS 3 (2-4) at enrollment. Fifty-five (7%) patients experienced self-reported bone fractures during the 2-year follow-up period. Higher MIS score showed linear association with increased risk of fracture. Each one-point higher MIS was associated with 23% higher risk of bone fractures (odds ratio (OR) and 95% CI 1.23, 1.12-1.34), which remained significant after multivariable adjustments (OR 1.17, 95% CI 1.06-1.29). CONCLUSION: The MIS is independently associated with new clinically detected bone fractures in prevalent KTR.
Entities:
Keywords:
Bone fracture; Kidney transplant; Malnutrition–inflammation score; Protein energy wasting
Authors: K C Abbott; R J Oglesby; I O Hypolite; A D Kirk; C W Ko; P G Welch; L Y Agodoa; W E Duncan Journal: Ann Epidemiol Date: 2001-10 Impact factor: 3.797
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