中年慢性肾脏病早期患者的骨折状况：CARTaGENE 调查的横断面分析。

Fracture status in middle-aged individuals with early CKD: cross-sectional analysis of the CARTaGENE survey.

机构信息

CHU de Québec Research Center, L'Hôtel-Dieu-de-Québec Hospital, Endocrinology and Nephrology Axis, Faculty and Department of Medicine, Université Laval, 10 McMahon, Quebec City, Quebec, G1R 2J6, Canada.

Nephrology Division, Hôpital du Sacré-Coeur de Montréal, Montreal, CA, Canada.

出版信息

Osteoporos Int. 2019 Apr;30(4):787-795. doi: 10.1007/s00198-019-04902-1. Epub 2019 Feb 22.

DOI:10.1007/s00198-019-04902-1

PMID:30796539

Abstract

UNLABELLED

Whether early chronic kidney disease (CKD) is associated with fracture in middle-aged adults is unclear. In a cross-sectional analysis of the CARTaGENE survey, we observed that early CKD was not associated with increased fracture, did not modify the association between calcaneal QUS and fracture, but modified the association between clinical, pharmacological parameters and fracture.

INTRODUCTION

The association between advanced CKD and increased fracture risk is well described. However, whether early CKD is associated with increased fractures, especially in middle-aged adults, is unclear. We aimed to assess if early CKD is associated with increased fracture status and whether early CKD status modifies the association between calcaneal quantitative ultrasound parameters, clinical, pharmacological parameters, and fractures.

METHODS

Cross-sectional analysis of CARTaGENE, a population-based survey of 40- to 69-year-old individuals. Individuals with CKD (stage 2, estimated glomerular filtration rate [eGFR] 60-89 ml/min/1.73 m; stage 3, eGFR 30-59) were compared to non-CKD individuals (eGFR > 90). Fracture status (excluding face, toe, hand, and patella) was identified through a questionnaire at baseline. Calcaneal quantitative ultrasound (QUS) was measured in each participant.

RESULTS

A total of 17,608 individuals (656 CKD stage 3; 8227 stage 2; 8725 non-CKD) were included. CKD stage 2 and 3 individuals (mean eGFR 78 and 53 ml/min/1.73 m) were older and had more diabetes, cardiovascular disease, and hypertension. Fracture status prevalence was 14.9% in CKD stage 3, 10.8% in CKD stage 2, and 9.0% in non-CKD individuals. Fracture status prevalence was similar between CKD and non-CKD individuals when stratified by age or after adjustment for demographic and clinical parameters. QUS stiffness index was associated with fracture status in both CKD stage 3 (standardized odds ratio [sOR] = 1.525 [1.200 to 1.939] per 1 SD decrease), stage 2 (sOR = 1.415 [1.310 to 1.530]), and non-CKD individuals (sOR = 1.477 [1.361 to 1.602]). The associations between blood pressure, antihypertensive, and fracture status followed a U-shape throughout the progression of CKD.

CONCLUSIONS

CKD stage 3 was not associated with an increase in fracture status. QUS parameters were similarly associated with fracture status in patients with and without CKD.

摘要

目的

评估早期慢性肾脏病（CKD）与骨折状态之间的关系，以及早期 CKD 状态是否会改变跟骨定量超声参数、临床、药物参数与骨折之间的关联。

方法

本研究为基于人群的 CARTaGENE 调查的横断面分析，纳入了 40-69 岁的个体。将 CKD 患者（CKD 2 期，估算肾小球滤过率[eGFR]60-89 ml/min/1.73 m；CKD 3 期，eGFR 30-59）与非 CKD 患者（eGFR>90）进行比较。通过基线时的问卷调查确定骨折状态（不包括面部、脚趾、手和髌骨）。对每个参与者进行跟骨定量超声（QUS）测量。

结果

共纳入 17608 名个体（CKD 3 期 656 名；CKD 2 期 8227 名；非 CKD 期 8725 名）。CKD 2 期和 3 期患者（平均 eGFR 为 78 和 53 ml/min/1.73 m）年龄更大，且更易患糖尿病、心血管疾病和高血压。CKD 3 期、2 期和非 CKD 患者的骨折状态患病率分别为 14.9%、10.8%和 9.0%。按年龄分层或在调整了人口统计学和临床参数后，CKD 患者与非 CKD 患者的骨折状态患病率相似。在 CKD 3 期（每降低 1 个标准差，标准化优势比[sOR]为 1.525[1.200 至 1.939]）、2 期（sOR 为 1.415[1.310 至 1.530]）和非 CKD 患者中，QUS 硬度指数与骨折状态均相关（sOR 为 1.477[1.361 至 1.602]）。血压、降压药和骨折状态之间的关系呈 U 型，在 CKD 进展过程中均呈此模式。