慢性肾脏病相关骨质疏松症与糖尿病肾病患者发生虚弱有关：一项倾向评分匹配队列研究。
Chronic kidney disease-related osteoporosis is associated with incident frailty among patients with diabetic kidney disease: a propensity score-matched cohort study.
机构信息
Department of Internal Medicine, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan.
Geriatric and Community Medicine Research Center, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan.
出版信息
Osteoporos Int. 2020 Apr;31(4):699-708. doi: 10.1007/s00198-020-05353-9. Epub 2020 Feb 27.
UNLABELLED
Chronic kidney disease (CKD)-related osteoporosis is a major complication in patients with CKD, conferring a higher risk of adverse outcomes. We found that among those with diabetic kidney disease, this complication increased the risk of incident frailty, an important mediator of adverse outcomes.
INTRODUCTION
Renal osteodystrophy and chronic kidney disease (CKD)-related osteoporosis increases complications for patients with diabetic kidney disease (DKD). Since musculoskeletal degeneration is central to frailty development, we investigated the relationship between baseline osteoporosis and the subsequent frailty risk in patients with DKD.
METHODS
From the Longitudinal Cohort of Diabetes Patients in Taiwan (n = 840,000), we identified 12,027 patients having DKD with osteoporosis and 24,054 propensity score-matched controls having DKD but without osteoporosis. The primary endpoint was incident frailty on the basis of a modified FRAIL scale. Patients were prospectively followed-up until the development of endpoints or the end of this study. The Kaplan-Meier technique and Cox proportional hazard regression were used to analyze the association between osteoporosis at baseline and incident frailty in these patients.
RESULTS
The mean age of the DKD patients was 67.2 years, with 55.4% female and a 12.6% prevalence of osteoporosis at baseline. After 3.5 ± 2.2 years of follow up, the incidence rate of frailty in patients having DKD with osteoporosis was higher than that in DKD patients without (6.6 vs. 5.7 per 1000 patient-year, p = 0.04). A Cox proportional hazard regression showed that after accounting for age, gender, obesity, comorbidities, and medications, patients having DKD with osteoporosis had a significantly higher risk of developing frailty (hazard ratio, 1.19; 95% confidence interval, 1.02-1.38) than those without osteoporosis.
CONCLUSIONS
CKD-related osteoporosis is associated with a higher risk of incident frailty in patients with DKD.
目的
慢性肾脏病（CKD）相关骨质疏松症是 CKD 患者的主要并发症，增加了不良结局的风险。我们发现，在患有糖尿病肾病的患者中，这种并发症增加了虚弱的发病风险，而虚弱是不良结局的一个重要中介。
背景
肾性骨营养不良和 CKD 相关骨质疏松症增加了糖尿病肾病（DKD）患者的并发症。由于肌肉骨骼退化是虚弱发展的核心，我们研究了基线骨质疏松症与 DKD 患者随后发生虚弱的风险之间的关系。
方法
我们从台湾糖尿病患者纵向队列（n=840000）中确定了 12027 例患有 DKD 且合并骨质疏松症的患者和 24054 例患有 DKD 但无骨质疏松症的倾向评分匹配对照者。主要终点是根据改良 FRAIL 量表定义的新发虚弱。对患者进行前瞻性随访，直至终点事件发生或本研究结束。采用 Kaplan-Meier 技术和 Cox 比例风险回归分析基线骨质疏松症与这些患者新发虚弱的关系。
结果
DKD 患者的平均年龄为 67.2 岁，女性占 55.4%，基线时骨质疏松症的患病率为 12.6%。在 3.5±2.2 年的随访后，患有 DKD 且合并骨质疏松症的患者发生虚弱的发生率高于无骨质疏松症的患者（每 1000 患者年分别为 6.6 例和 5.7 例，p=0.04）。Cox 比例风险回归显示，在考虑年龄、性别、肥胖、合并症和药物治疗后，患有 DKD 且合并骨质疏松症的患者发生虚弱的风险显著高于无骨质疏松症的患者（风险比，1.19；95%置信区间，1.02-1.38）。
结论
CKD 相关骨质疏松症与 DKD 患者新发虚弱的风险增加相关。
Zotero 插件