Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, M99 Karolinska University Hospital Huddinge, 14186, Stockholm, Sweden.
Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan.
J Bone Miner Metab. 2021 Mar;39(2):260-269. doi: 10.1007/s00774-020-01144-8. Epub 2020 Sep 4.
Bone loss in end stage renal disease (ESRD) patients associates with fractures, vascular calcification, cardiovascular disease (CVD) and increased mortality. We investigated factors associated with changes of bone mineral density (ΔBMD) during the initial year on dialysis therapy and associations of ΔBMD with subsequent mortality in ESRD patients initiating dialysis.
In 242 ESRD patients (median age 55 years, 61% men) starting dialysis with peritoneal dialysis (PD; n = 138) or hemodialysis (HD; n = 104), whole-body dual-energy X-ray absorptiometry (DXA), body composition, nutritional status and circulating biomarkers were assessed at baseline and 1 year after dialysis start. We used multivariate linear regression analysis to determine factors associated with ΔBMD, and fine and gray competing risk analysis to determine associations of ΔBMD with subsequent mortality risk.
BMD decreased significantly in HD patients (significant reductions of BMD and BMD) but not in PD patients. HD compared to PD therapy associated with negative changes in BMD, BMD, BMD and BMD. Better preservation of BMD associated with significantly lower all-cause mortality for ΔBMD (sub-hazard ratio, sHR, 0.91), ΔBMD (sHR 0.91) and ΔBMD (sHR 0.92), while only ΔBMD (sHR 0.92) had a beneficial effect on CVD-mortality.
PD had beneficial effect compared with HD on BMD changes during first year of dialysis therapy. Better preservation of BMD, especially in bone sites rich in cortical bone, associated with lower subsequent mortality. BMD in cortical bone may have stronger association with clinical outcome than BMD in trabecular bone.
终末期肾病（ESRD）患者的骨丢失与骨折、血管钙化、心血管疾病（CVD）和死亡率增加有关。我们研究了在开始透析治疗的最初一年中与骨密度变化（ΔBMD）相关的因素，以及 ESRD 患者开始透析后ΔBMD 与随后死亡率的相关性。
在 242 名开始透析的 ESRD 患者（中位年龄 55 岁，61%为男性）中，有 138 名接受腹膜透析（PD），104 名接受血液透析（HD）。在透析开始时和 1 年后，对所有患者进行全身双能 X 射线吸收法（DXA）、身体成分、营养状况和循环生物标志物检查。我们使用多元线性回归分析来确定与ΔBMD 相关的因素，并使用精细和灰色竞争风险分析来确定ΔBMD 与随后的死亡率风险的相关性。
HD 患者的 BMD 显著下降（BMD 和 BMD 显著降低），但 PD 患者的 BMD 没有显著下降。与 PD 治疗相比，HD 治疗与 BMD、BMD、BMD 和 BMD 的负性变化相关。ΔBMD 与全因死亡率显著相关（亚危险比 sHR 为 0.91）、ΔBMD（sHR 为 0.91）和 ΔBMD（sHR 为 0.92）更好地保留 BMD，而只有ΔBMD（sHR 为 0.92）对 CVD 死亡率有有益的影响。
与 HD 相比，PD 在透析治疗的第一年对 BMD 变化有有益的影响。更好地保留 BMD，特别是在富含皮质骨的骨部位，与随后的死亡率降低相关。与松质骨相比，皮质骨的 BMD 与临床结局的相关性可能更强。
