Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Ren Fail. 2022 Dec;44(1):381-391. doi: 10.1080/0886022X.2022.2043375.
Chronic kidney disease (CKD) negatively affects bone strength; however, the osteoporotic conditions in patients with CKD are not fully understood. Moreover, the changes in bone microstructure between pre-dialysis and dialysis are unknown. High-resolution peripheral quantitative computed tomography (HR-pQCT) reveals the three-dimensional microstructures of the bone. We aimed to evaluate bone microstructures in patients with different stages of CKD. This study included 119 healthy men and 40 men admitted to Nagasaki University Hospital for inpatient education or the initiation of hemodialysis. The distal radius and tibia were scanned with HR-pQCT. Patient clinical characteristics and bone microstructures were evaluated within 3 months of initiation of hemodialysis (in patients with CKD stage 5 D), patients with CKD stage 4-5, and healthy volunteers. Cortical bone parameters were lower in the CKD group than in healthy controls. Tibial cortical and trabecular bone parameters (cortical thickness, cortical area, trabecular volumetric bone mineral density, trabecular-bone volume fraction, and trabecular thickness) differed between patients with CKD stage 5 D and those with CKD stage 4-5 ( < 0.01). These differences were also observed between patients with CKD stage 5 and those with CKD stage 5 D ( < 0.017), but not between patients with CKD stage 4 and those with CKD stage 5, suggesting that the bone microstructure rapidly changed at the start of hemodialysis. Patients with CKD stage 5 D exhibited tibial microstructural impairment compared with those with CKD stage 4-5. HR-pQCT is useful for elucidation of the pathology of bone microstructures in patients with renal failure.
慢性肾脏病 (CKD) 会对骨骼强度产生负面影响；然而，CKD 患者的骨质疏松情况尚未完全明了。此外，透析前和透析期间骨微观结构的变化也不清楚。高分辨率外周定量计算机断层扫描 (HR-pQCT) 可揭示骨骼的三维微观结构。我们旨在评估不同 CKD 阶段患者的骨微观结构。这项研究纳入了 119 名健康男性和 40 名因住院教育或开始血液透析而入住长崎大学医院的男性。使用 HR-pQCT 扫描桡骨远端和胫骨。在开始血液透析（CKD 5 期 D 患者）、CKD 4-5 期患者和健康志愿者的 3 个月内评估患者的临床特征和骨微观结构。与健康对照组相比，CKD 组的皮质骨参数较低。与 CKD 4-5 期患者相比，CKD 5 期 D 患者的胫骨皮质和小梁骨参数（皮质厚度、皮质面积、小梁体积骨密度、小梁骨体积分数和小梁厚度）不同（ < 0.01）。在 CKD 5 期和 CKD 5 期 D 患者之间也观察到了这些差异（ < 0.017），但在 CKD 4 期和 CKD 5 期患者之间没有观察到差异，表明骨微观结构在血液透析开始时迅速发生变化。与 CKD 4-5 期患者相比，CKD 5 期 D 患者的胫骨微观结构受损。HR-pQCT 有助于阐明肾衰竭患者的骨骼微观结构病理。
