Department of Internal Medicine, Institute of Clinical Medicine, University of Tartu, Puusepa str. 8, 50406, Tartu, Estonia.
Department of Internal Medicine, Tartu University Hospital, Tartu, Estonia.
BMC Nephrol. 2022 Oct 5;23(1):327. doi: 10.1186/s12882-022-02955-9.
Chronic kidney disease-mineral and bone disorders (CKD-MBD) is characterised by generalised vascular calcification (VC) and impaired bone health. We aimed to investigate the relationship between VC and bone mineral density (BMD) in CKD patients.
We performed a cross-sectional study of patients with different stages of CKD. For assessment of VC of abdominal aorta lateral lumbar X-rays (Kauppila score), the ankle-brachial index (ABI) and echocardiography were used. Total body densitometry provided BMD.
Ninety patients (41% male, median age 64 years (range 29-87)) were included, of whom 41.1% had a Kauppila score > 1. Evidence of peripheral VC as measured by ABI was detected in 23.3% of cases. Lesions of the heart valves were found in 46.7% of patients. There was a significant association between high ABI and lesions of the heart valves. In the multivariate regression model to analyse the independent determinants of abdominal aorta calcification (AAC) and ABI, the BMD of the femoral neck was identified as significant for both (p = 0.001, p = 0.001). The total spine BMD was found to be significant for AAC (p = 0.001), and the BMD of spine L1-L4 and the ribs were found to be significant for ABI (p = 0.01, p = 0.002 respectively). In factorial regression analysis, where BMD was independent determinant, valvular calcification was significant for BMD of femur, femoral neck and total BMD. Age and tALP were inversely correlated with the BMD of femur and femoral neck.
Our work highlighted clinically important relationships between VC and bone mineral density (BMD) in CKD patients. We detected inverse relationships between AAC, high ABI and BMD. Secondly, BMD at certain bone sites (femur, femoral neck) and total BMD were associated with important lesions of heart valves. Thirdly, a significant association between a high ABI and lesions of the heart valves. We believe that the results of our study will help in the planning of future research and in current clinical practice for the early diagnosis, further monitoring and management of CKD-MBD. Additionally, these results may have treatment implications on use of different CKD-MBD medications.
慢性肾脏病-矿物质和骨异常（CKD-MBD）的特征是全身性血管钙化（VC）和骨骼健康受损。本研究旨在探讨 CKD 患者的 VC 与骨密度（BMD）之间的关系。
我们对不同 CKD 阶段的患者进行了横断面研究。使用腹部主动脉侧腰椎 X 射线（Kauppila 评分）、踝臂指数（ABI）和超声心动图评估 VC。全身密度测量提供 BMD。
共纳入 90 例患者（41%为男性，中位年龄 64 岁（范围 29-87 岁）），其中 41.1%的 Kauppila 评分>1。通过 ABI 检测到 23.3%的患者存在外周 VC。46.7%的患者存在心脏瓣膜病变。ABI 高与心脏瓣膜病变之间存在显著相关性。在分析腹部主动脉钙化（AAC）和 ABI 的独立决定因素的多元回归模型中，发现股骨颈 BMD 对两者均有显著影响（p=0.001，p=0.001）。脊柱总骨密度（TBS）对 AAC 有显著影响（p=0.001），脊柱 L1-L4 及肋骨的 BMD 对 ABI 有显著影响（p=0.01，p=0.002）。在 BMD 为独立决定因素的析因回归分析中，瓣膜钙化与股骨、股骨颈和总 BMD 显著相关。年龄和 tALP 与股骨和股骨颈 BMD 呈负相关。
本研究强调了 CKD 患者 VC 与骨矿物质密度（BMD）之间的临床重要关系。我们发现 AAC、ABI 高与 BMD 降低之间存在反向关系。其次，某些骨部位（股骨、股骨颈）和总 BMD 的 BMD 与心脏瓣膜的重要病变相关。第三，ABI 高与心脏瓣膜病变之间存在显著相关性。我们相信，本研究的结果将有助于规划未来的研究和当前的临床实践，以便早期诊断、进一步监测和管理 CKD-MBD。此外，这些结果可能对不同 CKD-MBD 药物的治疗有意义。
