早期慢性肾脏病中衰弱与骨骼健康的关联：一项基于人群的CARTaGENE队列研究

Association between frailty and bone health in early-stage chronic kidney disease: a study from the population-based CARTaGENE cohort.

作者信息

Dufour Aurélie, Kurtz Kelly-Anne, Vachey Clément, Mac-Way Fabrice

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, Quebec City, Quebec, Canada.

出版信息

Clin Kidney J. 2025 Jan 16;18(2):sfaf015. doi: 10.1093/ckj/sfaf015. eCollection 2025 Feb.

DOI:10.1093/ckj/sfaf015

PMID:40235628

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11997783/

Abstract

BACKGROUND

Frailty is a clinical syndrome that is particularly prevalent in patients with chronic kidney disease (CKD). We aimed to assess the associations between renal function and the presence of frailty criteria and to assess the association between frailty and bone outcomes.

METHODS

We have conducted a retrospective study from a population-based cohort, which represents 1% of people aged 40-69 years in a Canadian province, excluding individuals with an estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m. Frailty was defined with Fried's criteria. Bone density was estimated with quantitative ultrasound at the calcaneus measuring speed of sound (SOS) and broadband ultrasound attenuation (BUA). Time to first fracture event was assessed and analyses were conducted using logistic regressions, multiple linear regressions and Cox models.

RESULTS

Overall, 19 973 individuals were included: mean ± standard deviation age 54.2 ± 7.8 years, women 51.6%, 47.0% CKD stage G2, 3.9% CKD stage G3, 34.8% with at least one frailty criterion. We observed a U-shaped association between eGFR and the odds ratio (OR) of presenting at least one frailty criterion, with a minimum OR around 77 mL/min/1.73 m [per a 10 mL/min/1.73 m increase, respectively, for an eGFR <77 and >77, OR = 0.93, 95% confidence interval (CI) 0.86-1.01 and OR 1.09, 95% CI 1.06-1.13]. After a median follow-up of 5.8 years, there were 837 fracture events. Having at least one frailty criterion was negatively associated with SOS (β = -3.97, < .0001) and BUA (β = -1.82, < .0001). Having at least one frailty criterion was associated with a higher fracture risk (hazard ratio 1.23, 95% CI 1.07-1.42).

CONCLUSION

In conclusion, having at least one frailty criterion was associated with a higher risk of fracture and a lower bone mineral density.

摘要

背景

衰弱是一种临床综合征，在慢性肾脏病（CKD）患者中尤为普遍。我们旨在评估肾功能与衰弱标准的存在之间的关联，并评估衰弱与骨骼结局之间的关联。

方法

我们对一个基于人群的队列进行了回顾性研究，该队列代表加拿大一个省份40-69岁人群的1%，排除了估计肾小球滤过率（eGFR）<30 mL/min/1.73 m²的个体。衰弱采用弗里德标准定义。使用定量超声在跟骨处测量声速（SOS）和宽带超声衰减（BUA）来估计骨密度。评估首次骨折事件的时间，并使用逻辑回归、多元线性回归和Cox模型进行分析。

结果

总体而言，纳入了19973名个体：平均年龄±标准差为54.2±7.8岁，女性占51.6%，47.0%为CKD G2期，3.9%为CKD G3期，34.8%至少有一项衰弱标准。我们观察到eGFR与至少有一项衰弱标准的比值比（OR）之间呈U形关联，最低OR约为77 mL/min/1.73 m²[eGFR<77和>77时，每增加10 mL/min/1.73 m²，OR分别为0.93，95%置信区间（CI）0.86-1.01和OR 1.09，95%CI 1.06-1.13]。中位随访5.8年后，有837例骨折事件。至少有一项衰弱标准与SOS（β=-3.97，P<.0001）和BUA（β=-1.82，P<.0001）呈负相关。至少有一项衰弱标准与较高的骨折风险相关（风险比1.23，95%CI 1.07-1.42）。