Bone Mineral Density in End-Stage Renal Disease Patients: Association with Wasting, Cardiovascular Disease and Mortality

Abstract

Background: Bone and mineral disorders may contribute to extraosseous ossifications and cardiovascular disease (CVD) in end-stage renal disease (ESRD) patients. We have investigated the relationship between bone mineral density (BMD) and inflammation, wasting, CVD and mortality in ESRD patients. Methods: BMD (dual energy X-ray absorptiometry) and biochemical, nutritional and inflammatory markers were assessed in 277 incident ESRD patients (GFR 7.1 ± 0.2 ml/min) who were then followed prospectively for a mean of 27 (range 1–60) months. Carotid plaques were determined in 103 patients. Results: Patients with carotid plaques, clinical manifestation of CVD and wasting (assessed by subjective global assessment) had significantly lower BMD than their counterparts. Low BMD was associated with high all-cause and cardiovascular mortality. Even after adjustment for several confounders and risk factors, all-cause (HR = 2.1, CI: 1.1–3.9, p = 0.02) and cardiovascular (HR = 2.8, CI: 1.2–6.3, p = 0.02) mortality remained significantly associated with low BMD. Conclusions: Low BMD is associated with wasting and CVD, and is an independent predictor of all-cause and cardiovascular mortality in ESRD patients.

Low Hip Bone Mineral Density Predicts Mortality in Maintenance Hemodialysis Patients: A Five-Year Follow-Up Study

“…The association between decreased BMD and mortality has been described previously in non-dialysis and incident dialysis CKD populations [5,6,7]. Few studies have evaluated such relationship in maintenance hemodialysis patients.…”

“…The association between arterial calcification and bone loss is believed to be one of the links that explain the relationship between decreased bone mass and poor cardiovascular outcomes. A handful of studies in non-dialysis and incident dialysis CKD populations reported the relationship between low BMD and cardiovascular disease (CVD) and mortality [5,6,7]. Such data in maintenance hemodialysis patients are lacking.…”

Phosphate – The Silent Stealthy Cardiorenal Culprit in All Stages of Chronic Kidney Disease

“…Moreover, recent clinical studies have shown that higher serum phosphate levels are strongly associated with vascular calcification and cardiovascular mortality among people who receive chronic dialysis [10][11][12][13][14][15] . Block et al [10] described, although in a post hoc analysis of a prospective trial, a direct relationship between hyperphosphatemia and mortality in dialysis patients.…”

Relation of calcium phosphorus product with cardiovascular risk and hscrp in hemodialysis patients

“…Bone mineral metabolism is dysregulated in chronic kidney disease (CKD) patients starting from the early stages [3]. In extensive studies done on this population it is determined that dysregulated bone mineral metabolism is closely associated with increased risk of hi p fracture, cardiovascular disease and increased morbidity and mortality risk [4][5][6][7]. In end-stage renal disease (ESRD) patients, bone mineral densitometry was determined significantly lower than normal population and it is detected that in these patients as the duration of dialysis increases reduction of bone mineral density in densitometer becomes more evident [8].…”