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

Disthabanchong, Sinee; Jongjirasiri, Sutipong; Adirekkiat, Surawat; Sumethkul, V.; Ingsathit, Atiporn; Domrongkitchaiporn, Somnuek; Phakdeekitcharoen, Bunyong; Kantachuvesiri, Surasak; Kitiyakara, Chagriya

doi:10.1159/000357639

Cited by 22 publications

(17 citation statements)

References 30 publications

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“…No differences were found in BMD between hemodialysis and peritoneal dialysis [17]. Low BMD also represents an independent mortality risk factor [18].…”

Section: Introductionmentioning

confidence: 90%

Osteoporosis and Impaired Trabecular Bone Score in Hemodialysis Patients

Brunerová

Ronová

Verešová

et al. 2016

Kidney Blood Press Res

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Background/Aims: Small attention is paid to other types of bone diseases then chronic kidney disease-mineral and bone disorder in dialysis patients. The aim of our study was to assess the occurrence of osteoporosis and bone microarchitecture by trabecular bone score in this population. Methods: 59 patients (67.6 ± 13.1 years, 43 males) treated with hemodiafIltration underwent densitometry (Lunar Prodigy, TBS software 2.1.2) and laboratory assessment. Results: Osteoporosis was observed in 34% patients, high bone turnover was found in 80% of them, with SHPT (PTH > 300 ng/l) present in 69%. TBS was significantly decreased in 47.5% of the patients. TBS correlated with T- and Z-scores of the lumbar spine and proximal femur in the total population (P < 0.0001) and in men (P < 0.00001) and there were significant differences between TBS in groups with normal densitometry, osteopenia, and osteoporosis, both in total population (P < 0.0001; P < 0.01) and in men (P < 0.001; P < 0.001). Conclusions: Osteoporosis was found in about 1/3 of patients treated with hemodiafiltration. Normal TBS was found in only 1/4 of the dialysis population. TBS correlated with densitometric parameters and was significantly different relative to T-scores.

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“…No differences were found in BMD between hemodialysis and peritoneal dialysis [17]. Low BMD also represents an independent mortality risk factor [18].…”

Section: Introductionmentioning

confidence: 90%

Osteoporosis and Impaired Trabecular Bone Score in Hemodialysis Patients

Brunerová

Ronová

Verešová

et al. 2016

Kidney Blood Press Res

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“…Comparing to general population of the same age, the severity of atherosclerosis and vascular calcification in CKD patients is intensified by the prolonged exposure to phosphate retention, the increased calcium load from calcium based phosphate binder and high dialysate calcium and the presence of uremia and inflammation [51,52] . The prevalence of coronary artery calcification (CAC) in dialysis patients ranges between 80%90% [53,54] . In a study that evaluated vascular calcification at the time of transplantation found the presence of CAC in 65% [55] .…”

Section: Vascular Calcificationmentioning

confidence: 99%

Mineral and bone disorder after kidney transplantation

Taweesedt

Disthabanchong

2015

WJT

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After successful kidney transplantation, accumulated waste products and electrolytes are excreted and regulatory hormones return to normal levels. Despite the improvement in mineral metabolites and mineral regulating hormones after kidney transplantation, abnormal bone and mineral metabolism continues to present in most patients. During the first 3 mo, fibroblast growth factor-23 (FGF-23) and parathyroid hormone levels decrease rapidly in association with an increase in 1,25-dihydroxyvitamin D production. Renal phosphate excretion resumes and serum calcium, if elevated before, returns toward normal levels. FGF-23 excess during the first 3-12 mo results in exaggerated renal phosphate loss and hypophosphatemia occurs in some patients. After 1 year, FGF-23 and serum phosphate return to normal levels but persistent hyperparathyroidism remains in some patients. The progression of vascular calcification also attenuates. High dose corticosteroid and persistent hyperparathyroidism are the most important factors influencing abnormal bone and mineral metabolism in long-term kidney transplant (KT) recipients. Bone loss occurs at a highest rate during the first 6-12 mo after transplantation. Measurement of bone mineral density is recommended in patients with estimated glomerular filtration rate > 30 mL/min. The use of active vitamin D with or without bisphosphonate is effective in preventing early post-transplant bone loss. Steroid withdrawal regimen is also beneficial in preservation of bone mass in long-term. Calcimimetic is an alternative therapy to parathyroidectomy in KT recipients with persistent hyperparathyroidism. If parathyroidectomy is required, subtotal to near total parathyroidectomy is recommended. Performing parathyroidectomy during the waiting period prior to transplantation is also preferred in patients with severe hyperparathyroidism associated with hypercalcemia.

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“…Evaluation of the effects of ELF-PEMF in our patients did not have the aim to investigate the effects on osteoporosis because, as mentioned above, the role and usefulness of DXA in assessing bone status is not well defined. But it was demonstrated that patients with ESRD and low BMD have a significantly shorter survival and that reduced BMD is also predictive of increased allcause mortality and cardiovascular mortality [14][15][16][17] . According to the eldest cross-sectional study of von der Recke et al 17 , low hip BMD seems to predict all-cause mortality in ESRD patients after adjustment for age, years of menopause, presence of hypertension, smoking, and abnormalities in the lipid profile.…”

Section: Discussionmentioning

confidence: 99%

The effects of extreme low frequency pulsed electromagnetic field on bone mineral density and incidence of fractures in patients with end - stage renal disease on dialysis - three year follow up study

et al. 2018

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Background/Aim. A variety of physical therapy options has been developed for the treatment of musculoskeletal disorders including those characterized with low bone mineral density (BMD). Extreme low frequency pulsed electromagnetic field (ELF-PEMF) can accelerate bone formation. Patients with end stage of renal disease (ESRD) are predisposed to high incidence of fractures due to bone disorder with multifactorial pathogenesis. Vitamin D, calcium supplements, antiresorptive and anabolic drugs in those patients have changed pharmacodynamics and pharmacokinetics and have minimal or limited effects. The aim of this study was to assess the effectiveness of longterm ELF-PEMF therapy applied in concordance with physical exercise on bone mass, incidence of new bone fractures and parathyroid hormone concentrations in ESRD patients on dialysis. Methods. In this 3-year prospective clinical trial, 151 patients with ESRD on dialysis program were subjected to treatment with ELF-PEMF (18 Hz, 2 mT) applied during 40 min after 10 consecutive dialysis procedures, 4 times through one year (120 treatments in total during three years) together with kinesitherapy (study group) or only with kinesitherapy (control group) on the voluntary basis. Results. Total of 124 patients have completed the study. In the study group (n = 54), regardless of sex, significant improvements of BMD, T-score and Z-score on both lumbar spine and femoral neck were achieved after 3-year treatment with ELF-PEMF. In the control group (n = 70), significant decreases of BMD, T-score and Z-score as well as the higher incidence of new bone fractures were recorded. Conclusion. ELF-PEMF could be a convenient and safe non-pharmacological therapeutic strategy for fracture prevention in nephrology practices.

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

Cited by 22 publications

References 30 publications

Osteoporosis and Impaired Trabecular Bone Score in Hemodialysis Patients

Osteoporosis and Impaired Trabecular Bone Score in Hemodialysis Patients

Mineral and bone disorder after kidney transplantation

The effects of extreme low frequency pulsed electromagnetic field on bone mineral density and incidence of fractures in patients with end - stage renal disease on dialysis - three year follow up study

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