Renal osteodystrophy and clinical outcomes: data from the Brazilian Registry of Bone Biopsies - REBRABO

Abstract

<jats:p>ABSTRACT Introduction: Mineral and bone disorders (MBD) are major complications of chronic kidney disease (CKD)-related adverse outcomes. The Brazilian Registry of Bone Biopsy (REBRABO) is an electronic database that includes renal osteodystrophy (RO) data. We aimed to describe the epidemiological profile of RO in a sample of CKD-MBD Brazilian patients and understand its relationship with outcomes. Methods: Between August 2015 and March 2018, 260 CKD-MBD stage 3-5D patients who underwent bone biopsy were followed for 12 to 30 months. Clinical-demographic, laboratory, and histological data were analyzed. Bone fractures, hospitalizations, and death were considered the primary outcomes. Results: Osteitis fibrosa, mixed uremic osteodystrophy, adynamic bone disease, osteomalacia, osteoporosis, and aluminum (Al) accumulation were detected in 85, 43, 27, 10, 77, and 65 patients, respectively. The logistic regression showed that dialysis vintage was an independent predictor of osteoporosis (OR: 1.005; CI: 1.001-1.010; p = 0.01). The multivariate logistic regression revealed that hemodialysis treatment (OR: 11.24; CI: 1.227-100; p = 0.03), previous parathyroidectomy (OR: 4.97; CI: 1.422-17.241; p = 0.01), and female gender (OR: 2.88; CI: 1.080-7.679; p = 0.03) were independent predictors of Al accumulation; 115 patients were followed for 21 ± 5 months. There were 56 hospitalizations, 14 deaths, and 7 fractures during follow-up. The COX regression revealed that none of the variable related to the RO/turnover, mineralization and volume (TMV) classification was an independent predictor of the outcomes. Conclusion: Hospitalization or death was not influenced by the type of RO, Al accumulation, or TMV classification. An elevated prevalence of osteoporosis and Al accumulation was detected.</jats:p>

A review and perspective on the assessment, management and prevention of fragility fractures in patients with osteoporosis and chronic kidney disease

“…Importantly, the histological characteristics of bone from CKD patients who fracture and whether a bone biopsy diagnosis will improve management to prevent clinical fractures, hospitalisation and mortality are unknown. A recent study examined this issue in 260 patients with CKD stages 3–5D with 12–30 months follow up [ 26 ]. Bone histology was available in 67% of patients.…”

Ginsenoside Rg3 Alleviates Aluminum Chloride-Induced Bone Impairment in Rats by Activating the TGF-β1/Smad Signaling Pathway

“…8 Some studies have proved that long-term accumulation of Al can cause osteitis fibrosa, mixed uremic osteodystrophy, osteomalacia, and osteoporosis. 28,29 Previous studies in our laboratory have demonstrated that AlCl 3 can cause bone impairment, which is detected by histological staining and transmission electron microscopy, through the TGF-β1/Smad signaling pathway, which is one of the main mechanisms. 11 Subsequently, we further confirmed that Rg3 has the effect of bone protection.…”

Bone Biopsy for Histomorphometry in Chronic Kidney Disease (CKD): State-of-the-Art and New Perspectives

“…In recent decades the definition, classification and treatment of ROD were changed as a consequence of the introduction of new drugs and the prolonged survival of patients ( Table 1 [ 4 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ]). Indeed, Malluche et al highlighted [ 18 ], in 630 bone biopsies carried out in CKD patients, both in Europe and the USA, from 2003 to 2008, a switch from a high bone turnover, as revealed in the past studies, to 58% of patients with a low bone turnover.…”