Risk factors leading to reduced bone mineral density in hemodialysis patients with metabolic syndrome

Binici, Doğan Nasır; Güneş, Nurettin

doi:10.3109/08860221003675260

Cited by 20 publications

(12 citation statements)

References 24 publications

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“…Calcium levels positively correlated with BMD at all measured sites. Several studies in CKD patients have not previously reported this association 25,[38][39][40] . It should be noted that calcium levels in our study were measured only during the three months before the determination of BMD and therefore do not reflect the long-term impact of calcium levels on BMD.…”

Section: Both Gender Females Malesmentioning

confidence: 90%

“…Several studies of dialysis patients have reported the same findings [21][22][23][24] . On the other hand, some other stud- [25][26][27] ). In our study, no statistically significant differences were found either in BMD values (expressed as g/cm 2 and T-score) or in the prevalence of T-scores ≤ -2.5 SD between non-diabetic and diabetic patients.…”

Section: Both Gender Females Malesmentioning

confidence: 99%

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Evaluation of biochemical markers and bone mineral density in patients with chronic kidney disease stage 5D at the start of hemodialysis treatment

Valkovský¹,

R²,

Tvrdík³

et al. 2015

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Background. Patients with chronic kidney disease (CKD) have significant disorders of bone and mineral metabolism. In addition, they can also develop other bone disorders including osteoporosis. This study evaluated the bone mineral density (BMD) of patients at the start of hemodialysis treatment as well as the relationship between BMD and possible risk factors or biochemical markers. Methods. The study was performed in 82 patients (28 females, 54 males). BMD was measured by dual-energy X-ray absorptiometry (DXA) at the lumbar spine and the proximal femur. Results. We found a high prevalence of 25-hydroxyvitamin D deficiency (96%; mean levels 30.0 ± 17.7 nmol/L) and a reduction of BMD in comparison with gender-and age-matched normal population values at the total hip (Z-score = -0.31 ± 1.11) and the femoral neck (Z-score = -0.48 ± 1.16), but not at the lumbar spine (Z-score = 0.68 ± 1.81). The prevalence of T-scores ≤ -2.5 SD in the group of patients over 50 years was 52.0% in females and 33.3% in males. BMD positively correlated: with male gender and calcium levels at all measured sites, with age at the lumbar spine and with weight or BMI at the proximal femur. Conclusion. CKD patients at the start of hemodialysis treatment had a high prevalence of low T-score values, corresponding to values for osteoporosis in the general population. BMD at the proximal femur was below the expected average for age and gender, but at the lumbar spine, BMD in hemodialysis patients was above average in persons without known CKD.

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Section: Both Gender Females Malesmentioning

confidence: 90%

Section: Both Gender Females Malesmentioning

confidence: 99%

Evaluation of biochemical markers and bone mineral density in patients with chronic kidney disease stage 5D at the start of hemodialysis treatment

Valkovský¹,

R²,

Tvrdík³

et al. 2015

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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“…95 Binici and Gunes 96 found no association between heparin use and reduced bone mineral density in hemodialysis patients with metabolic syndrome. Lai et al 97 found that bone mineral density was lower in a cohort of 40 stable hemodialysis patients treated with heparin than in age-matched controls without either kidney disease or heparin use, but this was confounded because bone mineral metabolism is deranged in all patients with kidney failure.…”

Section: Complications Of Ufh Usementioning

confidence: 97%

Use and Safety of Unfractionated Heparin for Anticoagulation During Maintenance Hemodialysis

Shen

Winkelmayer

2012

American Journal of Kidney Diseases

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Anticoagulation is essential to hemodialysis, and unfractionated heparin (UFH) is the most commonly used anticoagulant in the United States. However, there is no universally accepted standard for its administration in long-term hemodialysis. Dosage schedules vary and include weight-based protocols and low-dose protocols for those at high risk of bleeding, as well as regional anticoagulation with heparin and heparin-coated dialyzers. Adjustments are based largely on clinical signs of under- and overanticoagulation. Risks of UFH use include bleeding, heparin-induced thrombocytopenia, hypertriglyceridemia, anaphylaxis, and possibly bone mineral disease, hyperkalemia, and catheter-associated sepsis. Alternative anticoagulants include low-molecular-weight heparin, direct thrombin inhibitors, heparinoids, and citrate. Anticoagulant-free hemodialysis and peritoneal dialysis also are potential substitutes. However, some of these alternative treatments are not as available as or are more costly than UFH, are dependent on country and health care system, and present dosing challenges. When properly monitored, UFH is a relatively safe and economical choice for anticoagulation in long-term hemodialysis for most patients.

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“…Increasing age, diabetes, smoking, glucocorticoid therapy, and mineral metabolism have been described as risk factors for bone loss (19,20). The prevalence of CAC is also elevated among nondialyzed CKD patients and it has been associated with future cardiovascular events, hospitalization, and mortality (12).…”

Section: Discussionmentioning

confidence: 99%

Is Coronary Artery Calcification Associated with Vertebral Bone Density in Nondialyzed Chronic Kidney Disease Patients?

Filgueira

Carvalho

Tomiyama

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Low bone mineral density and coronary artery calcification (CAC) are highly prevalent among chronic kidney disease (CKD) patients, and both conditions are strongly associated with higher mortality. The study presented here aimed to investigate whether reduced vertebral bone density (VBD) was associated with the presence of CAC in the earlier stages of CKD.Design, setting, participants, & measurements Seventy-two nondialyzed CKD patients (age 52 Ϯ 11.7 years, 70% male, 42% diabetics, creatinine clearance 40.4 Ϯ 18.2 ml/min per 1.73 m 2 ) were studied. VBD and CAC were quantified by computed tomography.Results CAC Ͼ 10 Agatston units (AU) was observed in 50% of the patients (median 120 AU [interquartile range 32 to 584 AU]), and a calcification score Ն 400 AU was found in 19% (736 [527 to 1012] AU). VBD (190 Ϯ 52 Hounsfield units) correlated inversely with age (r ϭ Ϫ0.41, P Ͻ 0.001) and calcium score (r ϭ Ϫ0.31, P ϭ 0.01), and no correlation was found with gender, creatinine clearance, proteinuria, lipid profile, mineral parameters, body mass index, and diabetes. Patients in the lowest tertile of VBD had expressively increased calcium score in comparison to the middle and highest tertile groups. In the multiple logistic regression analysis adjusting for confounding variables, low VBD was independently associated with the presence of CAC.Conclusions Low VBD was associated with CAC in nondialyzed CKD patients. The authors suggest that low VBD might constitute another nontraditional risk factor for cardiovascular disease in CKD.

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Risk factors leading to reduced bone mineral density in hemodialysis patients with metabolic syndrome

Cited by 20 publications

References 24 publications

Evaluation of biochemical markers and bone mineral density in patients with chronic kidney disease stage 5D at the start of hemodialysis treatment

Evaluation of biochemical markers and bone mineral density in patients with chronic kidney disease stage 5D at the start of hemodialysis treatment

Use and Safety of Unfractionated Heparin for Anticoagulation During Maintenance Hemodialysis

Is Coronary Artery Calcification Associated with Vertebral Bone Density in Nondialyzed Chronic Kidney Disease Patients?

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