Impaired muscle strength is associated with fractures in hemodialysis patients

Jamal, Sophie A.; Leiter, Richard E.; Jassal, Vanita; Hamilton, Celeste J.; Bauer, Douglas C.

doi:10.1007/s00198-006-0133-y

Cited by 79 publications

(54 citation statements)

References 45 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…We did not distinguish traumatic from atraumatic fractures and falls are a major determinant of fractures. 13 Unfortunately, we did not collect data on muscle strength, falls, or physical activity in the EVOLVE trial. Although we accounted for the use of selected concomitant medications (phosphate binders, vitamin D sterols, and several other drugs prescribed at baseline), it is possible that participants took other medications at baseline or throughout the trial that might have made clinical fractures more or less likely.…”

Section: Discussionmentioning

confidence: 99%

“…8,9 Risk factors associated with fractures in patients with CKD include older age, female sex, lower serum albumin, prior kidney transplantation, peripheral vascular disease, muscle weakness, falls, and the administration of psychoactive medications. 2,3,[10][11][12][13][14] Thus, abnormalities of bone in terms of both quality and quantity, variable biochemical abnormalities, and multiple comorbid conditions are likely to contribute to the pathogenesis of fractures in ESRD. The complexity and nature of CKD-mineral and bone disorder (MBD) may also render conventional therapy for osteoporosis and osteopenia ineffective or possibly harmful in CKD or ESRD.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Effects of Cinacalcet on Fracture Events in Patients Receiving Hemodialysis

Moe

Abdalla

Chertow

et al. 2015

Journal of the American Society of Nephrology

178

116

View full text Add to dashboard Cite

Fractures are frequent in patients receiving hemodialysis. We tested the hypothesis that cinacalcet would reduce the rate of clinical fractures in patients receiving hemodialysis using data from the Evaluation of Cinacalcet HCl Therapy to Lower Cardiovascular Events trial, a placebo-controlled trial that randomized 3883 hemodialysis patients with secondary hyperparathyroidism to receive cinacalcet or placebo for #64 months. This study was a prespecified secondary analysis of the trial whose primary end point was all-cause mortality and non-fatal cardiovascular events, and one of the secondary end points was first clinical fracture event. Clinical fractures were observed in 255 of 1935 (13.2%) patients randomized to placebo and 238 of 1948 (12.2%) patients randomized to cinacalcet. In an unadjusted intention-to-treat analysis, the relative hazard for fracture (cinacalcet versus placebo) was 0.89 (95% confidence interval [95% CI], 0.75 to 1.07). After adjustment for baseline characteristics and multiple fractures, the relative hazard was 0.83 (95% CI, 0.72 to 0.98). Using a prespecified lag-censoring analysis (a measure of actual drug exposure), the relative hazard for fracture was 0.72 (95% CI, 0.58 to 0.90). When participants were censored at the time of cointerventions (parathyroidectomy, transplant, or provision of commercial cinacalcet), the relative hazard was 0.71 (95% CI, 0.58 to 0.87). Fracture rates were higher in older compared with younger patients and the effect of cinacalcet appeared more pronounced in older patients. In conclusion, using an unadjusted intention-to-treat analysis, cinacalcet did not reduce the rate of clinical fracture. However, when accounting for differences in baseline characteristics, multiple fractures, and/or events prompting discontinuation of study drug, cinacalcet reduced the rate of clinical fracture by 16%-29%. 26: 146626: -147526: , 201526: . doi: 10.1681 Patients with end stage renal disease (ESRD) on dialysis have increased risk of fractures compared with the general population. 1 Fracture incidence rates vary by geographic region, although rates are consistently higher in patients with CKD than matched controls from the same country. [2][3][4][5][6] Depending on the study, 10%-52% of patients receiving dialysis J Am Soc Nephrol

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Effects of Cinacalcet on Fracture Events in Patients Receiving Hemodialysis

Moe

Abdalla

Chertow

et al. 2015

Journal of the American Society of Nephrology

178

116

View full text Add to dashboard Cite

show abstract

“…Low BMD is associated strongly and consistently with increased risk of fracture in otherwise healthy men and women (4,26,27). ESRD patients with a low bone mass usually have a high incidence of fragility fracture (8,28,29). Decreased bone mass and disruption of microarchitecture occur early in the course of ESRD and worsen with the progressive decline in renal function, so much so that at the time of initiation of dialysis, at least 50% of patients have had a fracture (30).…”

Section: Discussionmentioning

confidence: 99%

The Osteoporotic Effect of Arteriovenous Fistula on the Ipsilateral Upper Extremity in Hemodialysis Patients

...

2012

Tftr

View full text Add to dashboard Cite

Objective: Hemodialysis requires an arteriovenous fistula (AVF), the presence of which may influence the structure of nearby bone. This study analyzed the effect of AVF on ipsilateral upper extremity bone mineral density (BMD), as measured by phalangeal radiographic absorptiometry (RA). Materials and Methods:In this cross-sectional study, phalangeal BMD was measured in both arms by RA in a convenience sample of end-stage renal disease (ESRD) patients with a forearm AVF. Patients were excluded if the patient had pathology which might affect distal arm circulation. BMD values (g/cm 2 ) from forearms with AVF were compared with values from forearms without AVF. Predialysis values of complete blood count, calcium, phosphorus, alkaline phosphatase, parathyroid hormone, urea, creatinine, potassium, albumin, total cholesterol, HDL cholesterol, and LDL cholesterol were determined in all patients; dialysis adequacy values were also calculated. Results: One hundred and sixteen patients agreed to participate in the study. Thirty-three patients were excluded, thus, data were analyzed from 83 patients (59% male, 41% female, mean hemodialysis time: 156±6 months, mean age: 53±16 years). AVFs were located in the nondominant hand in all patients. Phalangeal BMD in forearms with AVF (0.28±0.05 g/cm 2 , range: 0.14-0.40) was significantly lower than that in the contralateral forearm (0.30±0.04 g/cm 2 , range: 0.19-0.40, p<0.05). Conclusion: In ESRD patients on hemodialysis, BMD is lower in the ipsilateral-to-AVF hand compared to the contralateral-to-AVF hand. In these patients, further investigations should be made to ascertain the ability of BMD assessment in determining fracture risk and to prompt physicians to initiate treatments which will preserve BMD and reduce fractures. Turk J Phys Med Rehab 2013;59:236-41. Key Words: Osteoporosis, bone mineral density, phalangeal radiographic absorptiometry, arteriovenous fistula Özet Amaç: Hemodiyaliz hastalarındaki arterio-venöz fistül (AVF), çevresindeki kemik dokunun yapısını etkileyebilir. Bu çalışmada falangial radyografik absorbsiyometri (RA) ölçümü ile AVF'nin ipsilateral üst ekstremite kemik mineral yoğunluğu (KMY) üzerine etkisi araştırılacaktır. Gereç ve Yöntem: Bu kesitsel çalışmada, ön kollarında AVF olan son dönem böbrek yetmezlikli hastaların (SDBY) falangial KMY değerleri her iki koldan RA ile ölçüldü. Distal kol dolaşımını etkileyebilecek herhangi bir patolojisi olan hastalar çalışma dışı bırakıldı. Fistüllü kol falangial KMY değerleri (g/ cm 2 ) fistülsüz kol falangial KMY değerleri (g/cm 2 ) ile karşılaştırıldı. Tüm hastalara diyaliz öncesi tam kan sayımı yapıldı, kalsiyum, fosfor, alkalen fosfataz, paratiroid hormon, üre, kreatinin, potasyum, albümin, total kolesterol, HDL kolesterol ve LDL kolesterol değerleri ölçüldü; diyaliz yeterliliği değerleri hesaplandı. Bulgular: Çalışmaya 116 hasta katıldı. Otuz üç hasta çalışma dışı bırakıldı, 83 hastanın sonuçları değerlendirildi. Hastaların %59'u erkek, %41'i kadın olup, hemodiyalize girme süreleri 156± 6 ay ve yaşları 53±...

show abstract

“…Such derangements also likely contribute to tendon ruptures, which are relatively rare but serious events in patients on dialysis (14,15). Derangements include abnormalities directly linked with the mineral bone disorder of CKD, those associated with CKD (such as poor muscle strength or disturbances in body balance), the risk of orthostasis associated with large ultrafiltration volumes, and general risk factors (such as diabetes and osteoporosis) (1,2,16). Several factors have been associated with increased fracture risk in the dialysis population, including older age, female sex, longer dialysis duration, diabetes, and derangements in parathyroid hormone (PTH), among others (8)(9)(10)(11)(12)(17)(18)(19)(20)(21)(22)(23).…”

Section: Introductionmentioning

confidence: 99%

Geovariation in Fracture Risk among Patients Receiving Hemodialysis

Wetmore

Liu

Wirtz³

et al. 2016

CJASN

View full text Add to dashboard Cite

Background and objectives Fractures are a major source of morbidity and mortality in patients receiving dialysis. We sought to determine whether rates of fractures and tendon ruptures vary geographically.Design, setting, participants, & measurements Data from the US Renal Data System were used to create four yearly cohorts, 2007-2010, including all eligible prevalent patients on hemodialysis in the United States on January 1 of each year. A secondary analysis comprising patients in a large dialysis organization conducted over the same period permitted inclusion of patient-level markers of mineral metabolism. Patients were grouped into 10 regions designated by the Centers for Medicare and Medicaid Services and divided by latitude into one of three bands: south, ,35°; middle, 35°to ,40°; and north, $40°. Poisson regression was used to calculate unadjusted and adjusted region-level rate ratios for events.Results Overall, 327,615 patients on hemodialysis were included. Mean (SD) age was 61.8 (15.0) years old, 52.7% were white, and 55.0% were men. During 716,962 person-years of follow-up, 44,014 fractures and tendon ruptures occurred, the latter being only 0.3% of overall events. Event rates ranged from 5.36 to 7.83 per 100 person-years, a 1.5-fold rate difference across regions. Unadjusted region-level rate ratios varied from 0.83 (95% confidence interval, 0.81 to 0.85) to 1.20 (95% confidence interval, 1.18 to 1.23), a 1.45-fold rate difference. After adjustment for a wide range of case mix variables, a 1.33-fold variation in rates remained. Rates were higher in north and middle bands than the south (north rate ratio, 1.18; 95% confidence interval, 1.13 to 1.23; middle rate ratio, 1.13; 95% confidence interval, 1.10 to 1.17). Latitude explained 11% of variation, independent of region. A complementary analysis of 87,013 patients from a large dialysis organization further adjusted for circulating mineral metabolic parameters and protein energy wasting yielded similar results.Conclusions Rates of fractures vary geographically in the United States dialysis population, even after adjustment for known patient characteristics. Latitude seems to contribute to this phenomenon, but additional analyses exploring whether other factors might influence variation are warranted.

show abstract

Impaired muscle strength is associated with fractures in hemodialysis patients

Abstract: Impaired neuromuscular function is associated with fracture in hemodialysis patients.

Cited by 79 publications

References 45 publications

Effects of Cinacalcet on Fracture Events in Patients Receiving Hemodialysis

Effects of Cinacalcet on Fracture Events in Patients Receiving Hemodialysis

The Osteoporotic Effect of Arteriovenous Fistula on the Ipsilateral Upper Extremity in Hemodialysis Patients

Geovariation in Fracture Risk among Patients Receiving Hemodialysis

Contact Info

Product

Resources

About