Increased Risks of Mortality and Atherosclerotic Complications in Incident Hemodialysis Patients Subsequently with Bone Fractures: A Nationwide Case-Matched Cohort Study

Kuo, Chiu Huang; Hsieh, Tao-shih; Wang, Hsiu-Po; Chou, Chu Lin; Lai, Yu‐Hsien; Chen, Yi Ya; Lin, Yu Li; Wu, Sheng Teng; Fang, Te Chao

doi:10.1371/journal.pone.0121705

Cited by 20 publications

(15 citation statements)

References 26 publications

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“…Finally, one study reported that people with fractures had a similar chance to develop PVD in one study (HR ¼ 1.06; 95% CI, 0.91 to 1.23, p ¼ 0.44). (34)…”

Section: Site Of Fractures and Cvdmentioning

confidence: 99%

Relationship Between Low Bone Mineral Density and Fractures With Incident Cardiovascular Disease: A Systematic Review and Meta-Analysis

Veronese

Stubbs

Crepaldi

et al. 2017

Journal of Bone and Mineral Research

125

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An increasing evidence base suggests that low bone mineral density (BMD) and fractures are associated with cardiovascular disease (CVD). We conducted a systematic review and metaanalysis summarizing the evidence of low BMD and fractures as risk factors for future CVD. Two independent authors searched major databases from inception to 1 st August 2016 for longitudinal studies reporting data on CVD incidence (overall and specific CVD) and BMD status and fractures.The association between low BMD, fractures and CVD across longitudinal studies was explored by calculating pooled adjusted hazard ratios (HRs)±95% confidence intervals (CIs) with a randomeffects meta-analysis. Twenty-eight studies (18 regarding BMD and 10 fractures) followed-up a total of 1,107,885 participants for a median of 5 years. Taking those with higher BMD as the reference, people with low BMD were at increased risk of developing CVD during follow-up (11 studies; HR=1.33; 95%CI: 1.27-1.38; I 2 =53%), after adjusting for a median of 8 confounders. This finding was confirmed using a decrease in one standard deviation of baseline BMD (9 studies; HR=1.16; 95%CI: 1.09-1.24; I 2 =69%). The presence of fractures at baseline was associated with an increased risk of developing CVD (HR=1.20; 95%CI: 1.06-1.37; I 2 =91%). Regarding specific CVD, low BMD was associated with an increased risk of developing coronary artery disease, cerebrovascular conditions, and CVD associated death. Fractures at baseline was associated with an increased risk of cerebrovascular conditions and death due to CVD. In conclusion, low BMD and fractures are associated with a small, but significant increased risk of CVD risk and possibly death.

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“…Finally, one study reported that people with fractures had a similar chance to develop PVD in one study (HR ¼ 1.06; 95% CI, 0.91 to 1.23, p ¼ 0.44). (34)…”

Section: Site Of Fractures and Cvdmentioning

confidence: 99%

Relationship Between Low Bone Mineral Density and Fractures With Incident Cardiovascular Disease: A Systematic Review and Meta-Analysis

Veronese

Stubbs

Crepaldi

et al. 2017

Journal of Bone and Mineral Research

125

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“…Several studies report that nondialysis patients aged over 50 with estimated glomerular filtration rate (eGFR) below 60 mL/min/1.73 m 2 also have a twofold greater risk for hip fractures than individuals without CKD [3–7]. A hip fracture critically limits activities of daily living and increases fracture-related mortality [8–10], and this trend is more evident in dialysis patients [11, 12]. Japanese dialysis patients, however, have relatively better prognosis with regard to survival after a hip fracture [13].…”

Section: Introductionmentioning

confidence: 99%

Molecular Abnormalities Underlying Bone Fragility in Chronic Kidney Disease

Iwasaki

Kazama

Fukagawa

2017

BioMed Research International

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Prevention of bone fractures is one goal of therapy for patients with chronic kidney disease-mineral and bone disorder (CKD-MBD), as indicated by the Kidney Disease: Improving Global Outcomes guidelines. CKD patients, including those on hemodialysis, are at higher risk for fractures and fracture-related death compared to people with normal kidney function. However, few clinicians focus on this issue as it is very difficult to estimate bone fragility. Additionally, uremia-related bone fragility has a more complicated pathological process compared to osteoporosis. There are many uremia-associated factors that contribute to bone fragility, including severe secondary hyperparathyroidism, skeletal resistance to parathyroid hormone, and bone mineralization disorders. Uremia also aggravates bone volume loss, disarranges microarchitecture, and increases the deterioration of material properties of bone through abnormal bone cells or excess oxidative stress. In this review, we outline the prevalence of fractures, the interaction of CKD-MBD with osteoporosis in CKD patients, and discuss possible factors that exacerbate the mechanical properties of bone.

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“…The main complication of ROD is represented by fractures, which is a risk factor for mortality in dialysis patients [ 36 , 37 ]. In this study, there was no evidence that ROD was a prognostic factor in HD patients.…”

Section: Discussionmentioning

confidence: 99%

Mineral and bone disorders, morbidity and mortality in end-stage renal failure patients on chronic dialysis

Moldovan

Rusu

Kacsó

et al. 2016

Medicine and Pharmacy Reports

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Background and aimIn spite of numerous interventions, the control of mineral disturbances remains poor in end-stage renal failure (ESRF) patients. Chronic kidney disease - mineral and bone disorders (CKD-MBD) represent an important cause of mortality and morbidity. The aim of this study is to analyze the relationship between mineral and bone disorders (MBD) and their components impact on all-cause mortality and cardiovascular (CDV) mortality and morbidity in chronic dialysis patients.MethodsThis prospective study was carried out in a cohort of 92 randomly selected patients with ESRF treated with hemodialysis (HD) and peritoneal dialysis (PD). The data regarding demographic and clinical characteristics were recorded, including vascular disease (coronary, cerebral, peripheral). The follow-up lasted 40 months and the final evaluation included the number and causes of deaths, CDV events and disease. Serum Ca, P, ALP, iPTH, albumin, cholesterol, urea and creatinine levels were measured. The plain radiographic films of hands and pelvis evaluated all bone abnormalities suggestive of renal osteodystrophy (ROD) and peripheral vascular calcification (VC).ResultsAll-cause annual mortality represented 9.25% in HD and 9.09% in PD patients. The CDV mortality represented almost 44% in HD patients and 66% in PD patients from all deaths. There was a high prevalence of CDV diseases and events. High and low serum P levels were associated with a worse survival rate. Hypercalcaemia was associated with high risk for CDV events in HD patients. In PD patients, the relationship between increased ALP levels and all-cause mortality was significant. Other mineral markers were not predictive of the outcome in the studied patients. In the HD patients the severity of VC was associated with all-cause and CDV mortality, and with CDV events. Male gender, hypercholesterolemia, decreased URR, albumin and creatinine were identified as risk factors for all-cause mortality. The diabetics had higher death rates. Low dialysis efficacy represented a risk factor for mortality and CDV diseases and events. In PD patients, low albumin induced a higher death rate. In PD patients the death rate was similar to HD patients.ConclusionAll-cause mortality was higher than in general population, but lower than the chronic dialysis patients’ mortality reported in other studies. The death rates in HD and PD patients were similar. VC and serum P levels influenced the outcome in the HD patients – increased the risk for all-cause and CDV mortality, but also for CDV events. ALP levels influenced outcome in PD patients. There were no significant differences between HD and PD patients regarding outcome.

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Increased Risks of Mortality and Atherosclerotic Complications in Incident Hemodialysis Patients Subsequently with Bone Fractures: A Nationwide Case-Matched Cohort Study

Cited by 20 publications

References 26 publications

Relationship Between Low Bone Mineral Density and Fractures With Incident Cardiovascular Disease: A Systematic Review and Meta-Analysis

Relationship Between Low Bone Mineral Density and Fractures With Incident Cardiovascular Disease: A Systematic Review and Meta-Analysis

Molecular Abnormalities Underlying Bone Fragility in Chronic Kidney Disease

Mineral and bone disorders, morbidity and mortality in end-stage renal failure patients on chronic dialysis

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