title: Bone mineral density in end-stage renal disease patients: association with wasting, cardiovascular disease and mortality.
abstract: BACKGROUND
  Bone and mineral disorders may contribute to extraosseous ossifications and cardiovascular disease (CVD) in end-stage renal disease (ESRD) patients. We have investigated the relationship between bone mineral density (BMD) and inflammation, wasting, CVD and mortality in ESRD patients.
  
  
  METHODS
  BMD (dual energy X-ray absorptiometry) and biochemical, nutritional and inflammatory markers were assessed in 277 incident ESRD patients (GFR 7.1 +/- 0.2 ml/min) who were then followed prospectively for a mean of 27 (range 1-60) months. Carotid plaques were determined in 103 patients.
  
  
  RESULTS
  Patients with carotid plaques, clinical manifestation of CVD and wasting (assessed by subjective global assessment) had significantly lower BMD than their counterparts. Low BMD was associated with high all-cause and cardiovascular mortality. Even after adjustment for several confounders and risk factors, all-cause (HR = 2.1, CI: 1.1-3.9, p = 0.02) and cardiovascular (HR = 2.8, CI: 1.2-6.3, p = 0.02) mortality remained significantly associated with low BMD.
  
  
  CONCLUSIONS
  Low BMD is associated with wasting and CVD, and is an independent predictor of all-cause and cardiovascular mortality in ESRD patients.
authors.affiliation: Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Matsubara
authors.forename: Mohamed E
authors.initials: ME
authors.lastname: Suliman
authors.forename: Abdul Rashid
authors.initials: AR
authors.lastname: Qureshi
authors.forename: Jonas
authors.initials: J
authors.lastname: Axelsson
authors.forename: Leena
authors.initials: L
authors.lastname: Martola
authors.forename: Olof
authors.initials: O
authors.lastname: Heimbürger
authors.forename: Peter
authors.initials: P
authors.lastname: Barany
authors.forename: Peter
authors.initials: P
authors.lastname: Stenvinkel
authors.forename: Bengt
authors.initials: B
authors.lastname: Lindholm
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D000368:Aged; D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000453:epidemiology* / Q000209:etiology / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology / Q000378:metabolism / Q000401:mortality; D016893:Carotid Stenosis / Q000453:epidemiology / Q000209:etiology / Q000378:metabolism; D002423:Cause of Death; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007249:Inflammation / Q000453:epidemiology / Q000209:etiology / Q000378:metabolism; D015850:Interleukin-6 / Q000097:blood; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000150:complications / Q000453:epidemiology* / Q000378:metabolism / Q000628:therapy; D008297:Male; D044342:Malnutrition / Q000453:epidemiology / Q000209:etiology / Q000378:metabolism; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D017582:Renal Replacement Therapy; D012907:Smoking / Q000453:epidemiology; D016019:Survival Analysis; D013548:Sweden / Q000453:epidemiology; D019282:Wasting Syndrome / Q000453:epidemiology* / Q000209:etiology
chemical_list: C508600:IL6 protein, human; D015850:Interleukin-6