Bone mineral density in end-stage renal disease patients: association with wasting, cardiovascular disease and mortality.
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.
Matsubara
Keisuke
K
Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.
Suliman
Mohamed E
ME
Qureshi
Abdul Rashid
AR
Axelsson
Jonas
J
Martola
Leena
L
Heimbürger
Olof
O
Barany
Peter
P
Stenvinkel
Peter
P
Lindholm
Bengt
B
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
C508600:IL6 protein, human; D015850:Interleukin-6