Arteriovenous fistula affects bone mineral density measurements in end-stage renal failure patients.
OBJECTIVE
Hemodialysis needs an arteriovenous fistula (AVF) that may influence the structure and growth of nearby bone and affect bone mass measurement. The study analyzed the effect of AVF in the assessment of forearm bone mineral density (BMD) measured by dual energy x-ray absorptiometry (DXA) and examined its influence on the final diagnosis of osteoporosis.


METHODS
Forty patients (52 +/- 18 yr) in hemodialysis program (12 +/- 8 yr) with permeable AVF in forearm were included. Patients were divided in two groups (over and under 50 yr). BMD of both forearms(three areas), lumbar spine, and femur was measured by DXA. Forearm measurements in each arm were compared. Patients were diagnosed as normal only if all territories were considered nonpathologic and osteoporosis/osteopenia was determined by the lowest score found.


RESULTS
Ten patients were excluded and 30 patients were analyzed. BMD in the forearm with AVF was significantly lower than that observed in the contralateral forearm in both groups of patients and in all forearm areas analyzed. When only lumbar spine and femur measurements were considered, 70% of patients were nonpathologic and 30% were osteoporotic. However, inclusion of AVF forearm classified 63% as osteoporotic and a further 27% as osteopenic, leaving only 10% as nonpathologic.


CONCLUSIONS
Forearm AVF affects BMD measurements by decreasing their values in patients with end-stage renal failure. This may produce an overdiagnosis of osteoporosis, which should be taken into account when evaluating patients of this type.
Muxí
Africa
A
Servicio de Medicina Nuclear, Hospital Clínic, Universitat de Barcelona, 170 08036 Barcelona, Spain. amuxi@clinic.ub.es
Torregrosa
José-Vicente
JV
Fuster
David
D
Peris
Pilar
P
Vidal-Sicart
Sergi
S
Solá
Oriol
O
Domenech
Beatriz
B
Martín
Gloria
G
Casellas
Joan
J
Pons
Francisca
F
D015502:Absorptiometry, Photon; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D005189:False Positive Reactions; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging / Q000503:physiopathology; D005542:Forearm / Q000098:blood supply*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011884:Radius / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006435:Renal Dialysis; D015203:Reproducibility of Results; D055815:Young Adult