title: Nutritional markers, not markers of bone turnover, are related predictors of bone mineral density in chronic peritoneal dialysis patients.
abstract: OBJECTIVE
  this study evaluated the factors associated with bone mineral density (BMD) in chronic peritoneal dialysis (CPD) patients.
  
  
  METHODS
  in this cross-sectional study in 91 stable CPD patients, BMD was measured using dual-energy X-ray absorptiometry. Markers of bone turnover (iPTH, osteocalcin, bone alkaline phosphatase, serum C-telopeptide), 25-hydroxy (OH) vitamin D3 and nutritional markers (prealbumin, nPNA, BMI) were measured by standard techniques.
  
  
  RESULTS
  of the 91 patients, 48 were female and 22 (24%) had Type 2 diabetes. Mean age of the patients was 52.7, and patients had been on PD for about 44 months. For the lumbar spine (LS) and femoral neck (FN), the mean T-scores were -1.19 ± 1.53 and -1.24 ± 1.01, respectively, and the mean Z-scores were -0.78 ± 1.33 and -0.40 ± 0.92, respectively. Using the WHO-based criteria, osteopenia (-2.5 < T-score < -1.0) at the LS and FN was observed in 37 (41%) and 48 (53%) patients, respectively, and osteoporosis (T-score <= -2.5) at the LS and FN was observed in 15 (17%) and 6 (7%) patients, respectively. LS T-score was positively correlated with BMI (r = 0.40, p < 0.001) and albumin (r = 0.29, p = 0.005), and FN T-score was positively correlated with albumin (r = 0.40, p < 0.001), prealbumin (r = 0.38, p < 0.001), age (r = -0.32, p = 0.002) and BMI (r = 0.29, p < 0.006). Markers of bone turnover were not associated with BMD. In multiple linear regression models, independent predictors of FN T-score were age, BMI, albumin and prealbumin (r(2) = 0.259, F = 6.23, p < 0.001), whereas BMI was the only independent predictor of LS T-score (r(2) = 0.24, F = 6.63, p < 0.001).
  
  
  CONCLUSIONS
  nutritional markers, not markers of bone turnover, are correlated predictors of BMD in CPD patients.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of UIsan College of Medicine, Seoul, South Korea.
authors.forename: J U
authors.initials: JU
authors.lastname: Jeong
authors.forename: H K
authors.initials: HK
authors.lastname: Lee
authors.forename: Y J
authors.initials: YJ
authors.lastname: Kim
authors.forename: J S
authors.initials: JS
authors.lastname: Kim
authors.forename: S S
authors.initials: SS
authors.lastname: Kang
authors.forename: S B
authors.initials: SB
authors.lastname: Kim
mesh_terms: D015502:Absorptiometry, Photon; D000469:Alkaline Phosphatase / Q000097:blood; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000097:blood / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D016723:Bone Remodeling; D002112:Calcifediol / Q000097:blood; D002908:Chronic Disease; D024042:Collagen Type I / Q000097:blood; D003430:Cross-Sectional Studies; D005260:Female; D005272:Femur Neck / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology*; D006801:Humans; D007674:Kidney Diseases / Q000097:blood / Q000150:complications / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D016014:Linear Models; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D009842:Oligopeptides / Q000097:blood; D015675:Osteocalcin / Q000097:blood; D010281:Parathyroid Hormone / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D010455:Peptides / Q000097:blood; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D011228:Prealbumin / Q000032:analysis; D011498:Protein Precursors / Q000097:blood; D056910:Republic of Korea; D013997:Time Factors
chemical_list: D015415:Biomarkers; D024042:Collagen Type I; D009842:Oligopeptides; C470125:PTH protein, human; D010281:Parathyroid Hormone; D010446:Peptide Fragments; D010455:Peptides; D011228:Prealbumin; D011498:Protein Precursors; C052929:collagen type I trimeric cross-linked peptide; D015675:Osteocalcin; C053651:phenylalanyl-leucyl-phenylalanyl-glutaminyl-prolyl-glutaminyl-arginyl-phenylalaninamide; D000469:Alkaline Phosphatase; D002112:Calcifediol