Nutritional markers, not markers of bone turnover, are related predictors of bone mineral density in chronic peritoneal dialysis patients.
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.
Jeong
J U
JU
Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of UIsan College of Medicine, Seoul, South Korea.
Lee
H K
HK
Kim
Y J
YJ
Kim
J S
JS
Kang
S S
SS
Kim
S B
SB
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
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