Bone microarchitecture is more severely affected in patients on hemodialysis than in those receiving peritoneal dialysis.
We used high-resolution quantitative computed tomography to study the microarchitecture of bone in patients with chronic kidney disease on dialysis. We compared bone characteristics in 56 maintenance hemodialysis (21 women, 14 post-menopausal) and 23 peritoneal dialysis patients (9 women, 6 post-menopausal) to 79 healthy men and women from two cohorts matched for age, body mass index, gender, and menopausal status. All underwent dual-energy X-ray absorptiometry of the spine and hip to measure areal bone mineral density, and high-resolution peripheral quantitative computed tomography of the radius and tibia to measure volumetric bone mineral density and microarchitecture. When compared to their matched healthy controls, patients receiving hemodialysis and peritoneal dialysis had a significantly lower areal bone mineral density in the hip. Hemodialysis patients had significantly lower total, cortical, and trabecular volumetric bone mineral density at both sites. Hemodialysis patients had significantly lower trabecular volumetric bone mineral density and microarchitecture at the tibia than the peritoneal dialysis patients. Overall, peritoneal dialysis patients were less affected, their cortical thickness at the distal tibia being the only significant difference versus controls. Thus, we found more severe trabecular damage at the weight-bearing tibia in hemodialysis compared to peritoneal dialysis patients, but this latter finding needs confirmation in larger cohorts.
Department of Nephrology, Hospital Edouard Herriot, Hospices Civils de Lyon, Lyon, France. solenne.pelletier@chu-lyon.fr
Solenne
S
Pelletier
Nicolas
N
Vilayphiou
Stéphanie
S
Boutroy
Justine
J
Bacchetta
Elisabeth
E
Sornay-Rendu
Pawel
P
Szulc
Walid
W
Arkouche
Fitsum
F
Guebre-Egziabher
Denis
D
Fouque
Roland
R
Chapurlat
D015502:Absorptiometry, Photon; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D015519:Bone Density; D001847:Bone Diseases / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D001842:Bone and Bones / Q000000981:diagnostic imaging / Q000473:pathology*; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D019587:Dietary Supplements; D005260:Female; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011884:Radius / Q000000981:diagnostic imaging / Q000473:pathology; D006435:Renal Dialysis / Q000009:adverse effects*; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000628:therapy*; D012720:Severity of Illness Index; D013131:Spine / Q000000981:diagnostic imaging / Q000473:pathology; D013977:Tibia / Q000000981:diagnostic imaging / Q000473:pathology; D014057:Tomography, X-Ray Computed; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood / Q000627:therapeutic use; D014808:Vitamin D Deficiency / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D055815:Young Adult
D015415:Biomarkers; C470125:PTH protein, human; D010281:Parathyroid Hormone; D014807:Vitamin D; C104450:25-hydroxyvitamin D