title: The FRAX ® as a predictor of mortality in Japanese incident hemodialysis patients: an observational, follow-up study.
abstract: The World Health Organization Fracture Risk Assessment Tool (FRAX(®)) was recently developed to estimate the 10-year absolute risk of osteoporotic fracture among the general population. However, the evidence for its use in chronic kidney disease patients has been lacking, and the association between the FRAX(®) and mortality is unknown. Therefore, a hospital-based, prospective, cohort study was conducted to evaluate the predictive ability of the FRAX(®) for mortality in hemodialysis patients. A total of 252 patients who had been started on maintenance hemodialysis, 171 men and 81 women, with a mean age of 67 ± 14 years, was studied. The endpoint was defined as all-cause death. The Cox proportional hazards model was used to calculate hazard ratios and 95 % confidence intervals. During the mean follow-up period of 3.4 ± 2.7 years, 61 deaths occurred. The median (interquartile range) of the FRAX(®) for major osteoporotic fracture was 6.9 (4.6-12.0) % in men and 19.0 (7.6-33.0) % in women. Cumulative survival rates at 5 years after starting dialysis, with the FRAX(®) levels above and below the median, were 51.9 and 87.9 %, respectively, in men and 67.4 and 83.7 %, respectively, in women. Overall, in men, the multivariate Cox regression analyses revealed that the log-transformed FRAX(®) remained an independent predictor of death after adjusting by confounding variables. However, in women, the significant association between the FRAX(®) value and the outcome was eliminated if age was put into these models. Among Japanese hemodialysis patients, the FRAX(®) seems to be useful for predicting death, especially in men.
authors.affiliation: Division of Nephrology, Toho University Ohashi Medical Center, 2-17-6 Ohashi, Meguro-Ku, Tokyo, 153-8515, Japan. thayashi0803@gmail.com.
authors.forename: Toshihide
authors.initials: T
authors.lastname: Hayashi
authors.affiliation: Division of Nephrology, Toho University Ohashi Medical Center, 2-17-6 Ohashi, Meguro-Ku, Tokyo, 153-8515, Japan. jokinobuhiko@gmail.com.
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Joki
authors.affiliation: Division of Nephrology, Toho University Ohashi Medical Center, 2-17-6 Ohashi, Meguro-Ku, Tokyo, 153-8515, Japan.
authors.forename: Yuri
authors.initials: Y
authors.lastname: Tanaka
authors.affiliation: Division of Nephrology, Toho University Ohashi Medical Center, 2-17-6 Ohashi, Meguro-Ku, Tokyo, 153-8515, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Iwasaki
authors.affiliation: Division of Nephrology, Toho University Ohashi Medical Center, 2-17-6 Ohashi, Meguro-Ku, Tokyo, 153-8515, Japan.
authors.forename: Shun
authors.initials: S
authors.lastname: Kubo
authors.affiliation: Division of Nephrology, Toho University Ohashi Medical Center, 2-17-6 Ohashi, Meguro-Ku, Tokyo, 153-8515, Japan.
authors.forename: Takasuke
authors.initials: T
authors.lastname: Asakawa
authors.affiliation: Division of Nephrology, Toho University Ohashi Medical Center, 2-17-6 Ohashi, Meguro-Ku, Tokyo, 153-8515, Japan.
authors.forename: Ai
authors.initials: A
authors.lastname: Matsukane
authors.affiliation: Division of Nephrology, Toho University Ohashi Medical Center, 2-17-6 Ohashi, Meguro-Ku, Tokyo, 153-8515, Japan.
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Takahashi
authors.affiliation: Division of Dialysis, Nissan Tamagawa Hospital, Tokyo, Japan.
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Imamura
authors.affiliation: Hirahata Clinic, Tokyo, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Hirahata
authors.affiliation: Division of Nephrology, Toho University Ohashi Medical Center, 2-17-6 Ohashi, Meguro-Ku, Tokyo, 153-8515, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Hase
mesh_terms: D000368:Aged; D044466:Asian People / Q000706:statistics & numerical data*; D015331:Cohort Studies; D003710:Demography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D015999:Multivariate Analysis; D058866:Osteoporotic Fractures / Q000453:epidemiology*; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000401:mortality*; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors
keywords: CKD; FRAX; Hemodialysis; Mortality