title: Kidney Function and Fracture Risk: The Atherosclerosis Risk in Communities (ARIC) Study.
abstract: BACKGROUND
  People with end-stage renal disease are at high risk for bone fracture. Less is known about fracture risk in milder chronic kidney disease and whether chronic kidney disease-associated fracture risk varies by sex or assessment with alternative kidney markers.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  10,955 participants from the Atherosclerosis Risk in Communities (ARIC) Study followed up from 1996 to 2011.
  
  
  METHODS
  Kidney function as assessed by creatinine-based estimated glomerular filtration rate (eGFRcr), urine albumin-creatinine ratio, and alternative filtration markers.
  
  
  RESULTS
  Fracture-related hospitalizations determined by diagnostic code.
  
  
  METHODS
  Baseline kidney markers; hospitalizations identified by self-report during annual telephone contact and active surveillance of local hospital discharge lists.
  
  
  RESULTS
  Mean age of participants was 63 years, 56% were women, and 22% were black. During a median follow-up of 13 years, there were 722 incident fracture-related hospitalizations. Older age, female sex, and white race were associated with higher risk for fracture (P<0.001). The relationship between eGFRcr and fracture risk was nonlinear: <60mL/min/1.73m(2), lower eGFRcr was associated with higher fracture risk (adjusted HR per 10mL/min/1.73m(2) lower, 1.24; 95% CI, 1.05-1.47); there was no statistically significant association for ≥60mL/min/1.73m(2) in the primary analysis. In contrast, there was a graded association between other markers of kidney function and subsequent fracture, including albumin-creatinine ratio (HR per doubling, 1.10; 95% CI, 1.06-1.14), cystatin C-based eGFR (HR per 1-SD decrease, 1.15; 95% CI, 1.06-1.25), and 1/β2-microglobulin (HR per 1-SD decrease, 1.26, 95% CI, 1.15-1.37).
  
  
  CONCLUSIONS
  No bone mineral density assessment; one-time measurement of kidney function.
  
  
  CONCLUSIONS
  Both low eGFR and higher albuminuria were significant risk factors for fracture in this community-based population. The shape of the association in the upper ranges of eGFR varied by the filtration marker used in estimation.
authors.affiliation: Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Natalie
authors.initials: N
authors.lastname: Daya
authors.affiliation: Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland.
authors.forename: Annie
authors.initials: A
authors.lastname: Voskertchian
authors.affiliation: Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland.|Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland.|Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Andrea L C
authors.initials: ALC
authors.lastname: Schneider
authors.affiliation: Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland.|Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland.
authors.forename: Shoshana
authors.initials: S
authors.lastname: Ballew
authors.affiliation: Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland.|Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Mara
authors.initials: M
authors.lastname: McAdams DeMarco
authors.affiliation: Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland.|Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland.|Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Josef
authors.initials: J
authors.lastname: Coresh
authors.affiliation: Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland.|Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland.|Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Appel
authors.affiliation: Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland.|Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland.|Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Selvin
authors.affiliation: Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland.|Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland.|Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Morgan E
authors.initials: ME
authors.lastname: Grams
mesh_terms: D000419:Albuminuria / Q000175:diagnosis / Q000453:epidemiology; D050197:Atherosclerosis / Q000175:diagnosis / Q000453:epidemiology*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000175:diagnosis / Q000453:epidemiology*; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000453:epidemiology*; D007677:Kidney Function Tests / Q000639:trends; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012111:Residence Characteristics; D012307:Risk Factors
keywords: Bone fracture; albumin-creatinine ratio (ACR); albuminuria; chronic kidney disease (CKD); estimated glomerular filtration rate (eGFR); fracture risk; hospitalization; hospitalized fracture; kidney filtration markers; renal function