1
|
Liu X, Liu Z, Niu Y, Zhang K, Zhang X, Yu C. The Relationship Between Fracture and Mortality in a Chinese Maintenance Hemodialysis Patients Cohort. J Multidiscip Healthc 2024; 17:2031-2038. [PMID: 38706503 PMCID: PMC11070156 DOI: 10.2147/jmdh.s457193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 04/17/2024] [Indexed: 05/07/2024] Open
Abstract
Background Patients on maintenance hemodialysis have an increased risk of fracture. However, the relationship between fracture and poor prognosis is not clear. Methods A total of 182 maintenance hemodialysis patients were enrolled in the study. The relationship between fracture and poor prognosis (cardiovascular events, stroke, malignancy and 5-year all-cause mortality) were analyzed. Results 21 of 182 patients had a history of fracture at the time of enrollment. 26 patients had a new fracture after enrollment. A total of 57 fractures occurred in 47 patients, the most common fracture site was the rib. Patients with fracture group had a higher proportion of elderly and female, higher serum phosphorus and B-type natriuretic peptide and lower hemoglobin, albumin, and potassium compared with those without fracture. Age (OR=3.809, 95% CI: 1.064-8.966, p=0.038), hemoglobin (OR=0.961, 95% CI: 0.925-0.997, p=0.035), and serum phosphorus (OR=3.325, 95% CI:1.104-10.019, p=0.033) were the independent risk factors of new fractures in MHD patients. The incidence of malignancy and 5-year all-cause mortality in patients with fracture was higher than those without fracture (p<0.05). But there was no significant difference in the incidence of acute myocardial infarction or stroke. Conclusion 25.8% of maintenance hemodialysis patients had at least one fracture, with rib fractures accounting for the highest proportion. Age, hemoglobin and serum phosphorus were the independent risk factors of new fractures. The incidence of malignancy and 5-year all-cause mortality in patients with fracture was higher than those without fracture, but there was no significant difference in the incidence of acute myocardial infarction and stroke.
Collapse
Affiliation(s)
- Xi Liu
- Department of Nephrology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200092, People’s Republic of China
| | - Zhonghan Liu
- Department of Spinal Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, People’s Republic of China
| | - Yangyang Niu
- Department of Nephrology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200092, People’s Republic of China
| | - Kun Zhang
- Department of Nephrology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200092, People’s Republic of China
| | - Xiaoqin Zhang
- Department of Nephrology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200092, People’s Republic of China
| | - Chen Yu
- Department of Nephrology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200092, People’s Republic of China
| |
Collapse
|
2
|
Jørgensen HS, Lloret MJ, Lalayiannis AD, Shroff R, Evenepoel P. Ten tips on how to assess bone health in patients with chronic kidney disease. Clin Kidney J 2024; 17:sfae093. [PMID: 38817914 PMCID: PMC11137676 DOI: 10.1093/ckj/sfae093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Indexed: 06/01/2024] Open
Abstract
Patients with chronic kidney disease (CKD) experience a several-fold increased risk of fracture. Despite the high incidence and the associated excess morbidity and premature mortality, bone fragility in CKD, or CKD-associated osteoporosis, remains a blind spot in nephrology with an immense treatment gap. Defining the bone phenotype is a prerequisite for the appropriate therapy of CKD-associated osteoporosis at the patient level. In the present review, we suggest 10 practical 'tips and tricks' for the assessment of bone health in patients with CKD. We describe the clinical, biochemical, and radiological evaluation of bone health, alongside the benefits and limitations of the available diagnostics. A bone biopsy, the gold standard for diagnosing renal bone disease, is invasive and not widely available; although useful in complex cases, we do not consider it an essential component of bone assessment in patients with CKD-associated osteoporosis. Furthermore, we advocate for the deployment of multidisciplinary expert teams at local, national, and potentially international level. Finally, we address the knowledge gaps in the diagnosis, particularly early detection, appropriate "real-time" monitoring of bone health in this highly vulnerable population, and emerging diagnostic tools, currently primarily used in research, that may be on the horizon of clinical practice.
Collapse
Affiliation(s)
- Hanne Skou Jørgensen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Nephrology, Aalborg University Hospital, Aalborg, Denmark
- Department of Microbiology, Immunology and Transplantation, Nephrology and Renal Transplantation Research Group, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Maria Jesús Lloret
- Department of Nephrology, Hospital Fundació Puigvert, Barcelona, Spain
- Institut de Recerca Sant-Pau (IR-Sant Pau), Barcelona, Spain
| | - Alexander D Lalayiannis
- Department of Pediatric Nephrology, Birmingham Women's and Children's Hospitals, Birmingham, UK
| | - Rukshana Shroff
- Renal Unit, UCL Great Ormond Street Hospital and Institute of Child Health, London, UK
| | - Pieter Evenepoel
- Department of Microbiology, Immunology and Transplantation, Nephrology and Renal Transplantation Research Group, Katholieke Universiteit Leuven, Leuven, Belgium
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
3
|
Petrauskiene V, Hellberg M, Svensson P, Zhou Y, Clyne N. Bone mineral density after exercise training in patients with chronic kidney disease stages 3 to 5: a sub-study of RENEXC-a randomized controlled trial. Clin Kidney J 2024; 17:sfad287. [PMID: 38186908 PMCID: PMC10768767 DOI: 10.1093/ckj/sfad287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Indexed: 01/09/2024] Open
Abstract
Background We evaluated the effects of 12 months of exercise training on bone mineral density (BMD) in patients with chronic kidney disease (CKD) stages 3-5 not on kidney replacement therapy (KRT). Methods A total of 151 patients were randomized to 12 months of either balance or strength training, both together with endurance training. Some 112 patients completed and 107 (69 men, 38 women) were analysed, with a mean age 66 ± 13.5 years and 31% having diabetes. The exercise training was self-administered, prescribed and monitored by a physiotherapist. Total body, hip and lumbar BMD, T score and Z score were measured at baseline and after 12 months using dual energy X-ray absorptiometry. Results Both groups showed increased physical performance. The prevalence of osteoporosis and osteopenia was unchanged. The strength group (SG) decreased total body BMD (P < .001), the balance group (BG) increased total body T score (P < .05) and total body Z score (P < .005). Total body ΔT score was negative in the SG and unchanged in the BG (P < .005). Total body ΔZ score was negative in the SG and positive in the BG (P < .001). The proportion of progressors measured by ΔT (P < .05) and ΔZ scores (P < .05) was significantly lower in the BG compared with the SG. In multivariate logistic regression analysis, belonging to the BG was the only factor with a lower risk of deterioration of total body BMD, T and Z scores. Conclusions Twelve months of balance training together with endurance training seemed to be superior to strength training in maintaining and improving BMD in patients with CKD not on KRT.
Collapse
Affiliation(s)
- Vaida Petrauskiene
- Lund University, Skåne University Hospital, Faculty of Medicine, Department of Clinical Sciences Lund, Nephrology, Lund, Sweden
| | - Matthias Hellberg
- Lund University, Skåne University Hospital, Faculty of Medicine, Department of Clinical Sciences Lund, Nephrology, Lund, Sweden
| | - Philippa Svensson
- Lund University, Skåne University Hospital, Faculty of Medicine, Department of Clinical Sciences Lund, Nephrology, Lund, Sweden
| | - Yunan Zhou
- Lund University, Skåne University Hospital, Faculty of Medicine, Department of Clinical Sciences Lund, Nephrology, Lund, Sweden
| | - Naomi Clyne
- Lund University, Skåne University Hospital, Faculty of Medicine, Department of Clinical Sciences Lund, Nephrology, Lund, Sweden
| |
Collapse
|
4
|
Feng JN, Zhang CG, Li BH, Zhan SY, Wang SF, Song CL. Global burden of hip fracture: The Global Burden of Disease Study. Osteoporos Int 2024; 35:41-52. [PMID: 37704919 DOI: 10.1007/s00198-023-06907-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/31/2023] [Indexed: 09/15/2023]
Abstract
This study is the first to measure global burden of hip fracture in patients aged 55 years and older across 204 countries and territories from 1990 to 2019. Our study further proved that the global burden of hip fracture is still large. Hip fractures among males are perhaps underestimated, and older adults should be given more attention. PURPOSE Hip fracture is a tremendous universal public health challenge, but no updated comprehensive and comparable assessment of hip fracture incidence and burden exists for most of the world in older adults. METHODS Using data from the Global Burden of Diseases (GBD) 2019, we estimated the number and rates of the incidence, prevalence, and years lived with disability (YLD) of hip fracture across 204 countries and territories in patients aged 55 years and older from 1990 to 2019. RESULTS In 2019, the incidence, prevalence, and YLDs rates of hip fracture in patients aged 55 years and older were 681.35 (95% UI 508.36-892.27) per 100000 population, 1191.39 (95% UI 1083.80-1301.52) per 100000 population, and 130.78 (95% UI 92.26-175.30) per 100000 population. During the three decades, the incidence among people aged below 60 years showed a downward trend, whereas it showed a rapid upward trend among older adults. All the numbers and rates of hip fractures among females were higher than those among males and increased with age, with the highest number and rate in the highest age group. Notably, the male to female ratio of the incidence for people aged over 55 years increased from 0.577 in 1990 to 0.612 in 2019. Falls were the leading cause among both sexes and in all age groups. CONCLUSIONS The incidence and the number of hip fractures among patients aged 55 years and older increased over the past three decades, indicating that the global burden of hip fracture is still large. Hip fractures among males are perhaps underestimated, and older adults should be given more attention.
Collapse
Affiliation(s)
- Jing-Nan Feng
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Cheng-Gui Zhang
- Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong, China
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Bao-Hua Li
- Institute of Medical Innovation, Peking University Third Hospital, Beijing, China
| | - Si-Yan Zhan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
- Institute for Artificial Intelligence, Peking University, Beijing, China
| | - Sheng-Feng Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.
| | - Chun-Li Song
- Department of Orthopedics, Peking University Third Hospital, Beijing, China.
| |
Collapse
|
5
|
Shimamura Y, Kuniyoshi Y, Ueta H, Miyauchi T, Yamamoto M, Tsujimoto Y. Mortality After Hip and Spine Fractures in Patients With End-Stage Kidney Disease: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e49636. [PMID: 38161869 PMCID: PMC10756010 DOI: 10.7759/cureus.49636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2023] [Indexed: 01/03/2024] Open
Abstract
Fractures represent a major cause of disability in the elderly, and patients with fractures exhibit a higher mortality rate than those without. Fractures are also an important health problem among patients with end-stage kidney disease (ESKD) requiring hemodialysis, peritoneal dialysis, or kidney transplantation. To the best of our knowledge, no study in the literature has yet quantitatively summarized the mortality rates, and a summary of evidence on post-hip and spine fracture mortality in patients with ESKD is lacking. The purpose of this study is to quantitatively evaluate the mortality rate, one-year mortality rate, and five-year mortality rate after hip and spine fractures in patients with ESKD receiving kidney replacement therapy. The MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, and ClinicalTrials.gov databases were comprehensively searched for reports on mortality rate and time-period mortality in patients with ESKD after hip or spine fractures up to June 2022. Prospective and retrospective cohort studies, as well as case series involving four or more patients, were included. Pooled mortality rate, one-year rate, and five-year mortality rate with 95% confidence intervals (CIs) were examined using a random-effects model. The risk of bias was assessed using the Joanna Briggs Institute (JBI) Prevalence Critical Appraisal Tool. Additionally, heterogeneity between studies was evaluated. A total of 26 studies were included in this meta-analysis. The one-year and five-year mortality rates after hip and spine fractures were 215.35-774.0 per 1,000 person-year and 148-194.1 per 1,000 person-year, respectively. After hip fractures, the one-year mortality rate was 27% (95% CI: 18-38%, I2 = 98%), whereas the five-year mortality rate was 56% (95% CI: 41-71%, I2 = 99%). After spine fractures, the one-year mortality rate was 10% (95% CI: 4-17%, I2 = 70%), whereas the five-year mortality rate was 48.3%. The post-fracture mortality rate was high in patients with ESKD, particularly within one year after the occurrence of fractures. Additionally, the five-year mortality rate after hip femoral or spine fractures was high at approximately 50%.
Collapse
Affiliation(s)
| | | | - Hiroshi Ueta
- Anesthesiology and Critical Care, Kobe City Hospital Organization, Kobe City Medical Center General Hospital, Kobe, JPN
| | - Takamasa Miyauchi
- Nephrology and Hypertension, St. Marianna University School of Medicine, Kawasaki, JPN
| | | | - Yasushi Tsujimoto
- Medicine, Oku Medical Clinic, Osaka, JPN
- Systematic Reviewers, Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, JPN
| |
Collapse
|
6
|
Lafage-Proust MH. Bone and Chronic Kidney Disease. Semin Musculoskelet Radiol 2023; 27:463-470. [PMID: 37748470 DOI: 10.1055/s-0043-1770353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
Chronic kidney disease (CKD) induces mineral and bone disorders (CKD-MBD) that affect calcium and phosphate metabolism. This review links pathophysiology, histologic aspects, and radiologic signs. CKD leads to bone lesions, namely renal osteodystrophy, which may combine low or high bone remodeling, impaired mineralization, and bone loss. CKD-MBD also comprises vascular calcifications, which, together with bone disease, lead to a high risk of cardiovascular events and osteoporotic fractures that increase both morbidity and mortality. Osteoporosis assessment is based on screening for classic risk factors and CKD-related factors (disease duration/severity, transplantation history, dialysis vintage). Treatment of mineral disorders may combine serum phosphate lowering drugs, natural vitamin D or its 1-α derivatives, or calcium-sensing receptor agonists. Treatment of osteoporosis is conventional in mild to moderate stages but more complex in severe CKD because evidence about the efficacy and safety of anti-osteoporosis drugs is scant.
Collapse
Affiliation(s)
- Marie-Hélène Lafage-Proust
- INSERM U1059 SAINBIOSE Université Jean Monnet, Saint-Etienne, France
- Service de Rhumatologie, CHU Saint-Etienne, Saint-Etienne, France
| |
Collapse
|