Femoral Neck X-Ray Absorptiometry Parameters and Peripheral Quantitative Computer Tomography Tibial Cortical Density Predict Survival in Dialysis Patients.
BACKGROUND
Low bone mineral density (BMD) is a known independent predictor of mortality in the general elderly population. However, studies in patients with end-stage renal disease (ESRD) are limited. The present study evaluated mortality during long-term follow-up in a population of patients having dialysis for ESRD, in whom BMD was also measured.


METHODS
Fifty-eight patients with ESRD were recruited consecutively from a dialysis clinic and followed prospectively for 6 years. Baseline BMD of the lumbar spine and femoral neck (FN) were measured by X-ray absorptiometry and by peripheral quantitative CT at the radius and tibia. Serum calcium, phosphate, parathyroid hormone (PTH), and albumin were measured at baseline.


RESULTS
During follow-up, 25 patients died. Univariate analysis showed that mortality was significantly associated with FN-BMD: hazards ratio (HR) per 0.1 g/cm2 decrease 1.50 (95% CI 1.07-2.10), p = 0.019; FN-T score: HR per 1-SD decrease 1.84 (95% CI 1.16-2.92), p = 0.009; and tibial cortical density: HR per 10 mg/cm3 decrease 1.08 (95% CI 1.02-1.14), p = 0.010. In multivariate analysis with stepwise adjustment for age, sex, transplant status, albumin, PTH, phosphate, dialysis duration, diabetes, and smoking, FN-T score remained significantly associated with mortality: HR per 1-SD decrease 1.82 (95% CI 1.02-3.24), p = 0.044, whereas the HR for FN-BMD and tibial cortical density were no longer significant. When 4 patients who had peritoneal dialysis were excluded, the HR relating FN-BMD, FN-T score, and tibial cortical density to mortality remained significant but became insignificant when albumin was included in the multivariate analysis.


CONCLUSION
Reduced FN-BMD, FN-T score, and tibial cortical density were significantly associated with an increased risk of death in patients with ESRD.
['Yap|Natalie|N|', 'Wong|Phillip|P|', 'McGinn|Stella|S|', 'Nery|Maria-Liza|ML|', 'Doyle|Jean|J|', 'Wells|Lynda|L|', 'Clifton-Bligh|Phillip|P|', 'Clifton-Bligh|Roderick J|RJ|']
D015502:Absorptiometry, Photon D000328:Adult D000368:Aged D015519:Bone Density D005260:Female D005272:Femur Neck D006801:Humans D007676:Kidney Failure, Chronic D008297:Male D008875:Middle Aged D006435:Renal Dialysis D016019:Survival Analysis D013977:Tibia D014057:Tomography, X-Ray Computed
X-ray absorptiometry Dialysis Mortality Bone quantitative computer tomography Chronic kidney disease-mineral and bone disorder Osteoporosis