Sparing effect of peritoneal dialysis vs hemodialysis on BMD changes and its impact on mortality
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ORIGINAL ARTICLE
Sparing effect of peritoneal dialysis vs hemodialysis on BMD changes and its impact on mortality Ken Iseri1,5 · Abdul Rashid Qureshi1 · Jonaz Ripsweden2,3 · Olof Heimbürger1 · Peter Barany1 · Ingrid B. Bergström4 · Peter Stenvinkel1 · Torkel B. Brismar2,3 · Bengt Lindholm1 Received: 24 April 2020 / Accepted: 14 August 2020 © The Japanese Society Bone and Mineral Research and Springer Japan KK, part of Springer Nature 2020
Abstract Introduction Bone loss in end stage renal disease (ESRD) patients associates with fractures, vascular calcification, cardiovascular disease (CVD) and increased mortality. We investigated factors associated with changes of bone mineral density (ΔBMD) during the initial year on dialysis therapy and associations of ΔBMD with subsequent mortality in ESRD patients initiating dialysis. Materials and methods In 242 ESRD patients (median age 55 years, 61% men) starting dialysis with peritoneal dialysis (PD; n = 138) or hemodialysis (HD; n = 104), whole-body dual-energy X-ray absorptiometry (DXA), body composition, nutritional status and circulating biomarkers were assessed at baseline and 1 year after dialysis start. We used multivariate linear regression analysis to determine factors associated with ΔBMD, and fine and gray competing risk analysis to determine associations of ΔBMD with subsequent mortality risk. Results BMD decreased significantly in HD patients (significant reductions of BMDtotal and BMDleg, trunk, rib, pelvis and spine) but not in PD patients. HD compared to PD therapy associated with negative changes in B MDtotal (β=− 0.15), BMDhead (β=− 0.14), BMDleg (β=− 0.18) and BMDtrunk (β=− 0.16). Better preservation of BMD associated with significantly lower all-cause mortality for ΔBMDtotal (sub-hazard ratio, sHR, 0.91), ΔBMDhead (sHR 0.91) and ΔBMDleg (sHR 0.92), while only ΔBMDhead (sHR 0.92) had a beneficial effect on CVD-mortality. Conclusions PD had beneficial effect compared with HD on BMD changes during first year of dialysis therapy. Better preservation of BMD, especially in bone sites rich in cortical bone, associated with lower subsequent mortality. BMD in cortical bone may have stronger association with clinical outcome than BMD in trabecular bone. Keywords Renal osteodystrophy · Bone mineral density · End-stage renal disease · Dialysis · Mortality
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00774-020-01144-8) contains supplementary material, which is available to authorized users. * Ken Iseri [email protected]‑u.ac.jp 1
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Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, M99 Karolinska University Hospital Huddinge, 14186 Stockholm, Sweden Division of Medical Imaging and Technology, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
Chronic kidney disease––mineral and bone disorders (CKD–MBD) lead to an increased risk of fractures—due
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