Kidney Week

Abstract: SA-PO893

Association of Pre-ESRD Mineral and Bone Disorder Parameters with Post-ESRD Hospitalization for Fractures

Session Information

• Mineral Disease: CKD-Bone
  November 04, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Mineral Disease

• 1203 Mineral Disease: CKD-Bone

Authors

• Sumida, Keiichi, Nephrology Center, Toranomon Hospital Kajigaya, Kawasaki, kanagawa, Japan

Keiichi Sumida,

• Molnar, Miklos Zsolt, University of Tennessee Health Science Center, Memphis, Tennessee, United States

Miklos Zsolt Molnar,

• Potukuchi, Praveen Kumar, University of Tennessee Health Science Center, Memphis, Tennessee, United States

Praveen Kumar Potukuchi,

• Gaipov, Abduzhappar, University of Tennessee Health Science Center, Memphis, Tennessee, United States

Abduzhappar Gaipov,

• Thomas, Fridtjof, University of Tennessee Health Science Center, Memphis, Tennessee, United States

Fridtjof Thomas,

• Streja, Elani, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States

Elani Streja,

• Yamagata, Kunihiro, University of Tsukuba, Tsukuba, Japan

Kunihiro Yamagata,

• Kalantar-Zadeh, Kamyar, University of California Irvine, School of Medicine, Orange, California, United States

Kamyar Kalantar-Zadeh,

• Kovesdy, Csaba P., University of Tennessee Health Science Center, Memphis, Tennessee, United States

Csaba P. Kovesdy,

Background

Mineral and bone disorder (MBD) is associated with fractures both in CKD and ESRD. However, the association of MBD parameters in advanced CKD with fracture risk after dialysis is unknown.

Methods

We identified 10,942 US veterans starting dialysis between 10/2007-3/2014 with measurements of serum intact parathyroid hormone [iPTH], alkaline phosphatase [ALP], albumin-corrected calcium, and phosphorus within six months prior to dialysis start. MBD parameters were examined using splines and were also categorized into 3 groups with the reference group defined using guideline-based ranges, except for ALP which was categorized into tertiles. Associations of each MBD parameter with post-ESRD fracture-related hospitalization were examined in multivariable adjusted Cox regressions.

Results

478 events occurred over a median follow-up of 1.8 years. Higher ALP was associated with higher fracture risk (adjusted hazard ratio [HR] [95% CI] for the highest [vs. lowest] tertile: 1.43 [1.11-1.85]). Both higher iPTH and lower calcium were associated with lower fracture risk (0.76 [0.59-0.98] and 0.64 [0.43-0.94], vs. referent). No association was seen between phosphorus and fracture risk (Figure).

Conclusion

Derangements of distinct pre-ESRD MBD parameters are associated with fracture risk after dialysis start. Further studies are needed to determine if correction of ALP, iPTH and calcium could prevent fractures.

Funding

• NIDDK Support