The Regina CKD-MBD Study
November 04, 2017 | 10:00 AM - 10:00 AM
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The Regina CKD-MBD Study
- 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
- Prasad, Bhanu, None, Regina, Saskatchewan, Canada
- Giebel, Shelley, Regina QuAppelle Health Region, Regina, Saskatchewan, Canada
- Nickolas, Thomas, Columbia University Medical Center, New York, New York, United States
Recent studies have demonstrated that measurement of areal bone mineral density (BMD) by dual energy X-ray absorptiometry predicts fractures in patients with chronic kidney disease (CKD). However, whether fracture risk prediction by BMD is enhanced by assessment of biochemical markers of CKD-mineral and bone disease or clinical risk factors is not clear. We hypothesized that in a selected cohort of patients managed in a CKD clinic, that combining T scores with biochemical markers would optimize fracture discrimination than using DXA alone.
We conducted a retrospective review of 374 consecutive patients who underwent mandatory DXA imaging at the point of entry into our multidisciplinary CKD program. BMD measurements were obtained from DXA scan reports from the Nuclear Medicine Department. BMD data were collected at four sites: the lumbar spine, total hip, mean of left and right femoral neck, and the 1/3- radius. We collected data on demographic, lab markers of mineral metabolism and fractures (identified through self-reported questionnaires, hospital electronic medical records and physician billing records.
In our cohort, 14.3% of stage 3 CKD, 15.7% of stage 4 CKD and 19.7% of stage 5 CKD experienced a clinical fracture during the study period. In an unadjusted model, each standard deviation decrease in total hip T-Score was associated with a 47% higher odds of fracture (OR=1.47, 95%CI: 1.18-1.82, p=0.0006). After adjustment for clinical risk factors (age, sex, BMI and diabetes) the odds of fracture remained unchanged (OR=1.47, 95%CI: 1.14-1.89, p=0.0028), and after adjustment for clinical risk factors and markers of CKD-MBD, BMD remained a significant predictor of fracture (OR=1.52, 95%CI: 1.17-1.99, p=0.0018). In the final model, additional adjustment for eGFR did alter the relationship between total hip T-Score and fracture (OR=1.53, 95%CI: 1.17-1.99, p=0.0017). Neither clinical risk factors nor markers of CKD-MBD were related to fracture in multivariate models and there was no interaction between total hip T-score and eGFR (p=0.5).
We conclude that measurement of BMD by DXA scans predicts fractures in stages 3-5. However, fracture risk prediction was not further enhanced by the addition of biochemical markers of CKD-MBD.