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Abstract: TH-PO571

Association Between Normalized Protein Catabolic Rate (nPCR) and the Risk for Bone Fracture in Patients Undergoing Hemodialysis: The Q-Cohort Study

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical


  • Ohnaka, Shotaro, Tagawa Municipal Hospital, Tagawa, Fukuoka, Japan
  • Tsujikawa, Hiroaki, Kyushu University, Fukuoka, Fukuoka, Japan
  • Yamada, Shunsuke, Kyushu University, Fukuoka, Fukuoka, Japan
  • Taniguchi, Masatomo, Fukuoka Renal Clinic, Fukuoka, Japan
  • Tokumoto, Masanori, Department of Internal Medicine, Fukuoka Dental College, Sawara-ku, FUKUOKA, Japan
  • Tsuruya, Kazuhiko, Nara Medical University, Kashihara, Japan
  • Nakano, Toshiaki, Kyushu University, Fukuoka, Fukuoka, Japan
  • Kitazono, Takanari, Kyushu University, Fukuoka, Fukuoka, Japan

Normalized protein catabolic rate (nPCR) is used as a surrogate of daily protein intake and nutritional status in patients receiving maintenance hemodialysis (HD). It remains unknown whether nPCR affect the incidence of bone fracture in HD patients.


A total of 2,869 patients registered to the Q Cohort Study, a multicenter, prospective, observational study, were followed up for a median of 4 years. The primary outcome was bone fracture at any site. The main exposure was nPCR level at baseline. Patients were divided into four groups based on their baseline nPCR levels (Q1: <0.85, Q2: 0.85-0.95, Q3: 0.95-1.05 [reference], Q4: ≥1.05 g/kg/day). We examined the relationship between nPCR levels and the risk for bone fracture using a Cox proportional hazards risk model.


During the follow-up period, 136 patients experienced bone fracture at any site. In the multivariable analyses, the risk for bone fracture was significantly higher in the lowest (Q1) and highest (Q4) nPCR groups compared with Q3 group (hazard ratio [95% confidence intervals]: Group 1, 1.93[1.05-3.66]; Q2, 1.27[0.68-2.44]; Q3 1.00 (reference); Q4, 2.21[1.27-4.02]. Even when analyses were limited to those whose dialysis vintage was longer than 2 years, the association remained unchanged.


Our results suggest that both lower and higher nPCR values increase the risk for bone fracture in HD patients. Further studies are necessary to confirm our observation and elucidate the underlying mechanisms on the association between nPCR level and bone fracture in HD patients.