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Abstract: SA-PO577

Changes in Modified Creatinine Index Following Bone Fractures in Patients Undergoing Maintenance Hemodialysis

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis


  • Soeda, Keisuke, Tokai Daigaku Igakubu Jinnai Bunpu Taisha Naika, Isehara, Kanagawa, Japan
  • Komaba, Hirotaka, Tokai Daigaku Igakubu Jinnai Bunpu Taisha Naika, Isehara, Kanagawa, Japan
  • Nakagawa, Yosuke, Tokai Daigaku Igakubu Jinnai Bunpu Taisha Naika, Isehara, Kanagawa, Japan
  • Hida, Miho, Medical Corporation Kuratakai, Hiratsuka, Kanagawa, Japan
  • Kakuta, Takatoshi, Tokai Daigaku Igakubu Fuzoku Hachioji Byoin, Hachioji, Tokyo, Japan
  • Fukagawa, Masafumi, Tokai Daigaku Igakubu Jinnai Bunpu Taisha Naika, Isehara, Kanagawa, Japan

Group or Team Name

  • Division of Nephrology, Endocrinology and Metabolism.

Previous research has shown associations between lower skeletal muscle mass and a subsequent increased risk of bone fractures in hemodialysis patients. However, limited data exist on whether fractures lead to a loss of muscle mass in this population.


We analyzed a historical cohort study of 2,292 patients undergoing maintenance hemodialysis in Japan. We compared longitudinal changes in modified creatinine index (mCI) as a surrogate marker of muscle mass in a subcohort of patients who experienced fractures during the 7-year study period and those who did not, matched by propensity score at 1:3. Follow-up started immediately prior to the occurrence of fracture in the fracture group and at study enrollment in the non-fracture group.


During a median follow-up of 5.4 years (IQR, 2.5-7.0 years), 113 patients experienced clinical fractures, among which 84 patients had data on mCI over time. With the use of propensity-score matching, 66 patients who experienced a clinical fracture were matched with 198 patients who did not sustain a fracture. While the mCI remained virtually unchanged in the non-fracture group, there was a progressive decrease in mCI in the fracture group, with a 3.0% decrease from baseline at 1 year and an 8.0% decrease at 5 years. Similar findings were obtained for changes in nutritional indicators such as serum albumin and body mass index.


In patients undergoing maintenance hemodialysis, the occurrence of clinical fractures may lead to a subsequent reduction in muscle mass, as indicated by the modified creatinine index. Whether interventions to prevent muscle mass loss following a fracture improve clinical outcomes warrants further investigation.