Prevalence of vertebral fractures and their prognostic significance in the survival in patients with chronic kidney disease stages 3-5 not on dialysis
Background: The prevalence of vertebral fractures (VF) and their association with clinical risk factors and outcomes are poorly documented in chronic kidney disease (CKD) cohorts. The aim of the study was to evaluate the prevalence of VF in patients with non-dialysis dependent CKD (NDD-CKD), their v...
| Autores: | , , , , , , , , , , , , , |
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| Tipo de recurso: | artículo |
| Estado: | Versión publicada |
| Fecha de publicación: | 2020 |
| País: | España |
| Institución: | Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau) |
| Repositorio: | r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau |
| OAI Identifier: | oai:iibsantpau.fundanetsuite.com:p10296 |
| Acceso en línea: | https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=10296 https://www.scopus.com/inward/record.uri?eid=2-s2.0-85096400028&doi=10.3390%2fJCM9051604&partnerID=40&md5=90dd5d4c1f8b0d2e0bd664fabbe7e90a |
| Access Level: | acceso abierto |
| Palabra clave: | albumin bisphosphonic acid derivative C reactive protein creatinine aged all cause mortality ankle brachial index Article blood vessel calcification bone mineral bone mineralization calcium blood level cause of death chronic kidney failure cohort analysis diabetes mellitus disease exacerbation disease severity estimated glomerular filtration rate female follow up hospitalization human major clinical study male mortality multicenter study osteoporosis peripheral vascular disease phosphate blood level prevalence prognosis prospective study radiography risk factor spine fracture survival thorax radiography vertebra body |
| Sumario: | Background: The prevalence of vertebral fractures (VF) and their association with clinical risk factors and outcomes are poorly documented in chronic kidney disease (CKD) cohorts. The aim of the study was to evaluate the prevalence of VF in patients with non-dialysis dependent CKD (NDD-CKD), their value in predicting mortality and its correlation with parameters of bone mineral metabolism and vascular calci?cation. Materials and Methods: 612 NDD 3-5 stage CKD patients participating in the OSERCE-2 study, a prospective, multicenter, cohort study, were prospectively evaluated and categorized into two groups according to presence or absence of VF at enrollment. VF were assessed with lateral radiographs and Genant semi-quantitative method was applied. Three radiologists specialized in musculoskeletal radiology performed consensual reading of individual images obtained using a Raim DICOM Viewer and a Canon EOS 350 camera to measure with Java Image software in those who had traditional acetate X-ray. Factors related to VF were assessed by logistic regression analysis. Association between VF and death over a 3-year follow-up was assessed by Kaplan-Meier survival curves and Cox-proportional hazard models. Results: VF were detected in 110patients(18%). Serumphosphatelevels(OR0.719,95%CI0.532to0.972,p = 0.032),ankle-brachial index < 0.9 (OR 1.694, 95% CI 1.056-2.717, p = 0.029) and treatment with bisphosphonates (OR 5.636, 95% CI 1.876-16.930, p = 0.002) were independently related to the presence of VF. After a median follow-up of 35 months (IQR: 17-37 months), 62 patients (10%) died. The causes of death were cardiovascular (n = 21, 34%) and infectious (n = 11, 18%). In the crude analysis, fractured patients group had poorer survival (log-rank test, p = 0.02). After multivariate adjustment for age, MDRD, albumin, diabetes mellitus, comorbidity, Adragao Score > 3 and serum phosphate, the presence of VF (HR 1.983, 95% CI 1.009-3.898, p = 0.047) were an independent predictor of all-cause mortality. Conclusions: In our study 18% of patients with NDD-CKD have VF. Factors associated with VF were age, low serum phosphate levels and peripheral vascular disease. The presence of VF was an independent risk factor for mortality in stages 3-5 NDD-CKD patients. Clinical trials are needed to con?rm whether this relationship is causal and reversible with treatment for osteoporosis. © 2020 by the authors. Licensee MDPI, Basel, Switzerland. |
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