DIALYSIS BONE DISEASE

Nephrology Dialysis Transplantation, May 2014

Introduction and Aims: Vertebral Fractures (VFs) are common in the general population and in Chronic Kidney Disease patients. VFs are associated with vascular calcifications (VCs) and to an increased risk of mortality. The Spine Deformity Index (SDI) is a summary measure of the VFs status, incorporating both the number and severity of VFs in a score. The aim of this study was to evaluate the relationships between the classic SDI, laboratory parameters of bone metabolism, and vascular calcifications within the context of the EVERFRACT study. Methods: In 387 hemodialysis patients, aged 64.2 ± 14.1 years, we determined routine biochemical parameters and: 25(OH)vitamin D, total Bone Gla Protein (BGP), undercarboxylated BGP (ucBGP) and total Matrix Gla Protein (MGP). We performed laterolateral x-Rays of the spine (T5 to L4) to evaluate both VFs (defined as reduction > 20% in vertebral body height) by Quantitative Vertebral Morphometry and VCs, aortic (AoVC) and iliac (IaVC), by Witteman’s method. We divided the SDI score by the number of fractures, in order to obtain a more precise index of fracture severity (corrected-SDI: c-SDI). Results: We found a high prevalence (55.3%, n=214) of VFs. The mean SDI was 1.4 ± 1.74. The mean c-SDI was 0.74 ± 0.75. VFs had a grade of severity that was low through T5-T10 and higher through T11-L3. The severity of fractures was highlighted only by c-SDI (see Table). We found 80.6% of AAoC and 55.6% of IAC. SDI was significantly associated with AAoC (OR=1.15, 95% CI 1.02-1.30, p=0.023). A SDI >1 was significantly associated with: sex (male OR 1.86, 95% CI 1.20-2.91, p=0.007), age (OR 1.03, 95% 1.01-1.05, p=0.0003) and albumin ≥ 3.5 g/dL (OR 0.54, 95% CI 0.31-0.93, p=0.026). c-SDI score was significantly associated with AAoC (OR=1.48, 95% CI 1.11-1.98, p=0.0009) and with IAC (OR=1.54, 95% CI 1.06-2.24, p=0.025). A c-SDI >1 was significantly associated with: age (OR 1.05, 95% CI 1.03-1.07, p<0.0001), LDL Cholesterol ≥ 90 mg/dL (OR 1.74, 95% 1.04-2.92, p=0.0354) and ucBGP ≥ 17.2 mcg/L (OR 0.35, 95% CI 0.18-0.70, p=0.0025). Conclusions: SDI and c-SDI score associated with bone and vascular markers. c-SDI score performed better in the evaluation of the grade of fracture severity and it showed a stronger association with VC and vascular markers. This is the first time that the association of SDI with bone biochemical parameters and VC has been reported. View this table: In this window In a new window

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DIALYSIS BONE DISEASE

Hansjörg M Rothe 1 3 4 9 10 12 14 15 18 21 22 27 28 30 32 33 Philipp Eller 1 2 4 8 10 12 13 15 17 20 22 26 28 30 31 33 Gert Mayer 0 1 4 10 11 12 15 19 22 25 28 30 33 Markus Ketteler 1 3 4 9 10 12 14 15 18 21 22 27 28 30 32 33 Reinhard Kramar 1 4 7 10 12 15 16 22 24 28 29 30 33 0 Medical University Innsbruck , Innsbruck , Austria 1 Kae Hamamoto 2 Medical University Graz , Graz , Austria 3 Klinikum Coburg , Coburg , Germany 4 Maria Fusaro 5 Nephrology and Dialysis Unit, Ospedale San Carlo Borromeo , Milan , Italy 6 Laboratory Medicine Unit, University Hospital of Padua , Padua , Italy 7 Austrian Dialysis and Transplant Registry , Linz , Austria 8 Medical University of Lublin , Lublin , Poland 9 Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences , Warsaw , Poland 10 Jacek Waniewski 11 CHBA, Hopital Bois de L'Abbaye , Seraing , Belgium 12 Pierre Delanaye 13 CHR La Citadelle , Liège , Belgium 14 University of Liège , Liège , Belgium 15 Masahide Mizobuchi 16 5.Department of Public Health and Primary Care @ Kulak, University of Leuven , Kulak, Kortrijk, Belgium, Kortrijk , Belgium 17 Dong-Eui Medical Center , Busan , Republic of Korea 18 Dong-A University , Busan , Republic of Korea 19 Dialysezentrum , Mettmann , Germany 20 Dialyseteam , Dortmund , Germany 21 Nephrological Center , Schwenningen , Germany 22 Helmut Reichel 23 MVZ Davita Karlstrasse , Düsseldorf , Germany 24 Amgen GmbH , München , Germany 25 Department of Nephrology , Beijing , China 26 Air Force General Hospital , Beijing , China 27 Air Force General Hospital , Bejing , China 28 Matthias Klingele 29 Air Force of General Hospital, Department of Nephrology , Beijing , China 30 Vural Taner Yilmaz 31 Vifor Pharma AG , Glattbrugg , Switzerland 32 Akdeniz University School of Medicine , Antalya , Turkey 33 Florian S. Gutzwiller DIALYSIS BONE DISEASE SP572 - THE RELATIONSHIP BETWEEN THE SPINE DEFORMITY INDEX BIOCHEMICAL PARAMETERS OF BONE METABOLISM AND VASCULAR CALCIFICATIONS: RESULTS FROM THE EPIDEMIOLOGICAL VERTEBRAL FRACTURES ITALIAN STUDY IN DIALYSIS PATIENTS (EVERFRACT STUDY) Introduction and Aims: Vertebral Fractures (VFs) are common in the general population and in Chronic Kidney Disease patients. VFs are associated with vascular calcifications (VCs) and to an increased risk of mortality. The Spine Deformity Index (SDI) is a summary measure of the VFs status, incorporating both the number and severity of VFs in a score. The aim of this study was to evaluate the relationships between the classic SDI, laboratory parameters of bone metabolism, and vascular calcifications within the context of the EVERFRACT study. Methods: In 387 hemodialysis patients, aged 64.2 ± 14.1 years, we determined routine biochemical parameters and: 25(OH)vitamin D, total Bone Gla Protein (BGP), undercarboxylated BGP (ucBGP) and total Matrix Gla Protein (MGP). We performed laterolateral x-Rays of the spine (T5 to L4) to evaluate both VFs (defined as reduction > 20% in vertebral body height) by Quantitative Vertebral Morphometry and VCs, aortic (AoVC) and iliac (IaVC), by Witteman’s method. We divided the SDI score by the number of fractures, in order to obtain a more precise index of fracture severity (corrected-SDI: c-SDI). Results: We found a high prevalence (55.3%, n=214) of VFs. The mean SDI was 1.4 ± 1.74. The mean c-SDI was 0.74 ± 0.75. VFs had a grade of severity that was low through T5-T10 and higher through T11-L3. The severity of fractures was highlighted only by c-SDI (see Table). We found 80.6% of AAoC and 55.6% of IAC. SDI was significantly associated with AAoC (OR=1.15, 95% CI 1.02-1.30, p=0.023). A SDI >1 was significantly associated with: sex (male OR 1.86, 95% CI 1.20-2.91, p=0.007), age (OR 1.03, 95% 1.01-1.05, p=0.0003) and albumin ≥ 3.5 g/dL (OR 0.54, 95% CI 0.31-0.93, p=0.026). c-SDI score was significantly associated with AAoC (OR=1.48, 95% CI 1.11-1.98, p=0.0009) and with IAC (OR=1.54, 95% CI 1.06-2.24, p=0.025). A c-SDI >1 was significantly associated with: age (OR 1.05, 95% CI 1.03-1.07, p<0.0001), LDL Cholesterol ≥ 90 mg/dL (OR 1.74, 95% 1.04-2.92, p=0.0354) and ucBGP ≥ 17.2 mcg/L (OR 0.35, 95% CI 0.18-0.70, p=0.0025). Conclusions: SDI and c-SDI score associated with bone and vascular markers. c-SDI score performed better in the evaluation of the grade of fracture severity and it showed a stronger association with VC and vascular markers. This is the first time that the association of SDI with bone biochemical parameters and VC has been reported. SP570 SDI and c-SDI by vertebra in all patients (*The severity of fractures was highlighted by c-SDI) Moderate VF Score2 (n,%) INCREASED ACTIVE PTH(1-84) FRACTION AS A PREDICTOR OF POOR MORTALITY IN MALE HEMODIALYSIS PATIENTS Introduction and Aims: We previously reported that PTH(1-84)/intact PTH ratio provides the most clinically relevant marker for parathyroid function and the resultant bone turnover state. The purpose of our study was to investigate the assoc (...truncated)


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Maria Fusaro, Sandro Giannini, Davide Miozzo, Marianna Noale, Giovanni Tripepi, Mario Plebani, Martina Zaninotto, Antonio Piccoli, Maria Teresa Vilei, Rosalba Cristofaro, Maurizio Gallieni, Kae Hamamoto, Masaaki Inaba, Senji Okuno, Yasuo Imanishi, Eiji Ishimura, Tomoyuki Yamakawa, Shigeichi Shoji, Hansjörg M Rothe, Philipp Eller, Gert Mayer, Markus Ketteler, Reinhard Kramar, Faissal Shaheen, Mona Al Rukhaimi, Ali Alsahow, Fadwa Al-Ali, Issa Al Salmi, Sumaya Al Ghareeb, Mia Wang, Brian Bieber, Bruce M Robinson, Ronald L Pisoni, Jacek Waniewski, Malgorzata Debowska, Alicja Wojcik-Zaluska, Andrzej Ksiazek, Wojciech Zaluska, Marc E. De Broe, Rosamund J. Wilson, J. Brian Copley, Rikako Hiramtasu, Yoshifumi Ubara, Junichi Hoshino, Kenmei Takaichi, Farid Girgis Ghalli, Farid Girgis Ghalli, Rajiva Ibakkanavar, James Chess, Gareth Roberts, Steve Riley, Alline S.A. Oliveira, Clarissa J.B. Carvalho, Camila B L Oliveira, Carla T B C Pessoa, Rodrigo A S Leão, José Edevanilson B Gueiros, Ana Paula S Gueiros, Kazuhiro Okano, Yuki Tsuruta, Asako Hibi, Misao Tsukada, Naoko Miwa, Naoki Kimata, Ken Tsuchiya, Takashi Akiba, Kosaku Nitta, Masahide Mizobuchi, Hiroaki Ogata, Nozomu Hosaka, Daisuke Sanada, Noriko Arai, Fumihiko Koiwa, Eriko Kinugasa, Takanori Shibata, Tadao Akizawa, Pierre Delanaye, Jean-Marie Krzesinski, Xavier Warling, Martial Moonen, Nicole Smelten, Laurent Médart, Hans Pottel, Etienne Cavalier, Pierre Delanaye, Jean-Claude Souberbielle, Romy Gadisseur, Bernard E Dubois, Jean-Marie Krzesinski, Etienne Cavalier, Patrícia Matias, Cristina Jorge, Marco Mendes, Ana Azevedo, David Navarro, Carina Ferreira, Tiago Amaral, Inês Aires, Célia Gil, Aníbal Ferreira, Hiroshi Kikuchi, Hisaki Shimada, Ryo Karasawa, Masashi Suzuki, Won Suk An, Su Mi Lee, You Jeong Oh, Young Ki Son, Luciano De Paola, Gianmarco Lombardi, Maria Teresa Panzino, Luigi Lombardi, Helmut Reichel, Kai-Michael Hahn, Matthias Kohnle, Christina Guggenberger, Frank Delanna, Naomi Sasaki, Masataka Tsunoda, Ryota Ikee, Nobuo Hashimoto, Laura Sola, Maria Noel Leyun, Juan Carlos Diaz, Cristina Sehabiague, Susana Gonzalez, Walter Alallon, Kateri Bourbeau, Chloé Lajoie, Fabrice Macway, Takayuki Fujii, Satoshi Suzuki, Mizuki Shinozaki, Hiroaki Tanaka, Matthias Klingele, Sarah Seiler, Aaron Poppleton, Philipp Lepper, Danilo Fliser, Roland Seidel, Lide Lun, Dong Liu, Xinlun Li, Xueming Wei, Jing Miao, Zuo Gao, Ruihai Hu, Luciano De Paola, Gianmarco Lombardi, Maria Teresa Panzino, Luigi Lombardi, Blanca Gros, Antonio Galán, Emilio González-Parra, José Antonio Herrero, María Echave, Stefan Vegter, Keith Tolley, Itziar Oyagüez, Florian S. Gutzwiller, Peter G Braunhofer, Thomas D. Szucs, Matthias Schwenkglenks, Vural Taner Yilmaz, Sebahat Ozdem, Levent Donmez, Huseyin Kocak, Ayhan Dinckan, Ramazan Cetinkaya, Gultekin Suleymanlar, Fettah Fevzi Ersoy. DIALYSIS BONE DISEASE, Nephrology Dialysis Transplantation, 2014, pp. iii263-iii271, 29/suppl 3, DOI: 10.1093/ndt/gfu157