Chronic kidney disease associated with decreased bone mineral density, uric acid and metabolic syndrome

January Chronic kidney disease associated with decreased bone mineral density, uric acid and metabolic syndrome Bo-Lin Pan 0 1 Song-Seng Loke 0 1 0 Department of Family Medicine, Kaohsiung Chang Gung Memorial Hospital , Niaosong District, Kaohsiung , Taiwan 1 Editor: Gregory Shearer, The Pennsylvania State University , UNITED STATES The relationship between decreased bone mineral density (BMD) and chronic kidney disease (CKD) is controversial. The associations among metabolic syndrome (MetS), serum uric acid and CKD are also unclear. We aimed to investigate the relationship between decreased BMD, MetS, serum uric acid and CKD in a general population. - Data Availability Statement: All relevant data are within the paper. Funding: The authors received no specific funding for this work. Competing interests: The authors have declared that no competing interests exist. Objective Results A total of 802 subjects who visited a medical center in Southern Taiwan and underwent a BMD measured by dual-energy X-ray absorptiometry (DEXA) during a health examination were enrolled in this retrospective cross-sectional study. Either osteopenia or osteoporosis was defined as decreased BMD. CKD was defined as the estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73m2. Simple and multivariate logistic regression analyses were used to investigate the association between variables, decreased BMD and CKD. Of the 802 subjects with a mean age of 54.4±10.2 years, the prevalence of decreased BMD was 62.9%, and CKD was 3.7%. Simple logistic analysis showed that sex (OR 3.50, 95% CI 1.21±10.12, p = 0.021), age (OR 1.14, 95% CI 1.07±1.21, p<0.001), BMI (OR 1.11, 95% CI 1.01±1.22, p = 0.028), waist circumference (OR 1.06, 95% CI 1.02±1.10, p = 0.002), SBP (OR 1.03, 95% CI 1.01±1.04, p = 0.003), DBP (OR 1.03, 95% CI 1.00±1.06, p = 0.030), HDL-C (OR 0.97, 95% CI 0.94±1.00, p = 0.026), uric acid (OR 1.84, 95% CI 1.49±2.27, p<0.001), metabolic syndrome (OR 2.68, 95% CI 1.29±5.67, p = 0.009), and decreased BMD (OR 3.998, 95% CI 1.38±11.57, p = 0.011) were significantly associated with CKD. Multivariate analysis showed that age (OR 1.05, 95% CI 1.03±1.07, p<0.001), decreased BMD (OR 0.64, 95% CI 0.45±0.91, p = 0.013), and uric acid (OR 1.40, 95% CI 1.24±1.59, p<0.001) were significantly independently associated with CKD. Conclusions Decreased BMD, uric acid and MetS were significantly associated with CKD.. Further large and prospective cohort studies are necessary to investigate whether management of osteoporosis, hyperuricemia, or MetS might prevent the progression of CKD. Introduction Chronic kidney disease (CKD) is a global health problem and increasing worldwide. The prevalence of CKD in Taiwan was 9.8±11.9% and 13.1% in the United States by National Health and Nutrition Examination Survey (NHANES III, 1999±2004) [ 1, 2 ]. The prevalence of CKD stage 3±5 or total CKD is approximately 12.9±15.1% in Japan, 3.2±11.3% in China, 7.2±13.7% in Korea, based on different published reports [1]. Osteoporosis is a silent health problem, which is characterized by decreased bone mineral density (BMD) with a risk of spine and hip fractures. Osteoporosis-related mortality and disability result in adverse impact on patients, their families, society and the health system. Endstage renal disease (ESRD) is significantly associated with decreased BMD and osteoporosis [ 3 ]; however, the relationship between decreased BMD and CKD is controversial. A study in cross-sectional analysis showed association between renal function and BMD, and this was strongest at higher CKD stages [ 4 ]. However from the Third National Health Assessment and Nutritional Examination Survey (NHANES III) data, there was no significant relationship of decreased BMD and CKD after adjustment for age, sex and race [ 5 ]. Recently, the Kidney Disease: Improving Global Outcomes (KDIGO) publication suggests BMD testing can play a role in screening among the population with stages 3±5 CKD [ 6 ]. Several studies have revealed the association of renal function and BMD in Asian countries [ 7, 8 ], but there is a lack of such studies performed in Taiwan. Metabolic syndrome (MetS) is a complicated disorder including several cardiovascular risk factors composed of abdominal obesity, high blood pressure, hyperglycemia, hypertriglyceridemia and low high-density lipoprotein cholesterol (HDL-C). MetS has been related to several diseases, such as cardiovascular disease, diabetes mellitus, fatty liver disease, and even with increased all-cause mortality [ 9 ]. MetS is also associated with the renal injury in previous studies [ 10, 11 ]. In addition, there is a correlation between MetS and hyperuricemia in increasing the risk of cardiovascular disease and mortality [ 12, 13 ]. Hyperuricemia and MetS also cause risk for CKD through similar mechanisms such as endothelial dysfunction, oxidative stress and systemic inflammation [ 13, 14 ]. No previous stud (...truncated)