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. 2024 Aug 13;17(9):sfae248.
doi: 10.1093/ckj/sfae248. eCollection 2024 Sep.

Kidney function and bone mineral density in chronic kidney disease patients

Dong Hoon Kang  1 , Cheol Ho Park  1 , Hyung Woo Kim  1 , Jung Tak Park  1 , Seung Hyeok Han  1 , Jayoun Kim  2 , Jong Cheol Jeong  3   4 , Yaeni Kim  5 , Soo Wan Kim  6 , Kook-Hwan Oh  7 , Shin-Wook Kang  1 , Tae-Hyun Yoo  1
Affiliations

Kidney function and bone mineral density in chronic kidney disease patients

Dong Hoon Kang et al. Clin Kidney J. .

Abstract

Background: Bone mineral density (BMD) predicts fracture risk in patients with chronic kidney disease (CKD) and in the general population. However, few studies have investigated risk factors for bone loss in patients with CKD. The aim of this study was to investigate whether renal function is associated with the rate of BMD decline.

Methods: A prospective cohort study included 1006 patients with CKD stages 2-4 between 2011 and 2016. BMD was measured using dual-energy X-ray absorptiometry at baseline and 4 years. The eGFR was measured 2-6 times during the 4-year follow-up. We analyzed the decline in bone mineral density according to CKD stage and further compared the rate of BMD decline according to eGFR trajectories at each stage.

Results: Advanced CKD stage was associated with a faster rate of decline in total hip BMD [stage 2 -0.23, stage 3A -0.39, stage 3B -0.80, stage 4 -1.23% change/year in men (P < .001); stage 2 -0.86, stage 3A -1.19, stage 3B -1.20, stage 4 -1.58% change/year in women (P < .03)]. Two distinct eGFR trajectories (Class 1 stable group; Class 2 rapid decline group) were observed. The rapid decline group showed a trend toward an increased rate of decline in total hip BMD. Subgroup analysis according to eGFR trajectories revealed a significant difference in BMD decline rate between stable and rapid decline groups.

Conclusions: Advanced CKD stage and accelerated decline in renal function were associated with rapid BMD decline in non-dialysis patients with CKD.

Keywords: bone mineral density; chronic kidney disease; mineral bone disorder; renal function.

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Conflict of interest statement

None declared.

Figures

Figure 1:
Figure 1:
Flow diagram of the included patients.
Figure 2:
Figure 2:
Total hip BMD at baseline and year 4 according to CKD stage. Adjusted means and standard errors of total hip BMD at baseline and 4 years are represented as bar plot according to CKD stage. Values are adjusted for age, BMI, smoking, eGFR, UPCR, albumin, diabetes, calcium, phosphate, 25(OH)D, PTH, ALP, FGF23, and klotho.
Figure 3:
Figure 3:
Decline in total hip BMD (% change/year) according to CKD stage. BMD slope according to CKD stage. BMD slope is expressed as percentage change/year. The percentage number for each group represents the percentage change/year of total hip BMD from baseline obtained from a linear mixed model. The error bar indicates standard errors. BMD slopes are adjusted for age, BMI, smoking, eGFR, UPCR, albumin, diabetes, calcium, phosphate, 25(OH)D, PTH, ALP, FGF23, and klotho.
Figure 4:
Figure 4:
Decline in total hip BMD (% change/year) according to the trajectory group of each CKD stage. A decline in total hip BMD is shown according to eGFR trajectories for CKD stages 2–4. A rapid eGFR decline was associated with a faster rate of BMD decline in both men and women. *P < .05, **P < .01, ***P < .001.
See this image and copyright information in PMC

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