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Published in: International Urology and Nephrology 9/2015

01-09-2015 | Nephrology - Original article

Relationship between mild-to-moderate chronic kidney disease and decreased bone mineral density in Chinese adult population

Authors: Xianglei Kong, Lijun Tang, Xiaojing Ma, Weiwei Liu, Zunsong Wang, Meiyu Cui, Dongmei Xu

Published in: International Urology and Nephrology | Issue 9/2015

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Abstract

Background

Several studies have shown ethnic differences in bone and mineral metabolism in healthy people and patients with chronic kidney disease (CKD). However, there have been few studies regarding CKD and bone mineral density (BMD) in Chinese population. We aimed to explore the relationship between mild-to-moderate CKD and decreased BMD in Chinese adult population.

Methods

A total of 24,002 adults were enrolled in this cross-sectional study. Mild-to-moderate CKD was defined as 30 < estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 or eGFR ≥ 60 mL/min/1.73 m2 with proteinuria greater than 1+. BMD was measured by dual-energy X-ray absorptiometry at the lumbar spine. Either osteopenia or osteoporosis was defined as decreased BMD. Multivariate logistic regression analysis was used to estimate the associations with decreased BMD.

Results

The subjects comprised 71.5 % men and 28.5 % women, the age was 49.9 ± 13.9 years. The overall prevalence of CKD was 2.9 %. Decreased BMD was 22.1, 19.9 % had osteopenia, and 2.2 % had osteoporosis. The percentage of patients with decreased BMD, osteopenia and osteoporosis were statistically higher (P < 0.05) in CKD patients compared with those of non-CKD participants, which was 29.5 versus 21.9 %, 25.9 versus 19.8 % and 3.6 versus 2.1 %, respectively. The risk for decreased BMD increased with CKD in a simple logistic analysis. However, the correlation disappeared after adjusted for age, sex, smoking, drinking, hypertension, diabetes and obesity.

Conclusions

Subjects with worse renal function have significantly lower BMD, but after adjusted for confounders, mild-to-moderate CKD is not independently associated with decreased BMD.
Literature
1.
go back to reference Meguid El Nahas A, Bello AK (2005) Chronic kidney disease: the global challenge. Lancet 365:331–340CrossRefPubMed Meguid El Nahas A, Bello AK (2005) Chronic kidney disease: the global challenge. Lancet 365:331–340CrossRefPubMed
2.
go back to reference Nugent RA, Fathima SF, Feigl AB et al (2011) The burden of chronic kidney disease on developing nations: a 21st century challenge in global health. Nephron Clin Pract 118:c269–c277CrossRefPubMed Nugent RA, Fathima SF, Feigl AB et al (2011) The burden of chronic kidney disease on developing nations: a 21st century challenge in global health. Nephron Clin Pract 118:c269–c277CrossRefPubMed
3.
go back to reference Zhang L, Wang F, Wang L et al (2012) Prevalence of chronic kidney disease in China: a cross-sectional survey. Lancet 379:815–822CrossRefPubMed Zhang L, Wang F, Wang L et al (2012) Prevalence of chronic kidney disease in China: a cross-sectional survey. Lancet 379:815–822CrossRefPubMed
4.
go back to reference Levey AS, Eckardt KU, Tsukamoto Y et al (2005) Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int 67:2089–2100CrossRefPubMed Levey AS, Eckardt KU, Tsukamoto Y et al (2005) Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int 67:2089–2100CrossRefPubMed
5.
go back to reference Lindberg JS, Moe SM (1999) Osteoporosis in end-state renal disease. Semin Nephrol 19:115–122PubMed Lindberg JS, Moe SM (1999) Osteoporosis in end-state renal disease. Semin Nephrol 19:115–122PubMed
6.
go back to reference Stehman-Breen CO, Sherrard DJ, Alem AM et al (2000) Risk factors for hip fracture among patients with end-stage renal disease. Kidney Int 58:2200–2205CrossRefPubMed Stehman-Breen CO, Sherrard DJ, Alem AM et al (2000) Risk factors for hip fracture among patients with end-stage renal disease. Kidney Int 58:2200–2205CrossRefPubMed
7.
go back to reference Fried LF, Biggs ML, Shlipak MG et al (2007) Association of kidney function with incident hip fracture in older adults. J Am Soc Nephrol 18:282–286CrossRefPubMed Fried LF, Biggs ML, Shlipak MG et al (2007) Association of kidney function with incident hip fracture in older adults. J Am Soc Nephrol 18:282–286CrossRefPubMed
8.
go back to reference Hsu CY, Cummings SR, McCulloch CE et al (2002) Bone mineral density is not diminished by mild to moderate chronic renal insufficiency. Kidney Int 61:1814–1820CrossRefPubMed Hsu CY, Cummings SR, McCulloch CE et al (2002) Bone mineral density is not diminished by mild to moderate chronic renal insufficiency. Kidney Int 61:1814–1820CrossRefPubMed
9.
go back to reference Kidney Disease: Improving Global Outcomes CKDMBDWG (2009) KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl:S1–S130 Kidney Disease: Improving Global Outcomes CKDMBDWG (2009) KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl:S1–S130
10.
11.
go back to reference Jorgetti V, dos Reis LM, Ott SM (2014) Ethnic differences in bone and mineral metabolism in healthy people and patients with CKD. Kidney Int 85:1283–1289CrossRefPubMed Jorgetti V, dos Reis LM, Ott SM (2014) Ethnic differences in bone and mineral metabolism in healthy people and patients with CKD. Kidney Int 85:1283–1289CrossRefPubMed
12.
go back to reference Andersen S, Boeskov E, Laurberg P (2005) Ethnic differences in bone mineral density between inuit and Caucasians in north Greenland are caused by differences in body size. J Clin Densitom 8:409–414CrossRefPubMed Andersen S, Boeskov E, Laurberg P (2005) Ethnic differences in bone mineral density between inuit and Caucasians in north Greenland are caused by differences in body size. J Clin Densitom 8:409–414CrossRefPubMed
13.
go back to reference Shin JH, Kim SH, Yu SH (2014) Metabolic syndrome and chronic kidney disease as risk factors of osteoporosis. Clin Nephrol 81:1–8CrossRefPubMed Shin JH, Kim SH, Yu SH (2014) Metabolic syndrome and chronic kidney disease as risk factors of osteoporosis. Clin Nephrol 81:1–8CrossRefPubMed
14.
go back to reference Myong JP, Kim HR, Koo JW et al (2013) Relationship between bone mineral density and moderate to severe chronic kidney disease among general population in Korea. J Korean Med Sci 28:569–574PubMedCentralCrossRefPubMed Myong JP, Kim HR, Koo JW et al (2013) Relationship between bone mineral density and moderate to severe chronic kidney disease among general population in Korea. J Korean Med Sci 28:569–574PubMedCentralCrossRefPubMed
15.
go back to reference Kaji H, Yamauchi M, Yamaguchi T et al (2010) Mild renal dysfunction is a risk factor for a decrease in bone mineral density and vertebral fractures in Japanese postmenopausal women. J Clin Endocrinol Metab 95:4635–4642CrossRefPubMed Kaji H, Yamauchi M, Yamaguchi T et al (2010) Mild renal dysfunction is a risk factor for a decrease in bone mineral density and vertebral fractures in Japanese postmenopausal women. J Clin Endocrinol Metab 95:4635–4642CrossRefPubMed
17.
go back to reference Kong X, Ma Y, Chen J et al (2013) Evaluation of the Chronic Kidney Disease Epidemiology Collaboration equation for estimating glomerular filtration rate in the Chinese population. Nephrol Dial Transplant 28:641–651CrossRefPubMed Kong X, Ma Y, Chen J et al (2013) Evaluation of the Chronic Kidney Disease Epidemiology Collaboration equation for estimating glomerular filtration rate in the Chinese population. Nephrol Dial Transplant 28:641–651CrossRefPubMed
18.
go back to reference National Kidney F (2002) K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 39:S1–S266 National Kidney F (2002) K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 39:S1–S266
19.
go back to reference Kanis JA (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO report. WHO Study Group. Osteoporos Int 4:368–381CrossRefPubMed Kanis JA (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO report. WHO Study Group. Osteoporos Int 4:368–381CrossRefPubMed
20.
go back to reference Miller PD (2014) Bone disease in CKD: a focus on osteoporosis diagnosis and management. Am J Kidney Dis 64:290–304CrossRefPubMed Miller PD (2014) Bone disease in CKD: a focus on osteoporosis diagnosis and management. Am J Kidney Dis 64:290–304CrossRefPubMed
21.
go back to reference Levin A, Bakris GL, Molitch M et al (2007) Prevalence of abnormal serum vitamin D, PTH, calcium, and phosphorus in patients with chronic kidney disease: results of the study to evaluate early kidney disease. Kidney Int 71:31–38CrossRefPubMed Levin A, Bakris GL, Molitch M et al (2007) Prevalence of abnormal serum vitamin D, PTH, calcium, and phosphorus in patients with chronic kidney disease: results of the study to evaluate early kidney disease. Kidney Int 71:31–38CrossRefPubMed
23.
go back to reference Kalantar-Zadeh K, Molnar MZ, Kovesdy CP et al (2012) Management of mineral and bone disorder after kidney transplantation. Curr Opin Nephrol Hypertens 21:389–403PubMedCentralCrossRefPubMed Kalantar-Zadeh K, Molnar MZ, Kovesdy CP et al (2012) Management of mineral and bone disorder after kidney transplantation. Curr Opin Nephrol Hypertens 21:389–403PubMedCentralCrossRefPubMed
24.
go back to reference Danese MD, Belozeroff V, Smirnakis K et al (2008) Consistent control of mineral and bone disorder in incident hemodialysis patients. Clin J Am Soc Nephrol 3:1423–1429PubMedCentralCrossRefPubMed Danese MD, Belozeroff V, Smirnakis K et al (2008) Consistent control of mineral and bone disorder in incident hemodialysis patients. Clin J Am Soc Nephrol 3:1423–1429PubMedCentralCrossRefPubMed
25.
go back to reference Lukowsky LR, Molnar MZ, Zaritsky JJ et al (2012) Mineral and bone disorders and survival in hemodialysis patients with and without polycystic kidney disease. Nephrol Dial Transplant 27:2899–2907PubMedCentralCrossRefPubMed Lukowsky LR, Molnar MZ, Zaritsky JJ et al (2012) Mineral and bone disorders and survival in hemodialysis patients with and without polycystic kidney disease. Nephrol Dial Transplant 27:2899–2907PubMedCentralCrossRefPubMed
26.
go back to reference Ott SM (2009) Review article: bone density in patients with chronic kidney disease stages 4–5. Nephrology (Carlton) 14:395–403CrossRef Ott SM (2009) Review article: bone density in patients with chronic kidney disease stages 4–5. Nephrology (Carlton) 14:395–403CrossRef
27.
go back to reference Ambrus C, Almasi C, Berta K et al (2011) Vitamin D insufficiency and bone fractures in patients on maintenance hemodialysis. Int Urol Nephrol 43:475–482CrossRefPubMed Ambrus C, Almasi C, Berta K et al (2011) Vitamin D insufficiency and bone fractures in patients on maintenance hemodialysis. Int Urol Nephrol 43:475–482CrossRefPubMed
28.
go back to reference Ambrus C, Almasi C, Berta K et al (2011) Bone mineral density and parathyroid function in patients on maintenance hemodialysis. Int Urol Nephrol 43:191–201CrossRefPubMed Ambrus C, Almasi C, Berta K et al (2011) Bone mineral density and parathyroid function in patients on maintenance hemodialysis. Int Urol Nephrol 43:191–201CrossRefPubMed
29.
go back to reference Iimori S, Mori Y, Akita W et al (2012) Diagnostic usefulness of bone mineral density and biochemical markers of bone turnover in predicting fracture in CKD stage 5D patients—a single-center cohort study. Nephrol Dial Transplant 27:345–351CrossRefPubMed Iimori S, Mori Y, Akita W et al (2012) Diagnostic usefulness of bone mineral density and biochemical markers of bone turnover in predicting fracture in CKD stage 5D patients—a single-center cohort study. Nephrol Dial Transplant 27:345–351CrossRefPubMed
30.
go back to reference Lima GA, Paranhos-Neto FD, Silva LC et al (2014) Bone density is directly associated with glomerular filtration and metabolic acidosis but do not predict fragility fractures in men with moderate chronic kidney disease. J Clin Densitom. s1094-6950:00031-6 Lima GA, Paranhos-Neto FD, Silva LC et al (2014) Bone density is directly associated with glomerular filtration and metabolic acidosis but do not predict fragility fractures in men with moderate chronic kidney disease. J Clin Densitom. s1094-6950:00031-6
31.
go back to reference Fujiwara S, Nakamura T, Orimo H et al (2008) Development and application of a Japanese model of the WHO fracture risk assessment tool (FRAX). Osteoporos Int 19:429–435PubMedCentralCrossRefPubMed Fujiwara S, Nakamura T, Orimo H et al (2008) Development and application of a Japanese model of the WHO fracture risk assessment tool (FRAX). Osteoporos Int 19:429–435PubMedCentralCrossRefPubMed
32.
go back to reference Ganesan K, Teklehaimanot S, Tran TH et al (2005) Relationship of C-reactive protein and bone mineral density in community-dwelling elderly females. J Natl Med Assoc 97:329–333PubMedCentralPubMed Ganesan K, Teklehaimanot S, Tran TH et al (2005) Relationship of C-reactive protein and bone mineral density in community-dwelling elderly females. J Natl Med Assoc 97:329–333PubMedCentralPubMed
33.
go back to reference Cappuccio FP, Meilahn E, Zmuda JM et al (1999) High blood pressure and bone-mineral loss in elderly white women: a prospective study. Study of Osteoporotic Fractures Research Group. Lancet 354:971–975CrossRefPubMed Cappuccio FP, Meilahn E, Zmuda JM et al (1999) High blood pressure and bone-mineral loss in elderly white women: a prospective study. Study of Osteoporotic Fractures Research Group. Lancet 354:971–975CrossRefPubMed
34.
go back to reference Forst T, Pfutzner A, Kann P et al (1995) Peripheral osteopenia in adult patients with insulin-dependent diabetes mellitus. Diabet Med 12:874–879CrossRefPubMed Forst T, Pfutzner A, Kann P et al (1995) Peripheral osteopenia in adult patients with insulin-dependent diabetes mellitus. Diabet Med 12:874–879CrossRefPubMed
Metadata
Title
Relationship between mild-to-moderate chronic kidney disease and decreased bone mineral density in Chinese adult population
Authors
Xianglei Kong
Lijun Tang
Xiaojing Ma
Weiwei Liu
Zunsong Wang
Meiyu Cui
Dongmei Xu
Publication date
01-09-2015
Publisher
Springer Netherlands
Published in
International Urology and Nephrology / Issue 9/2015
Print ISSN: 0301-1623
Electronic ISSN: 1573-2584
DOI
https://doi.org/10.1007/s11255-015-1082-1

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