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Measurement of Tissue Oxygenation Using Near-Infrared Spectroscopy in Patients Undergoing Hemodialysis
Published on: October 2, 2020
Bone fracture risk factors in prevalent hemodialysis patients
Patrícia João Matias1,2,3,4, Ivo Laranjinha5,6,7, Ana Azevedo5,6
1Dialysis Unit, Nephrocare Vila Franca de Xira, Praça Bartolomeu Dias, lote 3 r/c, 2600-063, Vila Franca de Xira, Portugal. patriciajoaomatias@gmail.com.
Insights
Bone fractures are common in hemodialysis patients. Risk factors include older age, female gender, low albumin, vascular calcifications, and abnormal parathyroid hormone levels.
Area of Science:
- Nephrology
- Orthopedics
- Endocrinology
Background:
- Bone fractures represent a significant cause of morbidity and mortality in patients undergoing hemodialysis (HD).
- Understanding fracture incidence and associated risk factors is crucial for improving patient outcomes in this population.
Purpose of the Study:
- To quantify the incidence of fractures in a cohort of prevalent hemodialysis patients.
- To evaluate the relationship between fracture risk and various demographic, clinical, biochemical parameters, and vascular calcifications.
Main Methods:
- Retrospective analysis of 341 prevalent hemodialysis patients.
- Evaluation of demographic, clinical, biochemical data, and vascular calcifications (VC).
- Identification of fracture episodes and calculation of incidence rates.
Main Results:
- An incidence rate of 31 fractures per 1000 person-years was observed.
- Independent risk factors for fractures included older age, female gender, lower serum albumin, and higher VC scores.
- Active vitamin D therapy showed a protective effect, while elevated bone-specific alkaline phosphatase (bALP) and abnormal intact parathyroid hormone (iPTH) levels (<300 or >800 pg/mL) were associated with increased fracture risk.
Conclusions:
- Bone fracture incidence is high in hemodialysis patients.
- Age, female gender, lower albumin, and vascular calcifications are key risk factors.
- Abnormal iPTH, elevated bALP, and vitamin D therapy status are important considerations for fracture risk assessment and management.
Abstract:
Bone fractures are an important cause of morbidity and mortality in hemodialysis (HD) patients. The aim of this study was to quantify the incidence of fractures in a cohort of prevalent HD patients and evaluate its relationship with possible risk factors. We performed a retrospective analysis of 341 patients, since they started HD (median of 51 months). Demographic, clinical, and biochemical parameters as well as vascular calcifications (VC) were evaluated. Fifty-seven episodes of fracture were identified with a median HD vintage of 47 months (incidence rate of 31 per 1000 person-years). Age (p < 0.001), female gender (p < 0.001), lower albumin (p = 0.02), and higher VC score (p < 0.001) were independently associated with increased risk of fracture, while active vitamin D therapy (p = 0.03) was associated with decreased risk. A significantly higher risk of incident fracture was also associated with higher values of bone-specific alkaline phosphatase (bALP) (p = 0.01) and intact parathyroid hormone (iPTH) levels either < 300 pg/mL (p = 0.02) or > 800 pg/mL (p < 0.001) compared with 300-800 pg/mL. In conclusion, bone fracture incidence in HD patients is high and its risk increases with age, female gender, lower serum albumin, and with the presence of more VC. Prevalent HD patients with low or high iPTH levels or increased bALP also had a higher fracture risk. Therapy with active vitamin D seems to have a protective role. Assessment of fracture risk and management in dialysis patients at greatest risk requires further study.
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