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Sparing effect of peritoneal dialysis vs hemodialysis on BMD changes and its impact on mortality
Ken Iseri1,2, Abdul Rashid Qureshi3, Jonaz Ripsweden4,5
1Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, M99 Karolinska University Hospital Huddinge, 14186, Stockholm, Sweden. iseriken@med.showa-u.ac.jp.
Insights
Peritoneal dialysis (PD) preserves bone mineral density (BMD) better than hemodialysis (HD) in end-stage renal disease (ESRD) patients. Better BMD preservation is linked to reduced mortality risk in ESRD patients on dialysis.
Area of Science:
- Nephrology
- Bone Metabolism
- Renal Osteodystrophy
Background:
- End-stage renal disease (ESRD) is associated with significant bone loss, increasing risks of fractures, vascular calcification, cardiovascular disease (CVD), and mortality.
- Understanding factors influencing bone mineral density (BMD) changes and their impact on mortality in ESRD patients initiating dialysis is crucial for improving patient outcomes.
Purpose of the Study:
- To investigate factors associated with changes in BMD during the first year of dialysis therapy in ESRD patients.
- To examine the association between BMD changes and subsequent all-cause and CVD mortality in ESRD patients.
Main Methods:
- A cohort of 242 ESRD patients initiating peritoneal dialysis (PD) or hemodialysis (HD) were assessed at baseline and 1 year.
- Whole-body dual-energy X-ray absorptiometry (DXA), body composition, nutritional status, and biomarkers were measured.
- Multivariate linear regression and competing risk analysis were used to determine factors associated with BMD changes and their impact on mortality.
Main Results:
- BMD significantly decreased in HD patients but not in PD patients.
- HD therapy was associated with negative BMD changes compared to PD therapy across multiple sites, including total body, head, leg, and trunk.
- Better BMD preservation correlated with significantly lower all-cause mortality and, for BMD of the head, a beneficial effect on CVD-mortality.
Conclusions:
- Peritoneal dialysis (PD) demonstrates a beneficial effect on BMD changes compared to hemodialysis (HD) during the initial year of therapy.
- Preservation of BMD, particularly in cortical bone sites, is associated with reduced subsequent mortality risk in ESRD patients.
- BMD in cortical bone may exhibit a stronger association with clinical outcomes than BMD in trabecular bone.
Introduction:
Bone loss in end stage renal disease (ESRD) patients associates with fractures, vascular calcification, cardiovascular disease (CVD) and increased mortality. We investigated factors associated with changes of bone mineral density (ΔBMD) during the initial year on dialysis therapy and associations of ΔBMD with subsequent mortality in ESRD patients initiating dialysis.
Materials And Methods:
In 242 ESRD patients (median age 55 years, 61% men) starting dialysis with peritoneal dialysis (PD; n = 138) or hemodialysis (HD; n = 104), whole-body dual-energy X-ray absorptiometry (DXA), body composition, nutritional status and circulating biomarkers were assessed at baseline and 1 year after dialysis start. We used multivariate linear regression analysis to determine factors associated with ΔBMD, and fine and gray competing risk analysis to determine associations of ΔBMD with subsequent mortality risk.
Results:
BMD decreased significantly in HD patients (significant reductions of BMDtotal and BMDleg, trunk, rib, pelvis and spine) but not in PD patients. HD compared to PD therapy associated with negative changes in BMDtotal (β=- 0.15), BMDhead (β=- 0.14), BMDleg (β=- 0.18) and BMDtrunk (β=- 0.16). Better preservation of BMD associated with significantly lower all-cause mortality for ΔBMDtotal (sub-hazard ratio, sHR, 0.91), ΔBMDhead (sHR 0.91) and ΔBMDleg (sHR 0.92), while only ΔBMDhead (sHR 0.92) had a beneficial effect on CVD-mortality.
Conclusions:
PD had beneficial effect compared with HD on BMD changes during first year of dialysis therapy. Better preservation of BMD, especially in bone sites rich in cortical bone, associated with lower subsequent mortality. BMD in cortical bone may have stronger association with clinical outcome than BMD in trabecular bone.
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