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Incidence of bone fractures among patients on maintenance hemodialysis
Abdullah Kashgary1, Feryal Omar A Attiah2, Nada AbuBakr AlKhateeb2
1Department of Medicine, Faculty of Medicine, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia.
Insights
Patients undergoing hemodialysis (HD) face a high risk of fractures. Higher bone-specific alkaline phosphatase (BSAP) levels, osteoporosis, and longer HD duration are key predictors of fracture incidence in these patients.
Area of Science:
- Nephrology
- Endocrinology
- Orthopedics
Background:
- Patients with chronic kidney disease (CKD), particularly those on hemodialysis (HD), exhibit an elevated risk of fragility fractures.
- The specific risk factors and incidence of fractures in this population within Saudi Arabia remain under-investigated.
Purpose of the Study:
- To investigate the incidence and risk factors of fractures in adult patients undergoing hemodialysis in Jeddah, Saudi Arabia.
- To identify key predictors of fracture development in the HD patient cohort.
Main Methods:
- A multicenter retrospective study was conducted across HD centers in Jeddah from 2015 to 2021.
- Data from 328 adult HD patients were collected, including demographics, medications, and clinical/biochemical parameters.
- Fracture incidence and associated risk factors were analyzed using registry records.
Main Results:
- The study included 328 HD patients (mean age 53 years; median HD duration 47 months).
- Fractures occurred in 32 patients, yielding an incidence rate of 20 cases/1000 end-stage kidney disease patient-years.
- Significant risk factors for fractures included osteoporosis, prior parathyroidectomy, longer HD vintage, and elevated bone-specific alkaline phosphatase (BSAP) levels.
- BSAP was the strongest predictor, with a cutoff of 96.6 µg/L showing 81.8% sensitivity and 49% specificity for fracture prediction.
Conclusions:
- Osteoporosis, parathyroidectomy, prolonged HD duration, and high BSAP levels are primary risk factors for fractures in HD patients.
- Elevated BSAP levels are the most significant predictor of incident fractures, underscoring the importance of monitoring bone turnover markers.
- High bone turnover negatively impacts patient health, necessitating targeted interventions and monitoring in CKD patients on HD.
Background:
Patients with chronic kidney disease, especially those undergoing hemodialysis (HD), have a higher risk of fragility fractures. However, the magnitude of the problem and risk factors associated with fracture incidence have not been well studied in the Kingdom of Saudi Arabia.
Methods:
This multicenter retrospective study involved HD centers in Jeddah from 2015 to 2021. This study included all adult HD patients. Patient demographics, medication usage, and clinical and biochemical parameters were collected from the registry records.
Results:
The study included 328 patients on HD, with a mean age of 53 years. The median duration of HD was 47 months. Osteoporosis was found in 9% of the patients, and 8% had a previous parathyroidectomy. Over the observation period, fractures occurred in 32 patients, with an incidence rate of 20 case/1000 end stage kidney disease patients-year. Patients with fractures had a higher rate of osteoporosis, underwent more parathyroidectomy, had longer HD vintage, and higher bone-specific alkaline phosphatase (BSAP) levels. BSAP was the most significant predictor of fracture incidence in the regression analysis. Using a BSAP cutoff value of 96.6 µg/L, the sensitivity and specificity to predict fractures were 81.8% and 49%, respectively.
Conclusion:
The main risk factors for incident fractures were osteoporosis, previous parathyroidectomy, longer HD vintage, and higher BSAP level. A higher BSAP score was the most significant predictor of incident fractures. This may highlight the importance of monitoring bone turnover markers and the negative impact of high bone turnover on patient health.
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