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Updated: Jun 16, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Cardiac Biomarkers are Associated with Incident Fracture Risk in Advanced Chronic Kidney Disease
Louise Aaltonen1, Tapio Hellman2, Roosa Lankinen2
1Kidney Center, Department of Medicine, Turku University Hospital, PL 52, Kiinamyllynkatu 4-8, 20521, Turku, Finland. louise.aaltonen@varha.fi.
Insights
Cardiovascular health markers and a composite risk score predict fracture risk in advanced chronic kidney disease (CKD) patients. This highlights the link between heart health and bone fragility in this high-risk population.
Area of Science:
- Nephrology
- Cardiology
- Bone Metabolism
Background:
- Cardiovascular disease (CVD) is linked to higher fracture risk in the general population.
- Limited data exist on cardiovascular health and incident fracture risk in advanced chronic kidney disease (CKD) patients, a population highly susceptible to fractures.
Purpose of the Study:
- To investigate the association between cardiovascular health and incident fracture risk in patients with advanced CKD (stages G4-5).
- To evaluate the predictive value of cardiovascular biomarkers and a composite risk score for fractures in this cohort.
Main Methods:
- Prospective cohort study of 210 patients with CKD stage G4-5.
- Baseline assessments included laboratory parameters (Troponin T - TnT, Pro-brain Natriuretic Peptide - ProBNP), abdominal aortic calcification, echocardiography, flow-mediated dilation, intima-media thickness, and maximal stress ergometry.
- Incident fractures were recorded over a 5-year follow-up period. Multivariable Cox proportional hazards models were used for analysis.
Main Results:
- A total of 51 fractures occurred in 40 patients (19%) over 5 years.
- Elevated TnT and ProBNP levels were independently associated with increased fracture risk, even after adjusting for coronary artery disease (CAD).
- Patients unable to complete ergometry had a significantly higher fracture risk. A composite cardiovascular risk score integrating TnT, ProBNP, and ergometry data strongly predicted incident fractures (HR 1.373).
Conclusions:
- Cardiovascular health, assessed through biomarkers like TnT and ProBNP, and functional capacity (ergometry), is significantly associated with incident fracture risk in advanced CKD.
- A composite cardiovascular risk score effectively identifies patients with advanced CKD at higher risk for fractures.
- These findings underscore the importance of evaluating cardiovascular health in managing fracture risk in CKD patients.
Abstract:
Cardiovascular disease is associated with increased fracture risk in the general population. Few data exist on the association between cardiovascular health and incident fracture risk in patients with advanced CKD, a high-risk population for fractures. We aimed to assess the link between fracture risk and cardiovascular health in a prospective cohort of 210 patients with CKD stage G4-5. Incident fractures were recorded during a prospective follow-up of 5 years. Laboratory parameters, abdominal aortic calcification score, echocardiography, ultrasound assessment of brachial artery flow-mediated dilatation and carotid intima-media thickness, and maximal stress ergometry were obtained at baseline. A total of 51 fractures were observed in 40 (19%) patients during follow-up. In separate multivariable Cox proportional hazards models adjusted for age, gender, and baseline eGFR, TnT (HR 1.007, CI 95% 1.003-1.010, p < 0.001) and ProBNP (HR 1.000, CI 95% 1.000-1.000, p = 0.017) were associated with incident fractures and the association persisted after adjusting for coronary artery disease (CAD). The patients unable to perform the ergometry test had a higher risk of incident fractures compared to others (36.1% vs 15.5%, p = 0.009). A cardiovascular composite risk score summarizing TnT, ProBNP, and ergometry data was independently associated with incident fractures in a multivariable Cox model (HR 1.373, CI 95% 1.180-1.599, p < 0.001). Patients with the lowest score were observed with no fractures, while patients with the highest score were observed with a fracture risk of 40.5% during follow-up. Risk of incident fractures is associated with biomarkers of cardiovascular health and a composite cardiovascular risk score in patients with advanced CKD.
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