期刊
CLINICAL NEPHROLOGY
卷 89, 期 1, 页码 10-17出版社
DUSTRI-VERLAG DR KARL FEISTLE
DOI: 10.5414/CN109006
关键词
bone metabolism; chronic kidney disease; bone mineral density; vitamin D; HR-pQCT
资金
- Divisions of Nephrology and Endocrinology, Hospital Universitario Clementino Fraga Filho
- Department of Internal Medicine, Universidade Federal do Rio de Janeiro, Brazil
- Laboratorio Morales, Niteroi - Rio de Janeiro, Brazil
- Fundacao Carlos Chagas Filho de Amparo a Pesquisa do Estado do Rio de Janeiro (BR) - FAPERJ [E-26/110.241/2014, E-26/010.001605/2014]
- Conselho Nacional de Desenvolvimento Cientifico e Tecnologico - CNPq [141704/2014-4]
Introduction: Factors associated with osteodystrophy in predialysis patients arc poorly understood. In the present study, we attempted to evaluate the impact of body composition and hormonal regulatory factors on the bone microstructure in a group of men with chronic kidney disease (CKD) stages 3 and 4. Materials and methods: 46 men, aged 50 - 75 years. with previously unrecognized CKD were evaluated by high-resolution peripheral quantitative computed tomography (HR-pQCT), and dual-energy X-ray absorptiometry (DXA). HR-pQCT parameters were correlated with estimated glomerular filtration rate (eGFR), age, body mass index (BMI), muscle mass index (MMI), and biochemistry. Results: As compared to patients in stage 3 CKD, those with stage 4 CKD showed lower serum 25-hydroxyvitamin D (25(OH)D) and bicarbonate levels, and higher serum fibroblast growth factor 23 (FGF23) and parathyroid hormone (PTH) levels. They also exhibited lower total, trabecular, and cortical volumetric bone mineral density, lower trabecular bone volume/tissue volume. trabecular number, trabecular and cortical thickness, and increased heterogeneity of the trabecular network. In the whole cohort, cortical bone density and thickness were negatively associated with age, PTH, and FGF23, and positively with BMI. Trabecular bone parameters were positively associated with MMI and 25(OH)D. After simultaneously adjusting for age and eGFR, BMI, and MMI remained significantly associated with bone microstructural variables. Conclusion: HR-pQCT showed significant differences in bone microstructure in stage 4 vs. stage 3 CKD patients. Increased BMI, probably due to increased muscle mass, may favorably affect bone architecture in predialysis CKD patients.
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