Role of Fracture Risk Assessment Tool and Bone Turnover Markers in Predicting All-Cause and Cardiovascular Mortality in Hemodialysis Patients

Frontiers in Medicine

article

Pei-Yu Wu¹  Szu-Chia Chen¹  Yi-Ching Lin³  Po-Chih Chen⁴  Wei-Shiuan Chung⁶  Ya-Chin Huang⁸  Ping-Hsun Wu¹  Yi-Chun Tsai¹  Jiun-Chi Huang¹  Yi-Wen Chiu¹  Jer-Ming Chang¹ 

[1] Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University;Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University;Faculty of Medicine, College of Medicine, Kaohsiung Medical University;Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University;Doctoral Degree Program of Toxicology, College of Pharmacy, Kaohsiung Medical University;Department of Radiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University;Department of Radiology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University;Department of Preventive Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University;Department of Occupational & Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University

关键词: Fracture Risk Assessment Tool;    bone turnover markers;    fracture;    mortality;    cardiovascular;    hemodialysis;   

DOI  :  10.3389/fmed.2022.891363

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Background Fracture Risk Assessment Tool (FRAX) and bone turnover markers (BTMs) predict fractures in the general population. However, the role of FRAX and BTMs in predicting mortality remains uncertain in hemodialysis (HD) patients. Methods One hundred and sixty-four HD patients stratified by low or high risk of 10-year fracture probability using FRAX. High risk of fracture was defined as 10-year probability of hip fracture ≥3% or major osteoporotic fracture ≥20%. The association of high risk of fracture and BTMs with all-cause mortality and cardiovascular (CV) mortality were evaluated using multivariate-adjusted Cox regression analysis. Results Eighty-five (51.8%) patients were classified as high risk of fracture based on FRAX among 164 HD patients. During a mean follow-up period of 3.5 ± 1.0 years, there were 39 all-cause deaths and 23 CV deaths. In multivariate-adjusted Cox regression, high risk of fracture based on FRAX was independently associated with all-cause mortality [hazard ratio (HR): 2.493, 95% confidence interval (CI): 1.026–6.056, p = 0.044) but not with CV mortality (HR: 2.129, 95% CI: 0.677–6.700, p = 0.196). There were no associations between BTMs and mortality risk. Furthermore, lower geriatric nutritional risk index (GNRI) was significantly associated with increased CV mortality (HR: 0.888, 95% CI: 0.802–0.983, p = 0.022) after adjusting by confounding variables. Conclusion High risk of fracture using FRAX was an independent predictor of all-cause mortality in patients undergoing HD. FRAX, rather than BTMs, has an important role of prognostic significance in HD patients.

【 授权许可】

CC BY