Association between frailty and bone loss in patients undergoing maintenance hemodialysis
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Frailty is significantly associated with bone loss in the general population. However, it is unclear whether this association also exists in patients undergoing hemodialysis who have chronic kidney disease-mineral and bone disorder (CKD-MBD). This study aimed to assess the association between frailty and bone loss in patients undergoing hemodialysis. This cross-sectional study included 214 (90 women, 124 men) Japanese outpatients undergoing maintenance hemodialysis three times per week, with a mean age of 67.1 years (women) and 66.8 years (men). Frailty was defined based on criteria set forth by the Cardiovascular Health Study (CHS)—19 (21.1%) women and 47 (37.9%) men were robust, 41 (45.6%) women and 43 (34.7%) men were pre-frail, and 30 (33.3%) women and 34 (27.4%) men were frail. For bone mass, quantitative ultrasound (QUS) parameters (speed of sound, broadband ultrasound attenuation, stiffness index) of the calcaneus were measured. The association between frailty and QUS parameters was determined separately for women and men using multivariate analysis of covariance (ANCOVA), with adjustments for clinical characteristics including age, body mass index, hemodialysis vintage, diabetes, current smoking, serum albumin, phosphate, corrected calcium, intact parathyroid hormone, and medication for CKD-MBD (vitamin D receptor activator, calcimimetics). ANCOVA revealed that all QUS parameters declined significantly with increasing levels of frailty in both sexes (P < 0.05). In conclusion, frailty (as defined by CHS criteria) should be considered a risk factor for bone loss in patients undergoing hemodialysis.
KeywordsFrailty Hemodialysis QUS Bone mass CKD-MBD
We thank all investigators and contributors to our study. This study was supported by JSPS KAKENHI (Grant Number 23500614). The funders had no role in the design, methods, subject recruitment, data collection, analysis, or preparation of the paper. The views expressed in this publication are those of the authors and not those of the funders.
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Conflict of interest
All authors have no conflict of interest to declare.
- 3.Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group (1994). World Health Organ Tech Rep Ser 843:1–129Google Scholar
- 5.Moe S, Drueke T, Cunningham J, Goodman W, Martin K, Olgaard K, Ott S, Sprague S, Lameire N, Eknoyan G (2006) Definition, evaluation, and classification of renal osteodystrophy: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int 69:1945–1953. https://doi.org/10.1038/sj.ki.5000414 CrossRefGoogle Scholar
- 16.Shimada H, Makizako H, Doi T, Yoshida D, Tsutsumimoto K, Anan Y, Uemura K, Ito T, Lee S, Park H, Suzuki T (2013) Combined prevalence of frailty and mild cognitive impairment in a population of elderly Japanese people. J Am Med Dir Assoc 14:518–524. https://doi.org/10.1016/j.jamda.2013.03.010 CrossRefGoogle Scholar
- 22.Johansen KL, Dalrymple LS, Delgado C, Kaysen GA, Kornak J, Grimes B, Chertow GM (2014) Comparison of self-report-based and physical performance-based frailty definitions among patients receiving maintenance hemodialysis. Am J Kidney Dis 64:600–607. https://doi.org/10.1053/j.ajkd.2014.03.016 CrossRefGoogle Scholar
- 25.Akizawa T, Kido R, Fukagawa M, Onishi Y, Yamaguchi T, Hasegawa T, Fukuhara S, Kurokawa K (2011) Decreases in PTH in Japanese hemodialysis patients with secondary hyperparathyroidism: associations with changing practice patterns. Clin J Am Soc Nephrol 6:2280–2288. https://doi.org/10.2215/cjn.11501210 CrossRefGoogle Scholar
- 26.Chastin SF, Mandrichenko O, Skelton DA (2014) The frequency of osteogenic activities and the pattern of intermittence between periods of physical activity and sedentary behaviour affects bone mineral content: the cross-sectional NHANES study. BMC Public Health 14:4. https://doi.org/10.1186/1471-2458-14-4 CrossRefGoogle Scholar