Association between CKD-MBD and hip-bone microstructures in dialysis patients

• Published in: Clinical kidney journal 2024-08, Vol.17 (8), p.sfae240
• Main Authors: Iseri, Ken, Mizobuchi, Masahide, Shishido, Kanji, Hida, Noriko
• Format: Article
• Language: English
• Subjects: Bone diseases; Care and treatment; Chronic kidney failure; Compact bone; Complications and side effects; Demographic aspects; Health aspects; Hemodialysis; Measurement; Original; Parathyroid hormone; Physiological aspects; Prevention; Risk factors; Trabecular bone
• ISSN: 2048-8505; 2048-8513
• DOI: 10.1093/ckj/sfae240

ABSTRACT Background The longitudinal changes in hip-bone microstructures and estimated bone strength in dialysis patients, and the impact of chronic kidney disease–mineral and bone disorder (CKD-MBD) biomarkers on these changes, remain insufficiently explored. Methods This retrospective study examined changes in cortical and trabecular bone compartments and estimated bone-strength indices, obtained by using 3D-SHAPER software, in the hip regions of 276 dialysis patients over up to 2.5 years. We used multivariate mixed models to investigate the associations between time-dependent CKD-MBD biomarkers and bone health metrics. Results There was a significant decrease in areal bone mineral density (aBMD), integral volumetric BMD (vBMD), trabecular vBMD, cortical thickness and cortical surface BMD (sBMD). Similar deteriorations were found in estimated bone-strength indices [cross-sectional area (CSA), cross-sectional moment of inertia (CSMI), section modulus (SM) and buckling ratio]. Neither serum calcium nor phosphate levels were significantly associated with changes in three-dimensional parameters or estimated bone-strength indices. In contrast, serum alkaline phosphatase levels showed a significant inverse correlation with aBMD and CSA. The intact-parathyroid hormone (i-PTH) was significantly inversely correlated with aBMD, integral vBMD, trabecular vBMD, cortical thickness, cortical vBMD, CSA, CSMI and SM. When applying the KDIGO criteria as a sensitivity analysis, the higher PTH group had significant negative associations with aBMD, integral vBMD, cortical vBMD, cortical thickness and cortical sBMD. Notably, the lower PTH group showed a positive significant correlation with integral vBMD and trabecular vBMD. Conclusions Elevated PTH, not low PTH, was associated with deterioration of hip-bone microstructures. Better management of PTH levels may play a crucial role in the hip-bone microstructure in dialysis patients. Graphical Abstract Graphical Abstract