The Factors Effective on Bone Mineral Density in Peritoneal Dialysis Patients

Abstract

Bone mineral metabolism deteriorates gradually beginning from the early stages of chronic kidney disease (CKD). But, the KDIGO-2009 guideline could not provide high quality data regarding the biochemical tests related with bone mineral disorder in CKD. The aim of our study was to analyse the relationship between bone mineral densitometry and clinical and biochemical parameters in chronic peritoneal dialysis (PD) patients. Besides the demographic parameters, routine hematological and biochemical analysis results of PD patients followed up in our clinic were recorded. Bone mineral density (BMD) was measured at lumbar vertebrae and femur neck using DEXA machine. The mean lumbar T- and femur T-score were -1.03±1.20 (minimum:-3.73; maximum:+1.75) and -2.49±1.20 (minimum:-4.63; maximum:-0.51), respectively. Lumbar T score was significantly higher than femur T score (p

Keywords

• Bone mineral density, peritoneal dialysis, osteoporosis

The Factors Effective on Bone Mineral Density in Peritoneal Dialysis Patients

Öz

Kronik böbrek yetersizliği (KBY)'nin erken evrelerinden başlayarak kemik-mineral metabolizması giderek bozulur. Ancak KDIGO-2009 kılavuzunda KBY'de kemik mineral bozukluğu ile ilişkili verilerin çoğunluğunun kanıt düzeyi düşük olduğu ifade edilmiştir. Bu çalışmada, kronik periton diyalizi (PD) hastalarımızın kemik mineral dansitesi (KMD) ölçümleri ile klinik ve biyokimyasal parametreleri arasındaki ilişkiyi araştırdık. Hastanemizin PD ünitesinden takipli 53 hastanın demografik verileri yanında rutin hematolojik ve biyokimyasal tetkikleri kaydedildi. Hastalarda lomber vertebra ve femur boynundan DEXA cihazıyla kemik mineral dansitesi (KMD) ölçümü yapıldı. Hastaların lomber-T skoru -1.03±1.20[(-3.73)-(+1.75)] bulunur iken femur-T skoru -2.49±1.20[(-4.63)-(0.51)] olarak saptandı. Lomber T skoru, femur T skorundan anlamlı olarak daha yüksekti (p<0.0001). Sekiz hastanın KMD değeri normalken 16'sında osteopenia, 29'unda osteoporoz saptandı. Femur-T skor ile yaş arasında negatif korelasyon saptanırken(r=-0.36, p=0.026), lomber-T skoruyla yaş arasında korelasyon saptanmadı(r=-0.17, p=0.21). Femur-T skoruyla ilişkili parametrelerin çok değişkenli analizi yapıldığında; yaş ve VKİ, femur-T skorunun bağımsız belirleyicileri olduğu, cinsiyet, PTH düzeyi ve aktif D vitamin kullanımının anlamlı olarak etkilemediği saptandı. Yaş negatif, VKİ ise pozitif yönde etkiliydi. PD hastalarında femur boynundan yapılan KMD ölçümleri lomber vertebradan yapılan ölçümlere göre daha anlamlıdır. PD hastalarının çoğunda KMD düşüklüğü mevcuttur ve özellikle yaş ve VKİ majör etkili faktörlerdir

Anahtar Kelimeler

• Kemik mineral yoğunluğu, periton diyalizi, osteoporoz

Kaynakça

1. Kidney Disease: Improving Global Outcomes (KDIGO) CKD- MBD Work Group. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD- MBD). Kidney Int Suppl 2009;(113):S1-130.
2. The World Health Organization Assessment of osteoporo- sis at the primary health care level. Summary report of a WHO Scientific Group 2007; WHO, Geneva.
3. Masud T, Langley S, Wiltshire P, Doyle DV, Spector TD. Effect of spinal osteophytosis on bone mineral den- sity measurements in vertebral osteoporosis. BMJ 1993 17;307(6897):172-3.
4. Ott SM. Review article: Bone density in patients with chronic kidney disease stages 4-5. Nephrology (Carlton) 2009;14(4):395-403.
5. Negri AL, Barone R, Quiroga MA, Bravo M, Marino A, Fradinger E, Bogado CE, Zanchetta JR. Bone mineral den- sity: serum markers of bone turnover and their relation- ships in peritoneal dialysis. Perit Dial Int 2004;24(2):163-8
6. Stein MS, Packham DK, Ebeling PR, Wark JD, Becker GJ. Prevalence and risk factors for osteopenia in dialysis pa- tients. Am J Kidney Dis 1996;28(4):515-22.
7. Taal MW, Masud T, Green D, Cassidy MJ. Risk factors for reduced bone density in haemodialysis patients. Nephrol Dial Transplant 1999;14(8):1922-8.
8. Grzegorzewska AE, Młot-Michalska M. Influence of age and sex on bone mineral density in dialysis patients. Adv Perit Dial 2007;23:77-81

9. Ersoy FF, Passadakis SP, Tam P, et al. Bone mineral density and its correlation with clinical and laboratory factors in chronic peritoneal dialysis patients. J Bone Miner Metab 2006;24(1):79-86.
10. Arici M, Erturk H, Altun B, et al. Bone mineral density in haemodialysis patients: A comparative study of dual-en- ergy X-ray absorptiometry and quantitative ultrasound. Nephrol Dial Transplant 2000;15(11):1847-51.
11. Pongchaiyakul C, Pongskul C, Ruengjui S, Sirivongs D. Bone mineral density among patients undergoing continu- ous ambulatory peritoneal dialysis (CAPD). J Med Assoc Thai 2005;88 Suppl 5:S40-5.
12. Daria Baszko–Blaszyk, Alicja E. Grzegorzewska, Wanda Horst–Sikorska, Jerzy Sowinski. Bone Mass in Chronic Renal Insufficiency Patients Treated with Continuous Ambulatory Peritoneal Dialysis. Adv Perit Dial 2001;17:109-13.
13. Ureña P, Bernard-Poenaru O, Ostertag A, et al. Bone min- eral density, biochemical markers and skeletal fractures in haemodialysis patients. Nephrol Dial Transplant 2003 18: 2325–33.
14. Orlic L, Crncevic Z, Pavlovic D, Zaputovic L. Bone min- eral densitometry in patients on hemodialysis: differ- ence between genders and what to measure. Ren Fail 2010;32(3):300-8.
15. Atsumi K, Kushida K, Yamazaki K, Shimizu S, Ohmura A, Inoue T. Risk factors for vertebral fractures in renal os- teodystrophy. Am J Kidney Dis 1999;33(2):287-93.
16. Kokado Y, Takahara S, Ichimaru N, et al. Factors influenc- ing vertebral bone density after renal transplantation. Transpl Int 2000;13 Suppl 1:S431-5.
17. Nakashima A, Yorioka N, Doi S, Takasugi N, Shigemoto K, Kohno N. Osteoprotegerin and bone mineral density in hemodialysis patients. Osteoporos Int 2006;17(6):841-6.
18. Elder GJ, Mackun K. 25-Hydroxyvitamin D deficiency and diabetes predict reduced BMD in patients with chronic kidney disease. J Bone Miner Res 2006;21(11):1778-84.
19. Sit D, Kadiroglu AK, Kayabasi H, Atay AE, Yilmaz Z, Yilmaz ME. Relationship between bone mineral density and bio- chemical markers of bone turnover in hemodialysis pa- tients. Adv Ther 2007;24(5):987-95.
20. Doumouchtsis KK, Kostakis AI, Doumouchtsis SK, Tziamalis MP, Stathakis CP, Diamanti-Kandarakis E, Dimitroulis D, Perrea DN. Associations between osteoprotegerin and femoral neck BMD in hemodialysis patients. J Bone Miner Metab 2008;26(1):66-72.
21. Negri AL, Del Valle EE, Zanchetta MB, Net al. Evaluation of bone microarchitecture by high-resolution peripheral quantitative computed tomography (HR-pQCT) in hemo- dialysis patients. Osteoporos Int 2012;23(10):2543-50.
22. Lei SF, Deng FY, Li MX, Dvornyk V, Deng HW. Bone min- eral density in elderly Chinese: effects of age, sex, weight, height, and body mass index. J Bone Miner Metab 2004;22(1):71-8.
23. Stehman-Breen CO, Sherrard D, Walker A, Sadler R, Alem A, Lindberg J. Racial differences in bone mineral density and bone loss among end-stage renal disease patients. Am J Kidney Dis 1999;33(5):941-6.