Densitometric justification of the diagnosis of osteoporosis in patients with chronic kidney disease stage 5D









https://doi.org/10.36485/1561-6274-2023-27-1-69-77
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Abstract
BACKGROUND. Chronic kidney disease leads to increased bone fragility and fractures. Assessing the risk of fractures is a direct way to prevent them.
THE AIM: to assess the possibility of using DXA to predict fracture risk in patients with stage 5D CKD.
PATIENTS AND METHODS. The prospective cohort study included 359 patients (166 men, 193 women). BMD was evaluated by DRA. Some markers of mineral and bone metabolism were also analyzed. All fractures in patients were recorded from the moment of inclusion in the study.
RESULTS. All patients with fractures had lower BMD and received longer-term renal replacement therapy (RRT). The absolute risk of fractures increased as BMD decreased. Patients with fractures had higher levels of parathyroid hormone and alkaline phosphatase. Stepwise multivariate regression analysis showed that the combination of BMD scores of the forearm, hip, lumbar vertebrae and the duration of RRT best predicts the risk of fractures. The presence of previous fractures also increases risk for the future. Risk of fractures in man and women did not differ.
CONCLUSION. The risk of fractures in patients with CKD 5 st. on maintenance hemodialysis increases with a decrease in BMD, an increase in the duration of RRT and the presence of previous fractures, but does not significantly depends on the gender of the patients. It is also can be concluded that it is possible to use criteria reflecting the state of BMD, taking into account their sensitivity and specificity, in assessing the risk of fractures in patients with CKD 5D st.
About the Authors
S. O. MazurenkoRussian Federation
Sergey O. Mazurenko, Prof., MD, PhD, DMedSci
Department of Propaedeutics of Internal Diseases
199034
7-9 Universitetskaya Embankment
Center for Osteoporosis and Metabolic Diseases of the Skeleton
194291
Kultury St. 4
Saint Petersburg
Phone: +79117942845
Ya. A. Nakatis
Russian Federation
Yakov A. Nakatis, Prof., MD, PhD, DMedSci
199034
7-9 Universitetskaya Embankment
194291
Kultury St. 4
Saint Petersburg
Phone: +79219633149
O. G. Mazurenko
Russian Federation
Oksana G. Mazurenko, MD, PhD
Center for Osteoporosis and Metabolic Diseases of the Skeleton
194291
Kultury St. 4
Saint Petersburg
A. N. Vasilyev
Russian Federation
Aleksander N. Vasilyev, Nephrologist
197022
L. Tolstoy st., 17, build. 54
Saint Petersburg
Phone: +79219097590
A. A. Enkin
Russian Federation
Aleksander A. Enkin, Nephrologist
194291
Lunacharsky pr. 45. K. 2
Saint Petersburg
Phone: +79219987542
K. G. Staroselsky
Russian Federation
Konstantin G. Staroselsky, Nephrologist
196247
Kostushko st 2
Saint Petersburg
Phone: +79052846301
N. A. Samokhvalova
Russian Federation
Natalia A. Samokhvalova, Nephrologist
191015
Kirochnaya st., 41
Saint Petersburg
Phone: +79213087511
T. S. Semenova
Russian Federation
Tatiana S. Semenova, Postgraduate student
Department of Propaedeutics of Internal Diseases
199034
7-9 Universitetskaya Embankment
Saint Petersburg
Phone: +79117243089
A. K. Grusmanov
Russian Federation
Andrey K. Grusmanov, Resident-doctor
Department of Propaedeutics of Internal Diseases
199034,
7-9 Universitetskaya Embankment
Saint Petersburg
Phone: +79818106502
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Review
For citations:
Mazurenko S.O., Nakatis Ya.A., Mazurenko O.G., Vasilyev A.N., Enkin A.A., Staroselsky K.G., Samokhvalova N.A., Semenova T.S., Grusmanov A.K. Densitometric justification of the diagnosis of osteoporosis in patients with chronic kidney disease stage 5D. Nephrology (Saint-Petersburg). 2023;27(1):69-77. (In Russ.) https://doi.org/10.36485/1561-6274-2023-27-1-69-77
ISSN 2541-9439 (Online)