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Association between frailty and bone loss in patients undergoing maintenance hemodialysis

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Abstract

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.

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Acknowledgements

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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Authors and Affiliations

  1. Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, 1-15-1 Kitasato, Sagamihara, Kanagawa, 252-0373, Japan

    Kei Yoneki, Jun Kitagawa, Manae Harada, Takaaki Watanabe, Takahiro Shimoda, Kentaro Kamiya & Atsuhiko Matsunaga

  2. Department of Hemodialysis Center, Sagami Circulatory Organ Clinic, Sagamihara, Japan

    Kei Yoneki, Manae Harada, Takaaki Watanabe, Takahiro Shimoda, Atsushi Yoshida & Yusuke Matsunaga

  3. Department of Hygiene, Kitasato University School of Medicine, Sagamihara, Japan

    Keika Hoshi

  4. Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan

    Ryota Matsuzawa

  5. Department of Sleep Medicine, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan

    Yusuke Matsunaga

  6. Division of Nephrology, Department of Internal Medicine, Kitasato University School of Medicine, Sagamihara, Japan

    Yasuo Takeuchi

Authors
  1. Kei Yoneki
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  2. Jun Kitagawa
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  3. Keika Hoshi
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  4. Manae Harada
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  5. Takaaki Watanabe
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  7. Ryota Matsuzawa
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  8. Atsushi Yoshida
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  9. Yusuke Matsunaga
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  12. Atsuhiko Matsunaga
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Corresponding author

Correspondence to Atsuhiko Matsunaga.

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Yoneki, K., Kitagawa, J., Hoshi, K. et al. Association between frailty and bone loss in patients undergoing maintenance hemodialysis. J Bone Miner Metab 37, 81–89 (2019). https://doi.org/10.1007/s00774-017-0898-4

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  • DOI: https://doi.org/10.1007/s00774-017-0898-4

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