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Sparing effect of peritoneal dialysis vs hemodialysis on BMD changes and its impact on mortality

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Journal of Bone and Mineral Metabolism Aims and scope Submit manuscript

Abstract

Introduction

Bone loss in end stage renal disease (ESRD) patients associates with fractures, vascular calcification, cardiovascular disease (CVD) and increased mortality. We investigated factors associated with changes of bone mineral density (ΔBMD) during the initial year on dialysis therapy and associations of ΔBMD with subsequent mortality in ESRD patients initiating dialysis.

Materials and methods

In 242 ESRD patients (median age 55 years, 61% men) starting dialysis with peritoneal dialysis (PD; n = 138) or hemodialysis (HD; n = 104), whole-body dual-energy X-ray absorptiometry (DXA), body composition, nutritional status and circulating biomarkers were assessed at baseline and 1 year after dialysis start. We used multivariate linear regression analysis to determine factors associated with ΔBMD, and fine and gray competing risk analysis to determine associations of ΔBMD with subsequent mortality risk.

Results

BMD decreased significantly in HD patients (significant reductions of BMDtotal and BMDleg, trunk, rib, pelvis and spine) but not in PD patients. HD compared to PD therapy associated with negative changes in BMDtotal (β=− 0.15), BMDhead (β=− 0.14), BMDleg (β=− 0.18) and BMDtrunk (β=− 0.16). Better preservation of BMD associated with significantly lower all-cause mortality for ΔBMDtotal (sub-hazard ratio, sHR, 0.91), ΔBMDhead (sHR 0.91) and ΔBMDleg (sHR 0.92), while only ΔBMDhead (sHR 0.92) had a beneficial effect on CVD-mortality.

Conclusions

PD had beneficial effect compared with HD on BMD changes during first year of dialysis therapy. Better preservation of BMD, especially in bone sites rich in cortical bone, associated with lower subsequent mortality. BMD in cortical bone may have stronger association with clinical outcome than BMD in trabecular bone.

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Acknowledgements

We thank all individuals who participated in the study and gratefully acknowledge the extensive work carried out by the staff at the clinical investigational unit and the Renal Laboratory, Department of Renal Medicine, Karolinska University Hospital Huddinge. Ken Iseri received support from Uehara Memorial Foundation, Japan. The study also benefited from generous support from Strategic Research Program in Diabetes at Karolinska Institutet (Swedish Research Council Grant No 2009-1068), European Union's Horizon 2020 research and innovation Program under the Marie Skłodowska-Curie Grant agreement No 722609; www.intricare.eu), Martin Rind Foundation, Heart and Lung Foundation, Njurfonden, and Westmans Foundation. Baxter Novum is the result of a grant from Baxter Healthcare to Karolinska Institutet.

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Authors and Affiliations

  1. Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, M99 Karolinska University Hospital Huddinge, 14186, Stockholm, Sweden

    Ken Iseri, Abdul Rashid Qureshi, Olof Heimbürger, Peter Barany, Peter Stenvinkel & Bengt Lindholm

  2. Division of Medical Imaging and Technology, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden

    Jonaz Ripsweden & Torkel B. Brismar

  3. Department of Radiology, Karolinska University Hospital, Huddinge, Sweden

    Jonaz Ripsweden & Torkel B. Brismar

  4. Division of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden

    Ingrid B. Bergström

  5. Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan

    Ken Iseri

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  1. Ken Iseri
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Contributions

PS, OH, and PB designed the MIA cohort study and recruited patients included in the present study. KI and ARQ designed the present study, performed statistical analyses, interpreted the results, prepared figures and tables, and drafted the manuscript. All authors contributed to data collection, revised the manuscript, and approved the final version of the manuscript.

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Correspondence to Ken Iseri.

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Conflict of interest

BL is employed by Baxter Healthcare Corporation. PS is on scientific advisory boards of REATA and Baxter Healthcare. None of the other authors declare any conflict of interest.

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Iseri, K., Qureshi, A.R., Ripsweden, J. et al. Sparing effect of peritoneal dialysis vs hemodialysis on BMD changes and its impact on mortality. J Bone Miner Metab 39, 260–269 (2021). https://doi.org/10.1007/s00774-020-01144-8

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