TY - JOUR
T1 - Association of normalized protein catabolic rate (nPCR) with the risk of bone fracture in patients undergoing maintenance hemodialysis
T2 - The Q-Cohort Study
AU - Ohnaka, Shotaro
AU - Yamada, Shunsuke
AU - Tsujikawa, Hiroaki
AU - Arase, Hokuto
AU - Taniguchi, Masatomo
AU - Tokumoto, Masanori
AU - Tsuruya, Kazuhiko
AU - Nakano, Toshiaki
AU - Kitazono, Takanari
N1 - Funding Information:
The Q-Cohort Study was supported by The Japan Kidney Foundation , Japan ( H19 JKFB 07-13 , H20 JKFB 08-8 , H23 JKFB 11-11 ) and The Japan Dialysis Outcome Research Foundation, Japan ( H19-076-02 and H20-003 ), without restriction on publications.
Publisher Copyright:
© 2020
PY - 2021/3
Y1 - 2021/3
N2 - Background & aims: Normalized protein catabolic rate (nPCR) is used as a surrogate for daily dietary protein intake and nutritional status in patients receiving maintenance hemodialysis. It remains uncertain whether the nPCR level is associated with the incidence of bone fracture. Methods: A total of 2869 hemodialysis patients registered in the Q-Cohort Study, a multicenter, prospective, observational study, were followed up for 4 years. The primary outcome was bone fracture at any site. The main exposure was the nPCR level at baseline. Patients were assigned to four groups based on their baseline nPCR levels (G1: <0.85, G2: 0.85≤, <0.95, G3: 0.95≤, <1.05 [reference], G4: ≥1.05 g/kg/day). We examined the relationship between the nPCR levels and the risk for bone fracture using Cox proportional hazards models. Results: During the follow-up period, 136 patients experienced bone fracture at any site. In the multivariable analyses, the risk for bone fracture was significantly higher in the lowest (G1) and highest (G4) nPCR groups than the reference (G3) group (hazard ratio [95% confidence intervals]: G1, 1.93 [1.04–3.58]; G2, 1.27 [0.67–2.40]; G3 1.00 (reference); G4, 2.21 [1.25–3.92]). The association remained almost unchanged, even when patients were divided into sex-specific nPCR quartiles, when analysis was limited to patients with a dialysis vintage ≥2 years, assumed to have lost residual kidney function, or when a competing risk model was applied. Conclusions: Our results suggest that both lower and higher nPCR levels are associated with an increased risk for bone fracture in hemodialysis patients.
AB - Background & aims: Normalized protein catabolic rate (nPCR) is used as a surrogate for daily dietary protein intake and nutritional status in patients receiving maintenance hemodialysis. It remains uncertain whether the nPCR level is associated with the incidence of bone fracture. Methods: A total of 2869 hemodialysis patients registered in the Q-Cohort Study, a multicenter, prospective, observational study, were followed up for 4 years. The primary outcome was bone fracture at any site. The main exposure was the nPCR level at baseline. Patients were assigned to four groups based on their baseline nPCR levels (G1: <0.85, G2: 0.85≤, <0.95, G3: 0.95≤, <1.05 [reference], G4: ≥1.05 g/kg/day). We examined the relationship between the nPCR levels and the risk for bone fracture using Cox proportional hazards models. Results: During the follow-up period, 136 patients experienced bone fracture at any site. In the multivariable analyses, the risk for bone fracture was significantly higher in the lowest (G1) and highest (G4) nPCR groups than the reference (G3) group (hazard ratio [95% confidence intervals]: G1, 1.93 [1.04–3.58]; G2, 1.27 [0.67–2.40]; G3 1.00 (reference); G4, 2.21 [1.25–3.92]). The association remained almost unchanged, even when patients were divided into sex-specific nPCR quartiles, when analysis was limited to patients with a dialysis vintage ≥2 years, assumed to have lost residual kidney function, or when a competing risk model was applied. Conclusions: Our results suggest that both lower and higher nPCR levels are associated with an increased risk for bone fracture in hemodialysis patients.
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U2 - 10.1016/j.clnu.2020.07.003
DO - 10.1016/j.clnu.2020.07.003
M3 - Article
C2 - 32736816
AN - SCOPUS:85088633571
VL - 40
SP - 997
EP - 1004
JO - Clinical Nutrition
JF - Clinical Nutrition
SN - 0261-5614
IS - 3
ER -