Modified Creatinine Index and the Risk of Bone Fracture in Patients Undergoing Hemodialysis: The Q-Cohort Study

Shunsuke Yamada, Masatomo Taniguchi, Masanori Tokumoto, Ryota Yoshitomi, Hisako Yoshida, Narihito Tatsumoto, Hideki Hirakata, Satoru Fujimi, Takanari Kitazono, Kazuhiko Tsuruya

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Abstract

Background Hemodialysis patients are at increased risk for bone fracture and sarcopenia. There is close interplay between skeletal muscle and bone. However, it is still unclear whether lower skeletal muscle mass increases the risk for bone fracture. Study Design Cross-sectional study and prospective longitudinal cohort study. Setting & Participants An independent cohort of 78 hemodialysis patients in the cross-sectional study and 3,030 prevalent patients undergoing maintenance hemodialysis prospectively followed up for 4 years. Predictor Skeletal muscle mass measured by bioelectrical impedance analysis (BIA) and modified creatinine index, an estimate of skeletal muscle mass based on age, sex, Kt/V for urea, and serum creatinine level. Outcomes Bone fracture at any site. Results In the cross-sectional study, modified creatinine index was significantly correlated with skeletal muscle mass measured by BIA. During a median follow-up of 3.9 years, 140 patients had bone fracture. When patients were divided into sex-specific quartiles based on modified creatinine index, risk for bone fracture estimated by a Fine-Gray proportional subdistribution hazards model with all-cause death as a competing risk was significantly higher in the lower modified creatinine index quartiles (Q1 and Q2) compared to the highest modified creatinine index quartile (Q4) as the reference value in both sexes (multivariable-adjusted HRs for men were 7.81 [95% CI, 2.63-23.26], 5.48 [95% CI, 2.08-14.40], 2.24 [95% CI, 0.72-7.00], and 1.00 [P for trend < 0.001], and for women were 4.44 [95% CI, 1.50-13.11], 2.33 [95% CI, 0.86-6.31], 1.96 [95% CI, 0.82-4.65], and 1.00 [P for trend = 0.007] for Q1, Q2, Q3, and Q4, respectively). Limitations One-time assessment of modified creatinine index; no data for residual kidney function and fracture sites and causes. Conclusions Modified creatinine index was correlated with skeletal muscle mass measured by BIA. Lower modified creatinine index was associated with increased risk for bone fracture in male and female hemodialysis patients.

Original languageEnglish
Pages (from-to)270-280
Number of pages11
JournalAmerican Journal of Kidney Diseases
Volume70
Issue number2
DOIs
Publication statusPublished - Aug 2017

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Bone Fractures
Renal Dialysis
Creatinine
Cohort Studies
Skeletal Muscle
Electric Impedance
Cross-Sectional Studies
Sarcopenia
Proportional Hazards Models
Longitudinal Studies
Urea
Cause of Death
Reference Values
Maintenance
Kidney
Bone and Bones
Serum

All Science Journal Classification (ASJC) codes

  • Nephrology

Cite this

Modified Creatinine Index and the Risk of Bone Fracture in Patients Undergoing Hemodialysis : The Q-Cohort Study. / Yamada, Shunsuke; Taniguchi, Masatomo; Tokumoto, Masanori; Yoshitomi, Ryota; Yoshida, Hisako; Tatsumoto, Narihito; Hirakata, Hideki; Fujimi, Satoru; Kitazono, Takanari; Tsuruya, Kazuhiko.

In: American Journal of Kidney Diseases, Vol. 70, No. 2, 08.2017, p. 270-280.

Research output: Contribution to journalArticle

Yamada, S, Taniguchi, M, Tokumoto, M, Yoshitomi, R, Yoshida, H, Tatsumoto, N, Hirakata, H, Fujimi, S, Kitazono, T & Tsuruya, K 2017, 'Modified Creatinine Index and the Risk of Bone Fracture in Patients Undergoing Hemodialysis: The Q-Cohort Study', American Journal of Kidney Diseases, vol. 70, no. 2, pp. 270-280. https://doi.org/10.1053/j.ajkd.2017.01.052
Yamada, Shunsuke ; Taniguchi, Masatomo ; Tokumoto, Masanori ; Yoshitomi, Ryota ; Yoshida, Hisako ; Tatsumoto, Narihito ; Hirakata, Hideki ; Fujimi, Satoru ; Kitazono, Takanari ; Tsuruya, Kazuhiko. / Modified Creatinine Index and the Risk of Bone Fracture in Patients Undergoing Hemodialysis : The Q-Cohort Study. In: American Journal of Kidney Diseases. 2017 ; Vol. 70, No. 2. pp. 270-280.
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abstract = "Background Hemodialysis patients are at increased risk for bone fracture and sarcopenia. There is close interplay between skeletal muscle and bone. However, it is still unclear whether lower skeletal muscle mass increases the risk for bone fracture. Study Design Cross-sectional study and prospective longitudinal cohort study. Setting & Participants An independent cohort of 78 hemodialysis patients in the cross-sectional study and 3,030 prevalent patients undergoing maintenance hemodialysis prospectively followed up for 4 years. Predictor Skeletal muscle mass measured by bioelectrical impedance analysis (BIA) and modified creatinine index, an estimate of skeletal muscle mass based on age, sex, Kt/V for urea, and serum creatinine level. Outcomes Bone fracture at any site. Results In the cross-sectional study, modified creatinine index was significantly correlated with skeletal muscle mass measured by BIA. During a median follow-up of 3.9 years, 140 patients had bone fracture. When patients were divided into sex-specific quartiles based on modified creatinine index, risk for bone fracture estimated by a Fine-Gray proportional subdistribution hazards model with all-cause death as a competing risk was significantly higher in the lower modified creatinine index quartiles (Q1 and Q2) compared to the highest modified creatinine index quartile (Q4) as the reference value in both sexes (multivariable-adjusted HRs for men were 7.81 [95{\%} CI, 2.63-23.26], 5.48 [95{\%} CI, 2.08-14.40], 2.24 [95{\%} CI, 0.72-7.00], and 1.00 [P for trend < 0.001], and for women were 4.44 [95{\%} CI, 1.50-13.11], 2.33 [95{\%} CI, 0.86-6.31], 1.96 [95{\%} CI, 0.82-4.65], and 1.00 [P for trend = 0.007] for Q1, Q2, Q3, and Q4, respectively). Limitations One-time assessment of modified creatinine index; no data for residual kidney function and fracture sites and causes. Conclusions Modified creatinine index was correlated with skeletal muscle mass measured by BIA. Lower modified creatinine index was associated with increased risk for bone fracture in male and female hemodialysis patients.",
author = "Shunsuke Yamada and Masatomo Taniguchi and Masanori Tokumoto and Ryota Yoshitomi and Hisako Yoshida and Narihito Tatsumoto and Hideki Hirakata and Satoru Fujimi and Takanari Kitazono and Kazuhiko Tsuruya",
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AU - Yamada, Shunsuke

AU - Taniguchi, Masatomo

AU - Tokumoto, Masanori

AU - Yoshitomi, Ryota

AU - Yoshida, Hisako

AU - Tatsumoto, Narihito

AU - Hirakata, Hideki

AU - Fujimi, Satoru

AU - Kitazono, Takanari

AU - Tsuruya, Kazuhiko

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N2 - Background Hemodialysis patients are at increased risk for bone fracture and sarcopenia. There is close interplay between skeletal muscle and bone. However, it is still unclear whether lower skeletal muscle mass increases the risk for bone fracture. Study Design Cross-sectional study and prospective longitudinal cohort study. Setting & Participants An independent cohort of 78 hemodialysis patients in the cross-sectional study and 3,030 prevalent patients undergoing maintenance hemodialysis prospectively followed up for 4 years. Predictor Skeletal muscle mass measured by bioelectrical impedance analysis (BIA) and modified creatinine index, an estimate of skeletal muscle mass based on age, sex, Kt/V for urea, and serum creatinine level. Outcomes Bone fracture at any site. Results In the cross-sectional study, modified creatinine index was significantly correlated with skeletal muscle mass measured by BIA. During a median follow-up of 3.9 years, 140 patients had bone fracture. When patients were divided into sex-specific quartiles based on modified creatinine index, risk for bone fracture estimated by a Fine-Gray proportional subdistribution hazards model with all-cause death as a competing risk was significantly higher in the lower modified creatinine index quartiles (Q1 and Q2) compared to the highest modified creatinine index quartile (Q4) as the reference value in both sexes (multivariable-adjusted HRs for men were 7.81 [95% CI, 2.63-23.26], 5.48 [95% CI, 2.08-14.40], 2.24 [95% CI, 0.72-7.00], and 1.00 [P for trend < 0.001], and for women were 4.44 [95% CI, 1.50-13.11], 2.33 [95% CI, 0.86-6.31], 1.96 [95% CI, 0.82-4.65], and 1.00 [P for trend = 0.007] for Q1, Q2, Q3, and Q4, respectively). Limitations One-time assessment of modified creatinine index; no data for residual kidney function and fracture sites and causes. Conclusions Modified creatinine index was correlated with skeletal muscle mass measured by BIA. Lower modified creatinine index was associated with increased risk for bone fracture in male and female hemodialysis patients.

AB - Background Hemodialysis patients are at increased risk for bone fracture and sarcopenia. There is close interplay between skeletal muscle and bone. However, it is still unclear whether lower skeletal muscle mass increases the risk for bone fracture. Study Design Cross-sectional study and prospective longitudinal cohort study. Setting & Participants An independent cohort of 78 hemodialysis patients in the cross-sectional study and 3,030 prevalent patients undergoing maintenance hemodialysis prospectively followed up for 4 years. Predictor Skeletal muscle mass measured by bioelectrical impedance analysis (BIA) and modified creatinine index, an estimate of skeletal muscle mass based on age, sex, Kt/V for urea, and serum creatinine level. Outcomes Bone fracture at any site. Results In the cross-sectional study, modified creatinine index was significantly correlated with skeletal muscle mass measured by BIA. During a median follow-up of 3.9 years, 140 patients had bone fracture. When patients were divided into sex-specific quartiles based on modified creatinine index, risk for bone fracture estimated by a Fine-Gray proportional subdistribution hazards model with all-cause death as a competing risk was significantly higher in the lower modified creatinine index quartiles (Q1 and Q2) compared to the highest modified creatinine index quartile (Q4) as the reference value in both sexes (multivariable-adjusted HRs for men were 7.81 [95% CI, 2.63-23.26], 5.48 [95% CI, 2.08-14.40], 2.24 [95% CI, 0.72-7.00], and 1.00 [P for trend < 0.001], and for women were 4.44 [95% CI, 1.50-13.11], 2.33 [95% CI, 0.86-6.31], 1.96 [95% CI, 0.82-4.65], and 1.00 [P for trend = 0.007] for Q1, Q2, Q3, and Q4, respectively). Limitations One-time assessment of modified creatinine index; no data for residual kidney function and fracture sites and causes. Conclusions Modified creatinine index was correlated with skeletal muscle mass measured by BIA. Lower modified creatinine index was associated with increased risk for bone fracture in male and female hemodialysis patients.

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