TY - JOUR
T1 - Kidney Function and Fracture Risk
T2 - The Atherosclerosis Risk in Communities (ARIC) Study
AU - Daya, Natalie R.
AU - Voskertchian, Annie
AU - Schneider, Andrea L.C.
AU - Ballew, Shoshana
AU - McAdams Demarco, Mara
AU - Coresh, Josef
AU - Appel, Lawrence J.
AU - Selvin, Elizabeth
AU - Grams, Morgan E.
N1 - Publisher Copyright:
© 2016 National Kidney Foundation, Inc.
PY - 2016/2/1
Y1 - 2016/2/1
N2 - Background People with end-stage renal disease are at high risk for bone fracture. Less is known about fracture risk in milder chronic kidney disease and whether chronic kidney disease-associated fracture risk varies by sex or assessment with alternative kidney markers. Study Design Prospective cohort study. Setting & Participants 10,955 participants from the Atherosclerosis Risk in Communities (ARIC) Study followed up from 1996 to 2011. Predictor Kidney function as assessed by creatinine-based estimated glomerular filtration rate (eGFRcr), urine albumin-creatinine ratio, and alternative filtration markers. Outcomes Fracture-related hospitalizations determined by diagnostic code. Measurements Baseline kidney markers; hospitalizations identified by self-report during annual telephone contact and active surveillance of local hospital discharge lists. Results Mean age of participants was 63 years, 56% were women, and 22% were black. During a median follow-up of 13 years, there were 722 incident fracture-related hospitalizations. Older age, female sex, and white race were associated with higher risk for fracture (P < 0.001). The relationship between eGFRcr and fracture risk was nonlinear: <60 mL/min/1.73 m2, lower eGFRcr was associated with higher fracture risk (adjusted HR per 10 mL/min/1.73 m2 lower, 1.24; 95% CI, 1.05-1.47); there was no statistically significant association for ≥60 mL/min/1.73 m2 in the primary analysis. In contrast, there was a graded association between other markers of kidney function and subsequent fracture, including albumin-creatinine ratio (HR per doubling, 1.10; 95% CI, 1.06-1.14), cystatin C-based eGFR (HR per 1-SD decrease, 1.15; 95% CI, 1.06-1.25), and 1/β2-microglobulin (HR per 1-SD decrease, 1.26, 95% CI, 1.15-1.37). Limitations No bone mineral density assessment; one-time measurement of kidney function. Conclusions Both low eGFR and higher albuminuria were significant risk factors for fracture in this community-based population. The shape of the association in the upper ranges of eGFR varied by the filtration marker used in estimation.
AB - Background People with end-stage renal disease are at high risk for bone fracture. Less is known about fracture risk in milder chronic kidney disease and whether chronic kidney disease-associated fracture risk varies by sex or assessment with alternative kidney markers. Study Design Prospective cohort study. Setting & Participants 10,955 participants from the Atherosclerosis Risk in Communities (ARIC) Study followed up from 1996 to 2011. Predictor Kidney function as assessed by creatinine-based estimated glomerular filtration rate (eGFRcr), urine albumin-creatinine ratio, and alternative filtration markers. Outcomes Fracture-related hospitalizations determined by diagnostic code. Measurements Baseline kidney markers; hospitalizations identified by self-report during annual telephone contact and active surveillance of local hospital discharge lists. Results Mean age of participants was 63 years, 56% were women, and 22% were black. During a median follow-up of 13 years, there were 722 incident fracture-related hospitalizations. Older age, female sex, and white race were associated with higher risk for fracture (P < 0.001). The relationship between eGFRcr and fracture risk was nonlinear: <60 mL/min/1.73 m2, lower eGFRcr was associated with higher fracture risk (adjusted HR per 10 mL/min/1.73 m2 lower, 1.24; 95% CI, 1.05-1.47); there was no statistically significant association for ≥60 mL/min/1.73 m2 in the primary analysis. In contrast, there was a graded association between other markers of kidney function and subsequent fracture, including albumin-creatinine ratio (HR per doubling, 1.10; 95% CI, 1.06-1.14), cystatin C-based eGFR (HR per 1-SD decrease, 1.15; 95% CI, 1.06-1.25), and 1/β2-microglobulin (HR per 1-SD decrease, 1.26, 95% CI, 1.15-1.37). Limitations No bone mineral density assessment; one-time measurement of kidney function. Conclusions Both low eGFR and higher albuminuria were significant risk factors for fracture in this community-based population. The shape of the association in the upper ranges of eGFR varied by the filtration marker used in estimation.
KW - Bone fracture
KW - albumin-creatinine ratio (ACR)
KW - albuminuria
KW - chronic kidney disease (CKD)
KW - estimated glomerular filtration rate (eGFR)
KW - fracture risk
KW - hospitalization
KW - hospitalized fracture
KW - kidney filtration markers
KW - renal function
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U2 - 10.1053/j.ajkd.2015.06.020
DO - 10.1053/j.ajkd.2015.06.020
M3 - Article
C2 - 26250781
AN - SCOPUS:84938633989
SN - 0272-6386
VL - 67
SP - 218
EP - 226
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 2
ER -