Kidney Function and Fracture Risk: The Atherosclerosis Risk in Communities (ARIC) Study

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• 作者：Natalie R. Daya ; MPH¹ ; ^&lowast ; ; Annie Voskertchian ; MPH² ; ^&lowast ; ; Andrea L.C. Schneider ; MD ; PhD¹ ; ² ; ³ ; Shoshana Ballew ; PhD¹ ; ² ; Mara McAdams DeMarco ; PhD² ; ³ ; Josef Coresh ; MD ; PhD¹ ; ² ; ³ ; Lawrence J. Appel ; MD ; MPH¹ ; ² ; ³ ; Elizabeth Selvin ; PhD¹ ; ² ; ³ ; Morgan E. Grams ; MD ; PhD¹ ; ² ; ³ ; ^{mgrams2@jhmi.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Bone fracture ; fracture risk ; kidney filtration markers ; chronic kidney disease (CKD) ; estimated glomerular filtration rate (eGFR) ; albuminuria ; albumin-creatinine ratio (ACR) ; renal function ; hospitalization ; hospitalized fracture
• 刊名：American Journal of Kidney Diseases
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：67
• 期：2
• 页码：218-226
• 全文大小：791 K

文摘

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 (eGFR_cr), 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 eGFR_cr and fracture risk was nonlinear: <60 mL/min/1.73 m², lower eGFR_cr 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.