Determinants of Bone Mineral Density in Patients on Dialysis; Considering EPO

초록

Introduction: Abnormal bone turnover and mineralization found in patients with chronic kidney disease (CKD) stage 5. Most of studies are in concordance with a reduced BMD in patients on dialysis. Erythropoietin (EPO) can increase bone marrow mesenchymal stem cell in vitro. The objective of this study is to evaluate the correlation of total dose of EPO and bone mineral density in patients with CKD 5. Materials and Methods: This study was a cross-sectional analysis of 56 patients (15 males, 41 females) on dialysis. Mean age was 58±10 (31-85) years and mean dialysis duration was 3.88±3.33 years. No patients had been previously treated with bisphosphonate or parathyroidectomy. Duration and total dose of EPO treatment and hemoglobin, iron and ferritin were examined. Bone mineral density was evaluated by dual-energy x-ray absorptiometry using Hologic QDR. Results: According to BMD measurement in femur and spine, 45% of patients (n=25) were osteoporotic, 46% (n=26), osteopenic, and 9% (n=5), normal. Body weight, BMI (body mass index) and corrected calcium (cCa) correlated positively with T score of spine and femur. Age and ALP correlated negatively with T score of femur. Total dose of EPO correlated with levels of Mg (r=0.32, 0.41, p<0.01), however no significant associations were observed for BMD. Time on dialysis correlated positively with BMD at the spine. Intact PTH (iPTH) correlated negatively with ALP, Mg and T score of spine and femur. According to time on dialysis, weight and phosphate correlated with spine BMD in group less than 2 years. For patients more than 2 years, cCa and ALP correlated with spine BMD. In multiple regression analysis, intact PTH (iPTH) can predict BMD. Conclusions: Determinants of BMD were different according to the Time on Dialysis. No significant association between EP