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Sex-specific relationship between vascular calcification and incident fracture in patients with end-stage renal disease

Kidney Research and Clinical Practice 2020년 39권 3호 p.344 ~ 355
남윤정, 황소연, 김다원, 김동률, 신석준, 윤혜은,
소속 상세정보
남윤정 ( Nam Yun-Jung ) - Catholic University College of Medicine Incheon St. Mary’s Hospital Department of Internal Medicine
황소연 ( Hwang So-Yeon ) - Catholic University College of Medicine Incheon St. Mary’s Hospital Department of Internal Medicine
김다원 ( Kim Da-Won ) - Catholic University College of Medicine Incheon St. Mary’s Hospital Department of Internal Medicine
김동률 ( Kim Dong-Ryul ) - Catholic University College of Medicine Incheon St. Mary’s Hospital Department of Internal Medicine
신석준 ( Shin Seok-Joon ) - Catholic University College of Medicine Incheon St. Mary’s Hospital Department of Internal Medicine
윤혜은 ( Yoon Hye-Eun ) - Catholic University College of Medicine Incheon St. Mary’s Hospital Department of Internal Medicine

Abstract


Background: Vascular calcification (VC) is a major component of mineral bone disorders in patients with endstage renal disease (ESRD). Bone metabolism is affected by various factors, including sex hormones. This study investigated whether there was a sex-specific relationship between VC and incident fracture in patients with ESRD.

Methods: This was a retrospective cohort study of dialysis patients from a single center. VC was assessed by the aortic calcification index (ACI) using abdominal computed tomography. Patients were grouped by sex and stratified into low or high ACI groups, according to the median ACI value. The association between ACI and incident fracture was analyzed.

Results: Data from 593 patients (male: n = 328, median ACI, 14.57; female: n = 265, median ACI, 19.44) were included. During a median follow-up of 36.7 months, 71 patients (12.0%) developed fractures. The fracturefree survival rate was significantly lower in the high ACI group versus the low ACI group, both in males (P = 0.021) and females (P = 0.001). In males, multivariate analysis showed that the high ACI group and ACI per se were not significant risks for fracture. However, in females, both the high ACI group (adjusted hazard ratio, 2.720; P = 0.003) and ACI per se (adjusted hazard ratio, 1.768; P = 0.035) were independently associated with fracture after adjustment for confounding variables.

Conclusion: VC was independently associated with incident fracture in female patients with ESRD. There may be a sex-specific relationship between VC and fracture in patients with ESRD.

키워드

Bone fracture; Dialysis; Kidney failure, chronic; Sex; Vascular calcification

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