MP354NO CLEAR ASSOCIATION WAS FOUND BETWEEN HIGH FRACTURE RISK AND MINERAL METABOLIC MARKERS AMONG JAPANESE DIALYSIS PATIENTS

Abstract

Introduction and Aims: Fractures are common in haemodialysis patients. KDIGO reported that fracture prevention is an expected outcome of chronic kidney disease related mineral and bone disorder (CKD-MBD) treatment. Indeed, severe secondary hyperparathyroidism and/or bone mineralization defect were major causes of bone fragility until the 1980s in Japan. However, the relationship between fracture and mineral metabolic status is unclear in recent haemodialysis patients. Methods: This study is a subanalysis of the MBD-5D multi-institutional joint study. Three-thousands and two hundred and seventy-four Japanese adult patients (63 y; age range 54-71 y.o., female 38%) undergoing stable haemodialysis therapy were prospectively followed-up from January 2008 to January 2011. Serum biochemical analyses were performed at the initiation of the observation period. Hospital admission due to any fractures were monitored. Results: During the observation period, 178 patients (5.4%) were admitted to hospital due to clinical fracture. Of these, 58 (32.6%) were hip fracture. The standard incidence ratio of hip fracture was significantly higher in the cohort haemodialysis patients regardless of age or sex. Younger age, male sex, higher serum albumin level, and prescription of renin-angiotensin-alodosteron inhibitor or oral vitamin D receptor activater were associated with significantly reduced risk of hospitalization due to fracture. In contrast, mineral metabolic markers including Ca, P, alkaline phosphatase and intact PTH showed no clear association with risk of hospitalization. Both the risk of hospitalization due to any fracture and hip fracture tended to decrease with the observation time. Conclusions: Although the fracture risk was obviously higher in Japanese haemodialysis patients than in the general population, we failed to find a clear association between hospital admission due to fractures and the levels of base-line mineral metabolic markers that are currently used to evaliuate the severity and the treatment effect of CKD-MBD. Thus, there is no reasonable ground to assume that current CKD-MBD treatment can satisfactorily reduce fracture risk in haemodialysis patients, today. We need to determine the background pathophysiological mechanisms that cause bone fragility among recent haemodialysis patients, and establish appropriate therapies.