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

Authors
  • Nam,, Yun Jung
  • Hwang,, So Yeon
  • Kim,, Da Won
  • Kim,, Dongryul
  • Shin,, Seok Joon
  • Yoon, Hye Eun
Type
Published Article
Journal
Kidney Research and Clinical Practice
Publisher
Korean Society of Nephrology
Publication Date
Sep 30, 2020
Volume
39
Issue
3
Pages
344–355
Identifiers
DOI: 10.23876/j.krcp.20.013
PMID: 32522894
PMCID: PMC7530357
Source
PubMed Central
Keywords
License
Green

Abstract

Background Vascular calcification (VC) is a major component of mineral bone disorders in patients with end-stage 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 fracture-free 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.

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