Cardiac Biomarkers are Associated with Incident Fracture Risk in Advanced Chronic Kidney Disease.
Louise AaltonenTapio HellmanRoosa LankinenMarkus HakamäkiKaj MetsärinneMikko JärvisaloPublished in: Calcified tissue international (2024)
Cardiovascular disease is associated with increased fracture risk in the general population. Few data exist on the association between cardiovascular health and incident fracture risk in patients with advanced CKD, a high-risk population for fractures. We aimed to assess the link between fracture risk and cardiovascular health in a prospective cohort of 210 patients with CKD stage G4-5. Incident fractures were recorded during a prospective follow-up of 5 years. Laboratory parameters, abdominal aortic calcification score, echocardiography, ultrasound assessment of brachial artery flow-mediated dilatation and carotid intima-media thickness, and maximal stress ergometry were obtained at baseline. A total of 51 fractures were observed in 40 (19%) patients during follow-up. In separate multivariable Cox proportional hazards models adjusted for age, gender, and baseline eGFR, TnT (HR 1.007, CI 95% 1.003-1.010, p < 0.001) and ProBNP (HR 1.000, CI 95% 1.000-1.000, p = 0.017) were associated with incident fractures and the association persisted after adjusting for coronary artery disease (CAD). The patients unable to perform the ergometry test had a higher risk of incident fractures compared to others (36.1% vs 15.5%, p = 0.009). A cardiovascular composite risk score summarizing TnT, ProBNP, and ergometry data was independently associated with incident fractures in a multivariable Cox model (HR 1.373, CI 95% 1.180-1.599, p < 0.001). Patients with the lowest score were observed with no fractures, while patients with the highest score were observed with a fracture risk of 40.5% during follow-up. Risk of incident fractures is associated with biomarkers of cardiovascular health and a composite cardiovascular risk score in patients with advanced CKD.
Keyphrases
- chronic kidney disease
- end stage renal disease
- cardiovascular disease
- coronary artery disease
- peritoneal dialysis
- newly diagnosed
- ejection fraction
- type diabetes
- magnetic resonance imaging
- hip fracture
- computed tomography
- electronic health record
- left ventricular
- cardiovascular events
- heart failure
- mental health
- pulmonary hypertension
- epidermal growth factor receptor
- optical coherence tomography
- cardiovascular risk factors
- coronary artery bypass grafting
- artificial intelligence
- heart rate
- patient reported outcomes
- stress induced
- ultrasound guided