Bone Mass, Microarchitecture Impaired in Patients With Chronic Kidney Disease Undergoing Dialysis

Patients with chronic kidney disease (CKD) undergoing dialysis were found to have lower total volumetric bone mineral density (BMD), lower cortical volumetric BMD and altered geometry, and deterioration of the trabecular network at both sites compared with individuals without CKD, according to the results of a study published in Osteoporosis International.

Researchers conducted a meta-analysis to assess trabecular and cortical parameters of the radius and tibia in patients with CKD undergoing dialysis.

The study authors searched PubMed, Web of Science, Google Scholar, and Scopus through December 23, 2021, to identify relevant studies. Eligible studies were original and available as full-text articles in English in which CKD was confirmed in the patient population, and high-resolution peripheral quantitative computed tomography (HR-pQCT) and pQCT were used to quantify the bone parameters.

A total of 10 studies were included: 4 used HR-pQCT and 6 used pQCT. All studies were published from 2000 to 2018 and included 457 patients with CKD and 2134 age-matched control individuals without CKD. The ages of study participants ranged from 12.2 to 61.5 years.

Total volumetric BMD at the radius of patients with CKD undergoing dialysis was significantly lower compared with patients in the control group (standard deviation of the mean [SDM] = -0.842; 95% CI, -1.167 to -0.517; P =.000). In addition, a significant decrease in total volumetric BMD was observed at the tibia of patients with CKD compared with patients in the control group (SDM = -0.705; 95% CI, -1.042 to -0.368; P =.000).

Regarding lower cortical volumetric BMD, a significant decrease was observed in patients undergoing dialysis at the radius (SDM = -1.037; 95% CI, -1.422 to -0.651; P =.000) but not at the tibia (SDM = -0.179; 95% CI, -1.690 to 1.333; P =.817) compared with individuals without CKD.

Among other findings, lower bone volume fraction (BV/TV) of the radius (SDM = -0.614; 95% CI, -1.013 to -0.215; P =.003) and tibia (SDM = -0.643; 95% CI, -0.876 to −-.411; P =.000) was reported among patients undergoing dialysis compared with patients in the control group.

A significant reduction (SDM = -0.544; 95% CI, -0.774 to -0.313; P =.000) in trabecular thickness was found at the radius but not at the tibia (SDM = -0.279; 95% CI, -0.651 to 0.093; P =.141) of patients with CKD undergoing dialysis vs patients in the control group.

A significant increase was observed in trabecular spacing at the tibia (SDM = 0.446; 95% CI, 0.187-0.745; P =.001) but not at the radius (SDM = 0.518; 95% CI, -0.107 to 1.144; P =.104) among patients with CKD undergoing dialysis compared with patients in the control groups.

In addition, a strong correlation was found between BV/TV and other microarchitectural parameters, including trabecular number, trabecular spacing, and trabecular spacing standard deviation at the trabecular sites of the tibia and radius.

“Assessments of study quality, heterogeneity, publication biases, and sensitivity analysis verified the validity of these findings that suggested that bone loss and deterioration of microarchitecture are significant in the tibia and radius of dialysis patients,” stated the study authors.

Reference

Sharma S, Mehta P, Patil A, Gupta SK, Rajender S, Chattopadhyay N. Meta-analyses of the quantitative computed tomography data in dialysis patients show differential impacts of renal failure on the trabecular and cortical bones. Osteoporos Int. Published online March 6, 2022. doi:10.1007/s00198-022-06366-2