Predictive value of quantitative ultrasound parameters in individuals with chronic kidney disease: A population-based analysis of CARTaGENE

Association between frailty and bone health in early-stage chronic kidney disease: a study from the population-based CARTaGENE cohort

Background

Frailty is a clinical syndrome that is particularly prevalent in patients with chronic kidney disease (CKD). We aimed to assess the associations between renal function and the presence of frailty criteria and to assess the association between frailty and bone outcomes.

Methods

We have conducted a retrospective study from a population-based cohort, which represents 1% of people aged 40-69 years in a Canadian province, excluding individuals with an estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m2. Frailty was defined with Fried's criteria. Bone density was estimated with quantitative ultrasound at the calcaneus measuring speed of sound (SOS) and broadband ultrasound attenuation (BUA). Time to first fracture event was assessed and analyses were conducted using logistic regressions, multiple linear regressions and Cox models.

Results

Overall, 19 973 individuals were included: mean ± standard deviation age 54.2 ± 7.8 years, women 51.6%, 47.0% CKD stage G2, 3.9% CKD stage G3, 34.8% with at least one frailty criterion. We observed a U-shaped association between eGFR and the odds ratio (OR) of presenting at least one frailty criterion, with a minimum OR around 77 mL/min/1.73 m2 [per a 10 mL/min/1.73 m2 increase, respectively, for an eGFR <77 and >77, OR = 0.93, 95% confidence interval (CI) 0.86-1.01 and OR 1.09, 95% CI 1.06-1.13]. After a median follow-up of 5.8 years, there were 837 fracture events. Having at least one frailty criterion was negatively associated with SOS (β = -3.97, P < .0001) and BUA (β = -1.82, P < .0001). Having at least one frailty criterion was associated with a higher fracture risk (hazard ratio 1.23, 95% CI 1.07-1.42).

Conclusion

In conclusion, having at least one frailty criterion was associated with a higher risk of fracture and a lower bone mineral density.

Replacing sedentary time for physical activity on bone density in patients with chronic kidney disease

INTRODUCTION

This study aimed to examine the cross-sectional associations of sedentary time and physical activity time with bone density in patients with chronic kidney disease (CKD). The isotemporal substitution (IS) modeling was used to estimate the beneficial effects of behavioral changes (e.g., replacing sedentary time with physical activity time) on bone density in these patients.

MATERIALS AND METHODS

A total of 92 patients with CKD (age: 65 ± 9 years; estimated glomerular filtration rate: 57 ± 22 mL/min/1.73 m²) were included in this cross-sectional study. The times spent in sedentary behavior (SB), light-intensity physical activity (LPA), and moderate- to vigorous-intensity physical activity (MVPA) were assessed using a triaxial accelerometer. Through quantitative ultrasound measurements, the stiffness index, as a measure of bone density, was calculated using the speed of sound and broadband ultrasound attenuation.

RESULTS

In multivariate analyses, the stiffness index was beneficially associated with the MVPA time (β = 0.748), but was not significantly associated with the SB and LPA times. The IS models showed that replacing 10 min/day of SB with the equivalent LPA time was not significantly associated with the stiffness index; however, replacing 10 min/day of SB with the equivalent MVPA time was beneficially associated with the stiffness index (β = 0.804).

CONCLUSION

These results suggest that a small increase in MVPA time (e.g., 10 min/day) may attenuate the decline in bone density in patients with CKD. Our findings may provide insight for the development of novel strategies for improving bone health in patients with CKD.