Abstract: TH-PO145
Association of Damaged Cardiovascular-Bone-Skeletal Muscle Axis with All-Cause Mortality and CKD Progression in Patients with Predialysis CKD: The Fukuoka Kidney Disease Registry (FKR) Study
Session Information
- CKD-MBD: Clinical
October 24, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Bone and Mineral Metabolism
- 502 Bone and Mineral Metabolism: Clinical
Authors
- Yamada, Shunsuke, Kyushu University, Department of Medicine and Clinical Science, Fukuoka, Japan
- Arase, Hokuto, NHO Fukuokahigashi Medical Center, Department of Nephrology, Fukuoka, Japan
- Tanaka, Shigeru, Kyushu University, Department of Medicine and Clinical Science, Fukuoka, Japan
- Tsuruya, Kazuhiko, Nara Medical University, Department of Nephrology, Nara, Japan
- Kitazono, Takanari, Kyushu University, Department of Medicine and Clinical Science, Fukuoka, Japan
- Nakano, Toshiaki, Kyushu University, Department of Medicine and Clinical Science, Fukuoka, Japan
Background
The cardiovascular system, bones, and skeletal muscles are interrelated and often concurrently damaged in patients with chronic kidney disease (CKD). While organ-related associations such as the bone-vascular axis and osteosarcopenia have been proposed, the impact of combined disorders in these three systems on all-cause mortality and CKD progression in pre-dialysis CKD patients remains unclear.
Methods
We defined organ damage in bones, skeletal muscles, and the cardiovascular system as a history of fractures, low skeletal muscle mass, and cardiovascular disease, respectively. Skeletal muscle mass was estimated using Yamada's formula, with the first quartile classified as low skeletal muscle mass. A total of 3,792 pre-dialysis CKD patients were categorized into four groups based on the number of damaged organs: G1 (no damaged organ), G2 (one damaged organ), G3 (two damaged organs), and G4 (three damaged organs). We then evaluated the association between the number of damaged organs and all-cause mortality as well as composite renal events (defined as a 1.5-fold increase in serum creatinine, kidney transplantation, or initiation of dialysis).
Results
Over a 5-year observation period, 382 patients died, and 1,305 experienced composite renal events. The numbers of patients in the G1, G2, G3, and G4 were 2,168, 1,217, 364, and 43, respectively. Survival analysis showed that the adjusted hazard ratios (HRs) for all-cause mortality, using the G1 group as a reference, were: G2: 1.54 (95% CI: 1.16-2.06), G3: 2.07 (95% CI: 1.47-2.92), and G4: 3.54 (95% CI: 2.07-6.07). Similarly, the adjusted HRs for composite renal events were: G2: 1.25 (95% CI: 1.10-1.42), G3: 1.30 (95% CI: 1.07-1.59), and G4: 2.01 (95% CI: 1.24-3.26). When all-cause death was set as a competing risk, a Fine-Gray competing risk model showed a similar association between the number of damaged organs and the composite renal events.
Conclusion
The risk of all-cause mortality and CKD progression increases with the number of damaged organs in the cardiovascular, bone, and skeletal muscle axis in patients with pre-dialysis CKD. Protection of the cardiovascular-bone-skeletal muscle axis may be a therapeutic option for preventing death and ESKD in this population.