Chronic kidney disease–related osteoporosis is associated with incident frailty among patients with diabetic kidney disease: a propensity score–matched cohort study
Journal
Osteoporosis International
Journal Volume
31
Journal Issue
4
Pages
699-708
Date Issued
2020
Author(s)
on behalf of the COhort of GEriatric Nephrology in NTUH (COGENT) study group
Abstract
Summary: Chronic kidney disease (CKD)-related osteoporosis is a major complication in patients with CKD, conferring a higher risk of adverse outcomes. We found that among those with diabetic kidney disease, this complication increased the risk of incident frailty, an important mediator of adverse outcomes. Introduction: Renal osteodystrophy and chronic kidney disease (CKD)-related osteoporosis increases complications for patients with diabetic kidney disease (DKD). Since musculoskeletal degeneration is central to frailty development, we investigated the relationship between baseline osteoporosis and the subsequent frailty risk in patients with DKD. Methods: From the Longitudinal Cohort of Diabetes Patients in Taiwan (n = 840,000), we identified 12,027 patients having DKD with osteoporosis and 24,054 propensity score-matched controls having DKD but without osteoporosis. The primary endpoint was incident frailty on the basis of a modified FRAIL scale. Patients were prospectively followed-up until the development of endpoints or the end of this study. The Kaplan-Meier technique and Cox proportional hazard regression were used to analyze the association between osteoporosis at baseline and incident frailty in these patients. Results: The mean age of the DKD patients was 67.2?years, with 55.4% female and a 12.6% prevalence of osteoporosis at baseline. After 3.5 ± 2.2?years of follow up, the incidence rate of frailty in patients having DKD with osteoporosis was higher than that in DKD patients without (6.6 vs. 5.7 per 1000 patient-year, p = 0.04). A Cox proportional hazard regression showed that after accounting for age, gender, obesity, comorbidities, and medications, patients having DKD with osteoporosis had a significantly higher risk of developing frailty (hazard ratio, 1.19; 95% confidence interval, 1.02–1.38) than those without osteoporosis. Conclusions: CKD-related osteoporosis is associated with a higher risk of incident frailty in patients with DKD. ? 2020, International Osteoporosis Foundation and National Osteoporosis Foundation.
SDGs
Other Subjects
adverse outcome; aged; Article; bone atrophy; chronic kidney failure; cohort analysis; comorbidity; controlled study; cross-sectional study; diabetic nephropathy; disease association; female; follow up; Frail Scale; frailty; functional status assessment; human; longitudinal study; major clinical study; male; morbidity; obesity; osteoporosis; prevalence; priority journal; propensity score; prospective study; renal osteodystrophy; retrospective study; risk factor; Taiwan; chronic kidney failure; complication; diabetes mellitus; diabetic nephropathy; frailty; osteoporosis; angiotensin receptor antagonist; dipeptidyl carboxypeptidase inhibitor; Aged; Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Cohort Studies; Diabetes Mellitus; Diabetic Nephropathies; Female; Frailty; Humans; Male; Osteoporosis; Propensity Score; Renal Insufficiency, Chronic; Risk Factors; Taiwan
Publisher
Springer
Type
journal article