Change in estimated glomerular filtration rate and fracture risk in the Action to Control Cardiovascular Risk in Diabetes Trial |
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| Institution: | 1. Department of Medicine, Division of Nephrology, Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA;2. Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA;3. Department of Medicine, Division of Nephrology, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA;4. Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York, NY, USA;5. University Suburban Health Center, South Euclid, OH, USA;6. Division of Endocrinology, Kaiser Permanente of Georgia and Division of Endocrinology, Emory University School of Medicine, Atlanta, GA, USA;7. Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA;1. New York Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA;2. Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA;1. Department of Bone Tumor Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China;2. Institute of Biomedical Sciences and School of Life Sciences, East China Normal University, China;1. Hebrew University School of Medicine, Tsameret, Ein Kerem, Jerusalem, Israel;2. Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN, USA;3. Department of Orthopaedics, Assaf HaRofeh Medical Center, Zerrifen and Tel Aviv Medical School, Tel Aviv, Israel;4. Department of Mechanical Engineering and Mechanics, Lehigh University, Bethlehem, PA, USA;1. School of Chinese Medicine, China Medical University, Taichung 40402, Taiwan;2. Department of Chinese Medicine, Taichung Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, Taichung 40427, Taiwan;3. School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan;4. Department of Integrated Chinese and Western Medicine, Chung Shan Medical University Hospital, Taichung 40201, Taiwan;5. Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung 40402, Taiwan;6. Department of Chemical and Materials Engineering, National Yunlin University of Science and Technology, Yunlin 64002, Taiwan;7. Department of Biomedical Informatics, Asia University, Taichung 41354, Taiwan;1. Stem Cell and Tissue Engineering Laboratory, Department of Orthopaedics, West Virginia University, Morgantown, WV 26506-9196, USA;2. Division of Exercise Physiology, West Virginia University, Morgantown, WV 26506-9227, USA;3. Department of Biostatistics, West Virginia University, Morgantown, 26506-9190, USA |
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| Abstract: | ObjectivePatients with type 2 diabetes (T2DM) are at increased risk of fracture. High prevalence of chronic kidney disease (CKD) in T2DM may contribute to bone fragility, but whether dynamic change in kidney function is associated with fracture risk is unclear.Research design and methodsTo evaluate the association of pre-randomization baseline estimated glomerular filtration (eGFR) and its change over time with subsequent fracture risk in the Bone substudy of Action to Control Cardiovascular Risk in Diabetes (ACCORD) Trial, we conducted an observational study of 2262 women and 4737 men with T2DM and with at least 2 eGFR values.ResultsDuring a mean follow-up of 4.40 ± 1.54 years, 235 women and 223 men sustained a new non-vertebral fracture. In multivariable adjusted sex-specific models, pre-randomization baseline eGFR was not a significant predictor of fracture risk in either men or women. However, a steeper decline in eGFR was associated with greater risk of fracture in women (hazard ratio HR] per standard deviation SD] decrement in eGFR slope, 1.30; 95%CI 1.17–1.44) but not men (HR per SD decrement in eGFR slope, 0.97; 95%CI 0.82–1.13). Accounting for competing risk of death modestly attenuated the association in women (HR per SD decrement in eGFR slope, 1.19; 95%CI 1.04–1.37), with the relationship in men remaining non-significant (HR per SD decrement in eGFR slope, 0.96; 95%CI 0.77–1.18).ConclusionsDeclining kidney function predicts fracture risk in women but not in men with T2DM. Future studies should investigate the mechanisms for these associations. |
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