Association between malnutrition–inflammation score and risk of subsequent self-reported bone fractures in prevalent kidney transplant recipients

A. Gaipov, O. Cseprekal, P. K. Potukuchi, K. Kabulbayev, A. Remport, Z. Mathe, M. Talwar, V. Balaraman, T. Fülöp, J. D. Eason, I. Mucsi, C. P. Kovesdy, M. Z. Molnar

Research output: Contribution to journalArticle

Abstract

Summary: Chronic inflammation and protein energy wasting (PEW) syndrome are common in kidney transplant recipients (KTR). The presence of inflammation and PEW syndrome can directly affect bone resorption and bone formation, leading to bone loss and fractures. We showed PEW is independently associated with new clinically detected bone fractures in prevalent KTR. Introduction: Kidney transplant recipients (KTR) have a 4-fold higher risk of fracture compared to the general population. Chronic inflammation and PEW syndrome are common in KTR and are associated with poor outcomes. We hypothesized that the Malnutrition–Inflammation Score (MIS), a validated measure of PEW, is associated with higher risk of bone fractures in KTR. Methods: This prospective cohort study included 839 prevalent KTR from a Central European academic center. MIS, a semiquantitative instrument of PEW, was calculated at the study entry. Self-reported history of fractures was recorded during the 2-year follow-up period. The association between MIS and bone fractures was examined in logistic regression analyses with adjustment for age, gender, eGFR, smoking habits, history of pre-transplant bone fractures, and acute rejection. Results: Mean age was 51 ± 13 years, and 56% of patients were males with median (interquartile range) transplant vintage 69 (38–112) months, estimated glomerular filtration rate 55 ± 21 ml/min/1.73 m2, and calculated MIS 3 (2–4) at enrollment. Fifty-five (7%) patients experienced self-reported bone fractures during the 2-year follow-up period. Higher MIS score showed linear association with increased risk of fracture. Each one-point higher MIS was associated with 23% higher risk of bone fractures (odds ratio (OR) and 95% CI 1.23, 1.12–1.34), which remained significant after multivariable adjustments (OR 1.17, 95% CI 1.06–1.29). Conclusion: The MIS is independently associated with new clinically detected bone fractures in prevalent KTR.

Original languageEnglish
JournalOsteoporosis International
DOIs
Publication statusAccepted/In press - Jan 1 2018

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Bone Fractures
Kidney
Wasting Syndrome
Proteins
Inflammation
Odds Ratio
Transplants
Social Adjustment
Transplant Recipients
Bone Resorption
Glomerular Filtration Rate
Osteogenesis
Habits
Cohort Studies
Logistic Models
Smoking
Regression Analysis
Prospective Studies
Bone and Bones
Population

Keywords

  • Bone fracture
  • Kidney transplant
  • Malnutrition–inflammation score
  • Protein energy wasting

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism

Cite this

Association between malnutrition–inflammation score and risk of subsequent self-reported bone fractures in prevalent kidney transplant recipients. / Gaipov, A.; Cseprekal, O.; Potukuchi, P. K.; Kabulbayev, K.; Remport, A.; Mathe, Z.; Talwar, M.; Balaraman, V.; Fülöp, T.; Eason, J. D.; Mucsi, I.; Kovesdy, C. P.; Molnar, M. Z.

In: Osteoporosis International, 01.01.2018.

Research output: Contribution to journalArticle

Gaipov, A, Cseprekal, O, Potukuchi, PK, Kabulbayev, K, Remport, A, Mathe, Z, Talwar, M, Balaraman, V, Fülöp, T, Eason, JD, Mucsi, I, Kovesdy, CP & Molnar, MZ 2018, 'Association between malnutrition–inflammation score and risk of subsequent self-reported bone fractures in prevalent kidney transplant recipients', Osteoporosis International. https://doi.org/10.1007/s00198-018-4774-4
Gaipov, A. ; Cseprekal, O. ; Potukuchi, P. K. ; Kabulbayev, K. ; Remport, A. ; Mathe, Z. ; Talwar, M. ; Balaraman, V. ; Fülöp, T. ; Eason, J. D. ; Mucsi, I. ; Kovesdy, C. P. ; Molnar, M. Z. / Association between malnutrition–inflammation score and risk of subsequent self-reported bone fractures in prevalent kidney transplant recipients. In: Osteoporosis International. 2018.
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abstract = "Summary: Chronic inflammation and protein energy wasting (PEW) syndrome are common in kidney transplant recipients (KTR). The presence of inflammation and PEW syndrome can directly affect bone resorption and bone formation, leading to bone loss and fractures. We showed PEW is independently associated with new clinically detected bone fractures in prevalent KTR. Introduction: Kidney transplant recipients (KTR) have a 4-fold higher risk of fracture compared to the general population. Chronic inflammation and PEW syndrome are common in KTR and are associated with poor outcomes. We hypothesized that the Malnutrition–Inflammation Score (MIS), a validated measure of PEW, is associated with higher risk of bone fractures in KTR. Methods: This prospective cohort study included 839 prevalent KTR from a Central European academic center. MIS, a semiquantitative instrument of PEW, was calculated at the study entry. Self-reported history of fractures was recorded during the 2-year follow-up period. The association between MIS and bone fractures was examined in logistic regression analyses with adjustment for age, gender, eGFR, smoking habits, history of pre-transplant bone fractures, and acute rejection. Results: Mean age was 51 ± 13 years, and 56{\%} of patients were males with median (interquartile range) transplant vintage 69 (38–112) months, estimated glomerular filtration rate 55 ± 21 ml/min/1.73 m2, and calculated MIS 3 (2–4) at enrollment. Fifty-five (7{\%}) patients experienced self-reported bone fractures during the 2-year follow-up period. Higher MIS score showed linear association with increased risk of fracture. Each one-point higher MIS was associated with 23{\%} higher risk of bone fractures (odds ratio (OR) and 95{\%} CI 1.23, 1.12–1.34), which remained significant after multivariable adjustments (OR 1.17, 95{\%} CI 1.06–1.29). Conclusion: The MIS is independently associated with new clinically detected bone fractures in prevalent KTR.",
keywords = "Bone fracture, Kidney transplant, Malnutrition–inflammation score, Protein energy wasting",
author = "A. Gaipov and O. Cseprekal and Potukuchi, {P. K.} and K. Kabulbayev and A. Remport and Z. Mathe and M. Talwar and V. Balaraman and T. F{\"u}l{\"o}p and Eason, {J. D.} and I. Mucsi and Kovesdy, {C. P.} and Molnar, {M. Z.}",
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T1 - Association between malnutrition–inflammation score and risk of subsequent self-reported bone fractures in prevalent kidney transplant recipients

AU - Gaipov, A.

AU - Cseprekal, O.

AU - Potukuchi, P. K.

AU - Kabulbayev, K.

AU - Remport, A.

AU - Mathe, Z.

AU - Talwar, M.

AU - Balaraman, V.

AU - Fülöp, T.

AU - Eason, J. D.

AU - Mucsi, I.

AU - Kovesdy, C. P.

AU - Molnar, M. Z.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Summary: Chronic inflammation and protein energy wasting (PEW) syndrome are common in kidney transplant recipients (KTR). The presence of inflammation and PEW syndrome can directly affect bone resorption and bone formation, leading to bone loss and fractures. We showed PEW is independently associated with new clinically detected bone fractures in prevalent KTR. Introduction: Kidney transplant recipients (KTR) have a 4-fold higher risk of fracture compared to the general population. Chronic inflammation and PEW syndrome are common in KTR and are associated with poor outcomes. We hypothesized that the Malnutrition–Inflammation Score (MIS), a validated measure of PEW, is associated with higher risk of bone fractures in KTR. Methods: This prospective cohort study included 839 prevalent KTR from a Central European academic center. MIS, a semiquantitative instrument of PEW, was calculated at the study entry. Self-reported history of fractures was recorded during the 2-year follow-up period. The association between MIS and bone fractures was examined in logistic regression analyses with adjustment for age, gender, eGFR, smoking habits, history of pre-transplant bone fractures, and acute rejection. Results: Mean age was 51 ± 13 years, and 56% of patients were males with median (interquartile range) transplant vintage 69 (38–112) months, estimated glomerular filtration rate 55 ± 21 ml/min/1.73 m2, and calculated MIS 3 (2–4) at enrollment. Fifty-five (7%) patients experienced self-reported bone fractures during the 2-year follow-up period. Higher MIS score showed linear association with increased risk of fracture. Each one-point higher MIS was associated with 23% higher risk of bone fractures (odds ratio (OR) and 95% CI 1.23, 1.12–1.34), which remained significant after multivariable adjustments (OR 1.17, 95% CI 1.06–1.29). Conclusion: The MIS is independently associated with new clinically detected bone fractures in prevalent KTR.

AB - Summary: Chronic inflammation and protein energy wasting (PEW) syndrome are common in kidney transplant recipients (KTR). The presence of inflammation and PEW syndrome can directly affect bone resorption and bone formation, leading to bone loss and fractures. We showed PEW is independently associated with new clinically detected bone fractures in prevalent KTR. Introduction: Kidney transplant recipients (KTR) have a 4-fold higher risk of fracture compared to the general population. Chronic inflammation and PEW syndrome are common in KTR and are associated with poor outcomes. We hypothesized that the Malnutrition–Inflammation Score (MIS), a validated measure of PEW, is associated with higher risk of bone fractures in KTR. Methods: This prospective cohort study included 839 prevalent KTR from a Central European academic center. MIS, a semiquantitative instrument of PEW, was calculated at the study entry. Self-reported history of fractures was recorded during the 2-year follow-up period. The association between MIS and bone fractures was examined in logistic regression analyses with adjustment for age, gender, eGFR, smoking habits, history of pre-transplant bone fractures, and acute rejection. Results: Mean age was 51 ± 13 years, and 56% of patients were males with median (interquartile range) transplant vintage 69 (38–112) months, estimated glomerular filtration rate 55 ± 21 ml/min/1.73 m2, and calculated MIS 3 (2–4) at enrollment. Fifty-five (7%) patients experienced self-reported bone fractures during the 2-year follow-up period. Higher MIS score showed linear association with increased risk of fracture. Each one-point higher MIS was associated with 23% higher risk of bone fractures (odds ratio (OR) and 95% CI 1.23, 1.12–1.34), which remained significant after multivariable adjustments (OR 1.17, 95% CI 1.06–1.29). Conclusion: The MIS is independently associated with new clinically detected bone fractures in prevalent KTR.

KW - Bone fracture

KW - Kidney transplant

KW - Malnutrition–inflammation score

KW - Protein energy wasting

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