Combination of Quantitative Computed Tomography and Blood Biochemistry for Evaluating the Relationship Between Nutrition and Bone Mineral Density in Patients on Maintenance Hemodialysis.

ABSTRACT

PURPOSE: To investigate the effect of nutritional factors on bone mineral density (BMD) using quantitative computed tomography combined with blood biochemistry in patients on maintenance hemodialysis (MHD). METHODS: Sixty patients on MHD were divided into osteopenia (n = 20) and nonosteopenia (n = 40) groups. BMD, fat, and muscle mass were measured by quantitative computed tomography. The calcification of coronary artery and hilar lymph node and computed tomography attenuation values of the liver and spleen were also analyzed. Differences between the two groups were compared, and the risk factors for osteopenia were analyzed by logistic regression analysis. RESULTS: Patients in the osteopenia group had lower albumin levels than those in the nonosteopenia group (37.84 ± 3.00 vs 42.03 ± 4.05 g/L; P < .001). Logistic regression showed that patients with lower albumin levels had a higher risk of osteopenia (odds ratio, 1.462; 95% confidence interval, 1.313-1.801; P = .003). BMD was negatively correlated with fat mass (r = -0.365, P = .004) and positively correlated with the ratio of muscle mass to fat mass (r = 0.431, P = .001). There was no significant difference in the rate of calcification of coronary artery or hilar lymph nodes between the two groups. Computed tomography values of the liver and spleen were positively correlated with the duration of dialysis (r = 0.55, P = .001; r = 0.42, P < .001, respectively). CONCLUSION: Low albumin levels are associated with an increased risk of osteopenia in patients on MHD. Abdominal fat is a risk factor for reduction in BMD in MHD patients, and the ratio of abdominal muscle mass to fat mass is a protective factor for BMD.