Risk Factors for Fracture in Patients with Coexisting Chronic Kidney Disease and Type 2 Diabetes: An Observational Analysis from the CREDENCE Trial
Background. The fracture pathophysiology associated with type 2 diabetes and chronic kidney disease (CKD) is incompletely understood. We examined individual fracture predictors and prediction sets based on different pathophysiological hypotheses, testing whether any of the sets improved prediction b...
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| Format: | Article |
| Language: | English |
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Wiley
2022-01-01
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| Series: | Journal of Diabetes Research |
| Online Access: | http://dx.doi.org/10.1155/2022/9998891 |
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| author | Tamara K. Young Nigel D. Toussaint Gian Luca Di Tanna Clare Arnott Carinna Hockham Amy Kang Aletta E. Schutte Vlado Perkovic Kenneth W. Mahaffey Rajiv Agarwal George L. Bakris David M. Charytan Hiddo J. L. Heerspink Adeera Levin Carol Pollock David C. Wheeler Hong Zhang Meg J. Jardine |
| author_facet | Tamara K. Young Nigel D. Toussaint Gian Luca Di Tanna Clare Arnott Carinna Hockham Amy Kang Aletta E. Schutte Vlado Perkovic Kenneth W. Mahaffey Rajiv Agarwal George L. Bakris David M. Charytan Hiddo J. L. Heerspink Adeera Levin Carol Pollock David C. Wheeler Hong Zhang Meg J. Jardine |
| author_sort | Tamara K. Young |
| collection | DOAJ |
| description | Background. The fracture pathophysiology associated with type 2 diabetes and chronic kidney disease (CKD) is incompletely understood. We examined individual fracture predictors and prediction sets based on different pathophysiological hypotheses, testing whether any of the sets improved prediction beyond that based on traditional osteoporotic risk factors. Methods. Within the CREDENCE cohort with adjudicated fracture outcomes, we assessed the association of individual factors with fracture using Cox regression models. We used the Akaike information criteria (AIC) and Schwartz Bayes Criterion (SBC) to assess six separate variable sets based on hypothesized associations with fracture, namely, traditional osteoporosis, exploratory general population findings, cardiovascular risk, CKD-mineral and bone disorder, diabetic osteodystrophy, and an all-inclusive set containing all variables. Results. Fracture occurred in 135 (3.1%) participants over a median 2.35 [1.88–2.93] years. Independent fracture predictors were older age (hazard ratio [HR] 1.04, confidence interval [CI] 1.01–1.06), female sex (HR 2.49, CI 1.70–3.65), previous fracture (HR 2.30, CI 1.58–3.34), Asian race (HR 1.74, CI 1.09–2.78), vitamin D therapy requirement (HR 2.05, CI 1.31–3.21), HbA1c (HR 1.14, CI 1.00–1.32), prior cardiovascular event (HR 1.60, CI 1.10–2.33), and serum albumin (HR 0.41, CI 0.23–0.74) (lower albumin associated with greater risk). The goodness of fit of the various hypothesis sets was similar (AIC range 1870.92–1849.51, SBC range 1875.60–1948.04). Conclusion. Independent predictors of fracture were identified in the CREDENCE participants with type 2 diabetes and CKD. Fracture prediction was not improved by models built on alternative pathophysiology hypotheses compared with traditional osteoporosis predictors. |
| format | Article |
| id | doaj-art-e95efd5aefe248e7bd867a88ada5f5aa |
| institution | Kabale University |
| issn | 2314-6753 |
| language | English |
| publishDate | 2022-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Diabetes Research |
| spelling | doaj-art-e95efd5aefe248e7bd867a88ada5f5aa2025-02-03T01:07:36ZengWileyJournal of Diabetes Research2314-67532022-01-01202210.1155/2022/9998891Risk Factors for Fracture in Patients with Coexisting Chronic Kidney Disease and Type 2 Diabetes: An Observational Analysis from the CREDENCE TrialTamara K. Young0Nigel D. Toussaint1Gian Luca Di Tanna2Clare Arnott3Carinna Hockham4Amy Kang5Aletta E. Schutte6Vlado Perkovic7Kenneth W. Mahaffey8Rajiv Agarwal9George L. Bakris10David M. Charytan11Hiddo J. L. Heerspink12Adeera Levin13Carol Pollock14David C. Wheeler15Hong Zhang16Meg J. Jardine17The George Institute for Global HealthDepartment of NephrologyThe George Institute for Global HealthThe George Institute for Global HealthThe George Institute for Global HealthThe George Institute for Global HealthThe George Institute for Global HealthThe George Institute for Global HealthStanford Center for Clinical ResearchIndiana University School of Medicine and Veterans Affairs Medical CenterDepartment of MedicineNephrology DivisionThe George Institute for Global HealthDivision of NephrologyKolling Institute of Medical ResearchDepartment of Renal MedicineRenal Division of Peking University First HospitalThe George Institute for Global HealthBackground. The fracture pathophysiology associated with type 2 diabetes and chronic kidney disease (CKD) is incompletely understood. We examined individual fracture predictors and prediction sets based on different pathophysiological hypotheses, testing whether any of the sets improved prediction beyond that based on traditional osteoporotic risk factors. Methods. Within the CREDENCE cohort with adjudicated fracture outcomes, we assessed the association of individual factors with fracture using Cox regression models. We used the Akaike information criteria (AIC) and Schwartz Bayes Criterion (SBC) to assess six separate variable sets based on hypothesized associations with fracture, namely, traditional osteoporosis, exploratory general population findings, cardiovascular risk, CKD-mineral and bone disorder, diabetic osteodystrophy, and an all-inclusive set containing all variables. Results. Fracture occurred in 135 (3.1%) participants over a median 2.35 [1.88–2.93] years. Independent fracture predictors were older age (hazard ratio [HR] 1.04, confidence interval [CI] 1.01–1.06), female sex (HR 2.49, CI 1.70–3.65), previous fracture (HR 2.30, CI 1.58–3.34), Asian race (HR 1.74, CI 1.09–2.78), vitamin D therapy requirement (HR 2.05, CI 1.31–3.21), HbA1c (HR 1.14, CI 1.00–1.32), prior cardiovascular event (HR 1.60, CI 1.10–2.33), and serum albumin (HR 0.41, CI 0.23–0.74) (lower albumin associated with greater risk). The goodness of fit of the various hypothesis sets was similar (AIC range 1870.92–1849.51, SBC range 1875.60–1948.04). Conclusion. Independent predictors of fracture were identified in the CREDENCE participants with type 2 diabetes and CKD. Fracture prediction was not improved by models built on alternative pathophysiology hypotheses compared with traditional osteoporosis predictors.http://dx.doi.org/10.1155/2022/9998891 |
| spellingShingle | Tamara K. Young Nigel D. Toussaint Gian Luca Di Tanna Clare Arnott Carinna Hockham Amy Kang Aletta E. Schutte Vlado Perkovic Kenneth W. Mahaffey Rajiv Agarwal George L. Bakris David M. Charytan Hiddo J. L. Heerspink Adeera Levin Carol Pollock David C. Wheeler Hong Zhang Meg J. Jardine Risk Factors for Fracture in Patients with Coexisting Chronic Kidney Disease and Type 2 Diabetes: An Observational Analysis from the CREDENCE Trial Journal of Diabetes Research |
| title | Risk Factors for Fracture in Patients with Coexisting Chronic Kidney Disease and Type 2 Diabetes: An Observational Analysis from the CREDENCE Trial |
| title_full | Risk Factors for Fracture in Patients with Coexisting Chronic Kidney Disease and Type 2 Diabetes: An Observational Analysis from the CREDENCE Trial |
| title_fullStr | Risk Factors for Fracture in Patients with Coexisting Chronic Kidney Disease and Type 2 Diabetes: An Observational Analysis from the CREDENCE Trial |
| title_full_unstemmed | Risk Factors for Fracture in Patients with Coexisting Chronic Kidney Disease and Type 2 Diabetes: An Observational Analysis from the CREDENCE Trial |
| title_short | Risk Factors for Fracture in Patients with Coexisting Chronic Kidney Disease and Type 2 Diabetes: An Observational Analysis from the CREDENCE Trial |
| title_sort | risk factors for fracture in patients with coexisting chronic kidney disease and type 2 diabetes an observational analysis from the credence trial |
| url | http://dx.doi.org/10.1155/2022/9998891 |
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