Single-centre cross-sectional study on the impact of cumulative erythropoietin on bone mineral density in maintenance dialysis patients

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OBJECTIVES: Numerous factors are associated with the risk of osteoporosis in patients with chronic kidney disease, including vitamin D deficiency, hypocalcaemia, hyperphosphataemia and secondary hyperparathyroidism. This study aimed to assess the correlation between cumulative erythropoietin (EPO) doses and osteoporosis risk in patients on chronic dialysis. A further objective was to determine the bone mineral density (BMD) of patients undergoing dialysis and its correlation with specific clinical and biochemical factors. SETTING: The study was undertaken at a tertiary care centre within the southern region of the Taipei Metropolitan area. PARTICIPANTS: This cross-sectional study included 165 participants aged 41-90 years. Dual-energy X-ray absorptiometry was used to measure BMD. A total of 108 age-matched and sex-matched participants were selected for further analysis. Stepwise multiple regression analysis was used to investigate the relationship between bone measurements and bone diseases' risk factors. PRIMARY AND SECONDARY OUTCOMES: The primary outcome of this study was to assess the T-scores of the participants who received dialysis for more than 3 months in our institution. The secondary outcome was using a receiver operating curve to predict osteoporosis development in patients on dialysis who received EPO treatments. RESULTS: The mean age of the participants was 66.6±11.1 years. A total of 99 (60%) participants (41 men, 58 women) were diagnosed as having osteoporosis. Fifty-four (32.7%) participants with T-scores >-2.5 but <-1.0 were diagnosed as having osteopenia. Osteoporotic participants received 1.61±1.52 million units EPO compared with nonosteoporotic participants, who received 1.01±0.64 million units (EPO1 model), p=0.015. The cumulative EPO dose negatively correlated with the T-scores of participants (p<0.0001). CONCLUSION: On the basis of the results of the study, cumulative EPO doses show a negative correlation with BMD development in patients on chronic dialysis.

Original languageEnglish
Pages (from-to)e056390
JournalBMJ Open
Issue number4
Publication statusPublished - Apr 12 2022


  • calcium & bone
  • chronic renal failure
  • dialysis
  • nephrology
  • rheumatology

ASJC Scopus subject areas

  • General Medicine


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