Work

Erythropoietin treatment and osteoporotic fracture risk in hemodialysis patients: A nationwide population-based study

Year: 2024

Type: article

Abstract: Introduction: Erythropoietin (EPO) serves as a primary treatment for anemia in patients with end-stage renal disease (ESRD), but concerns about EPO therapy contributing to potential bone loss and fracture risks are increasing. This study investigated the impact of EPO administration on the incidence of common osteoporotic fractures in ESRD patients.Materials and methods: This population-based retrospective cohort study compared EPO users and non-EPO users among ESRD patients ESRD undergoing hemodialysis. The cohorts were matched at a propensity score ratio of 1:1, resulting in equal sample sizes of 2839. Variables related to comorbidities were considered. Patients diagnosed with ESRD between 2000 and 2014 were included, identified from the National Health Insurance Research Database of Taiwan.Results: In the Kaplan-Meier survival analysis, EPO users exhibited higher cumulative incidences of major osteoporotic fractures, hip fractures, spine fractures, and wrist fractures compared with the non-EPO user (all p < 0.001). In adjusted Cox regression models based on the Fine and Gray model, which considered death as a competing risk, higher adjusted subdistribution hazard ratios (aSHRs) were observed for major osteoporotic fractures (2.41, 95% confidence interval [CI] = 2.01–2.89), osteoporotic hip fractures (2.19, 95% CI = 1.69–2.85), spine fractures (2.50, 95% CI = 1.87–3.34), and wrist fractures (2.34, 95% CI = 1.44–3.78) in EPO users than in non-EPO users. The risk of major osteoporotic fractures significantly increased with increasing EPO doses (p for trend <0.0001), and a similar trend was observed for the risks of osteoporotic hip, spine, and wrist fractures. Regardless of age and sex, EPO users had a higher occurrence of major osteoporotic fractures as well as osteoporotic hip and spine fractures than non-EPO users.Conclusion: Our findings suggest that EPO treatment in patients with ESRD undergoing hemodialysis is associated with an increased risk of osteoporotic fractures, and this risk has a dose–response relationship.

Source: Osteoporosis and Sarcopenia

DOI: 10.1016/j.afos.2024.11.002