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Arteriovenous Fistula Affects Bone Mineral Density Measurements in End-Stage Renal Failure Patients

África Muxí^*,, José-Vicente Torregrosa^,,, David Fuster^*,, Pilar Peris^,, Sergi Vidal-Sicart^*,, Oriol Solà^*, Beatriz Domenech^*, Gloria Martín, Joan Casellas, and Francisca Pons^*,

^* Servicio de Medicina Nuclear, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain;
Institut d‘Investigacions Biomèdiques August Pí i Sunyer (IDIBAPS), Barcelona, Spain; and
Servicio de Nefrología-Trasplante Renal and
Servicio de Reumatología, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain

Correspondence: África Muxí, Nuclear Medicine Department, Hospital Clínic, Villarroel 170 08036 Barcelona, Spain. Phone: 3493-227-55-16; Fax: 3493-451-81-37; E-mail: amuxi{at}clinic.ub.es

Background and objectives: Hemodialysis needs an arteriovenous fistula (AVF) that may influence the structure and growth of nearby bone and affect bone mass measurement. The study analyzed the effect of AVF in the assessment of forearm bone mineral density (BMD) measured by dual energy x-ray absorptiometry (DXA) and examined its influence on the final diagnosis of osteoporosis.

Design, setting, participants, & measurements: Forty patients (52 ± 18 yr) in hemodialysis program (12 ± 8 yr) with permeable AVF in forearm were included. Patients were divided in two groups (over and under 50 yr). BMD of both forearms (three areas), lumbar spine, and femur was measured by DXA. Forearm measurements in each arm were compared. Patients were diagnosed as normal only if all territories were considered nonpathologic and osteoporosis/osteopenia was determined by the lowest score found.

Results: Ten patients were excluded and 30 patients were analyzed. BMD in the forearm with AVF was significantly lower than that observed in the contralateral forearm in both groups of patients and in all forearm areas analyzed. When only lumbar spine and femur measurements were considered, 70% of patients were nonpathologic and 30% were osteoporotic. However, inclusion of AVF forearm classified 63% as osteoporotic and a further 27% as osteopenic, leaving only 10% as nonpathologic.

Conclusions: Forearm AVF affects BMD measurements by decreasing their values in patients with end-stage renal failure. This may produce an overdiagnosis of osteoporosis, which should be taken into account when evaluating patients of this type.