Paper of the month by ESCEO

REMS in nephrology

“Radiofrequency Echographic Multi‑Spectrometry and DXA for the evaluation of bone mineral density in a peritoneal dialysis setting” was elected “Paper Of The Month” by ESCEO for January 23

REMS lands in nephrology: the international journal Aging Clinical and Experimental Research (ACER) publishes the paper “Radiofrequency echographic multi-spectrometry and DXA for the evaluation of bone mineral density in a peritoneal dialysis setting” and the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) selects it as its article of the month (January 2023).

The study conducted by Dr. Angelo Fassio (Fassio A et. Al. ACER 2022) at the University Hospital of Verona, Italy showed the application of Radiofrequency Echographic Multi Spectrometry (REMS) for the assessment of bone health status in patients with chronic kidney disease (CKD) undergoing peritoneal dialysis (DP).

CKD disease is associated with a broad range of bone mineral and endocrine disorders and with an increased risk of fragility fractures.

In terms of fracture risk, peritoneal dialysis (PD) has shown less harmful effects than haemodialysis (HD) on early changes in bone density but is associated with significant vascular calcifications. In particular, aortic calcifications (AOC) predispose to an artefactual increase in lumbar spine bone density when measured with the Antero-Posterior Dual X ray Absiorptiometry (AP – DXA) scan.

A possible solution to this problem may be to roll the patient onto their side and switch to a laterolateral DXA (DXA LL) scan (thereby bypassing the aorta). However, this method is not widespread in daily clinical practice therefore, the clinical condition induced by chronic kidney disease could be overlooked. For these reasons, REMS Technology, being able to automatically discard artefacts, can help overcome such limitations in fragile populations such as CKD patients.

In this study REMS was compared with DXA in the assessment of bone density in CKD patients undergoing PD. Aclose correlation was shown for the first time between DXA LL and REMS in the diagnosis of osteoporosis in patients undergoing PD. Furthermore, the obtained data confirmed that REMS technology is not affected by the presence of aortic calcifications (AOC) which are instead responsible for the artificial overestimation of BMD with DXA.