Epidemiology and mortality of hip fracture among patients on dialysis: Taiwan National Cohort Study |
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| Institution: | 1. Department of Internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan;2. Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan;3. Department of Orthopedics, Chi-Mei Medical Center, Tainan, Taiwan;4. Department of Infectious Diseases, Chi-Mei Medical Center, Tainan, Taiwan;5. Development of Pharmacy, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan;6. Department of Safety Health and Environmental Engineering, Chung Hwa University of Medical Technology, Tainan, Taiwan;7. Department of Neurology, Chi-Mei Medical Center, Tainan, Taiwan;8. Department of Nephrology, Chi-Mei Medical Center, Tainan, Taiwan;9. Department of Food Nutrition, Chung Hwa University of Medical Technology, Tainan, Taiwan;1. Novartis Pharma AG, Basel, Switzerland, Novartis Corporation, East Hanover, NJ, USA;2. Novartis Institutes for Biomedical Research, Basel, Switzerland and Cambridge, MA, USA;1. Department of Applied Physics, University of Eastern Finland, POB 1627, FI-70211, Kuopio, Finland;2. Department of Clinical Neurophysiology, Kuopio University Hospital, POB 100, FI-70029, Kuopio, Finland;3. Department of Biomedical Engineering, Department of Orthopaedics, Lund University, POB 118, SE-22100, Lund, Sweden;1. Academic Unit of Bone Metabolism, University of Sheffield, Sheffield, United Kingdom;2. Department of Cardiovascular Science, University of Sheffield, Sheffield, United Kingdom;3. Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom;1. Institute for Research in Operative Medicine, Faculty of Health, School of Medicine, Witten/Herdecke University, Cologne, Germany;2. Department of Trauma Surgery and Reconstructive Surgery, University of Goettingen, Robert-Koch 40, 37075 Goettingen, Germany;3. Department of Radiology, University of Goettingen, Robert-Koch 40, 37075 Goettingen, Germany;1. Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Germany;2. Department of Nuclear Medicine, Hannover Medical School, Germany;3. Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Germany;4. Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Germany;5. Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Germany;6. Department of Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Germany;7. Institute of Pathology, University Medical Center Hamburg-Eppendorf, Germany |
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| Abstract: | Chronic kidney disease increases the risk for hip fractures. Hip fractures are associated with increased mortality, decreased quality of life, and higher economic burden. To determine whether dialysis modality is associated with a higher incidence of hip fractures in patients with end-stage renal disease (ESRD), we used the Taiwan National Health Insurance Research Database to examine the records of 51,473 patients who began dialysis between 1999 and 2005. The patients were followed until death, transplantation, dialysis cessation, or 31 December 2008. The follow-up period was (mean ± SD) 4.14 ± 2.48 years. The cumulative incidence rate of hip fracture was calculated using Kaplan–Meier methods. Predictors of hip fracture were determined using Cox models. During the study period, 1903 patients had a hip fracture. The overall incidence rate of hip fracture was 89.21/10,000 patient-years. Patients on hemodialysis (HD) had a 31% higher incidence of hip fracture than those on peritoneal dialysis (PD) (HR 1.31, 95% CI: 1.01–1.70). Patients ≥ 65 years old had more than 13 times the risk of a hip fracture than did those 18–44 years old (HR: 13.65; 95% CI: 10.12–18.40). Other factors that increased the risk of a hip fracture were a prior hip fracture (HR: 1.44; 95% CI: 1.15–1.80), osteoporosis (HR: 1.24; 95% CI: 1.07–1.45), DM (HR: 1.66; 95% CI: 1.51–1.83), and liver cirrhosis (HR: 1.37, 95% CI: 1.15–1.64). The overall in-hospital mortality rate was 3.2%. The cumulative survival rates after a hip fracture were 74.6% at one year and only 29.6% at seven years. Our findings supported the notion that being on HD is a risk for hip fracture. Additionally, old age, female gender, a prior hip fracture, osteoporosis, DM and liver cirrhosis were also risk factors for hip fracture in patients with ESRD and undergoing dialysis. |
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