Increased hip fracture and mortality in chronic kidney disease individuals: The importance of competing risks |
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| Institution: | 1. Department of Nephrology, Hospital del Mar, Barcelona, Spain;2. Institut Mar d''Investigacions Mediques, Barcelona, Spain;3. Idiap Jordi Gol Primary Care Research Institute, Universitat Autonoma de Barcelona, Barcelona, Spain;4. Musculoskeletal Epidemiology Unit, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK;5. Department of Internal Medicine, Hospital del Mar, Barcelona, Spain;1. Department of Therapeutic Radiology, University of Minnesota, MN, USA;2. Masonic Cancer Center, University of Minnesota, MN, USA;3. Department of Obstetrics and Gynecology, University of Minnesota, MN, USA;4. Mindways Software Inc., Austin, TX, USA;5. Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, MN, USA;6. Biostatistics Core, Masonic Cancer Center, University of Minnesota, MN, USA;7. Department of Medicine, Division of Rheumatology, University of Wisconsin, Madison, USA;8. Department of Medicine, University of Minnesota, MN, USA;9. Family Medicine and Community Health, University of Minnesota, MN, USA;10. Campus Bio-Medico University, School of Medicine, Rome, Italy;11. Department of Biostatistics, University of Minnesota, Minneapolis, USA;12. Maine Medical Center Research Institute, Scarborough, ME, USA;1. Clinical Research Support Center, Mie University Hospital, Mie, Japan;2. Ageo Central General Hospital, Ageo, Saitama, Japan;3. Graduate School of Medicine, Kyoto University, Kyoto, Japan;4. Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto and National Cerebral and Cardiovascular Center, Suita, Osaka, Japan;5. Fukuoka Sanno Hospital, Fukuoka, Japan;6. International University of Health and Welfare, Ohtawara, Japan;7. Division of Cardiology, Department of Medicine, Faculty of Medicine, Kinki University, Osaka, Japan;8. Life Science & Medical Bioscience, Faculty of Science and Engineering, Waseda University, Tokyo, Japan;9. Division of Cardiovascular Medicine, Ohashi Medical Center, Toho University, Tokyo, Japan;10. Clinical Data & Biostatistics Department, R&D Division, Daiichi Sankyo Co., Ltd., Tokyo, Japan;11. Division of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan;1. Graduate Institute of Clinical Medical Science, China Medical University, No. 91 Hsueh-Shih Rd., Taichung, Taiwan;2. Department of Pediatric Dentistry, China Medical University Hospital, No. 2 Yu-Der Rd., Taichung, Taiwan;3. School of Dentistry, China Medical University, No. 91 Hsueh-Shih Rd., Taichung, Taiwan;4. Department of Oral & Maxillofacial Surgeon, China Medical University Hospital, No. 2 Yu-Der Rd., Taichung, Taiwan;5. Division of Nephrology, Department of medicine, China Medical University Hospital, No. 2 Yu-Der Rd., Taichung, Taiwan;6. Division of Cardiology, Department of medicine, China Medical University Hospital, No. 2 Yu-Der Rd., Taichung, Taiwan;7. Department of Anesthesiology, China Medical University Hospital, No. 2 Yu-Der Rd., Taichung, Taiwan;1. Institute of Naval Medicine, Alverstoke, Gosport PO12 2DL, UK;2. Department of Nutritional Sciences, School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey GU2 7XH, UK;3. Bone Biology Laboratory, University College London, London WC1E 6BT, UK;4. The Osteoporosis Centre, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK;5. MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK;1. Schulich School of Engineering, University of Calgary, Canada;2. Roger Jackson Centre for Health and Wellness Research, University of Calgary, Canada;3. McCaig Institute for Bone and Joint Health, University of Calgary, Canada;4. Department of Radiology, Cumming School of Medicine, University of Calgary, Canada |
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| Abstract: | BackgroundMany studies have shown a correlation between chronic kidney disease (CKD) and fracture. However, increased mortality in CKD patients is a competing risk scenario not accounted for in previous studies. Our aim was to investigate the true impact of CKD on hip fracture after accounting for a competing risk with death.MethodsWe conducted a population-based cohort study to determine the impact of CKD on hip fractures in individuals aged ≥ 50 years old registered in the SIDIAPQ database (representative of 1.9 million people in Catalonia, Spain). Cox regression was used to estimate hazard ratio (HR) for death and hip fracture according to CKD status. A competing risk (Fine and Gray) model was fitted to estimate sub-HR for hip fracture in CKD or CKD-free patients accounting for differential mortality.ResultsA total of 873,073 (32,934 (3.8%) CKD) patients were observed for 3 years. During follow-up, 4,823 (14.6%) CKD and 36,328 (4.3%) CKD-free participants died (HR, 1.83 95% CI, 1.78–1.89]), whilst 522 (1.59%) and 6,292 (0.75%) sustained hip fractures, respectively. Adjusted Cox models showed a significantly increased risk of hip fractures for the CKD group (HR, 1.16 1.06–1.27]), but this association was attenuated in competing risk models accounting for mortality (SHR, 1.14 1.03–1.27]).ConclusionsBoth death and hip fracture rates are increased (by 83% and 16%, respectively) in CKD patients. However, the association between CKD and hip fractures is attenuated when an excess of mortality is taken into account. A competing risk with death must be considered in future analyses of association between CKD and any health outcomes. |
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