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Bone. 2020 Jan 17;133:115242. doi: 10.1016/j.bone.2020.115242. [Epub ahead of print]

Major fractures after initiation of dialysis: Incidence, predictors and association with mortality.

Author information

1
Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan. Electronic address: iseriken@med.showa-u.ac.jp.
2
Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
3
Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
4
Division of Orthopaedics and Biotechnology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.

Abstract

BACKGROUND:

Major fractures (MF) are common in dialysis patients. We investigated incidence, predictors and clinical outcomes associated with first MF occurring after initiation of dialysis (MFfirst).

METHODS:

In Swedish Renal Registry of 9714 incident (2005-2016) dialysis patients (age 68 years, 67% men), we identified all MFfirst in hip, spine, humerus and forearm. Using flexible parametric hazard models and Fine-Gray analysis, we estimated incidence, mortality rates and predictors of MFfirst, and, in time-dependent analysis, risk of all-cause and cardiovascular disease (CVD) mortality following MFfirst.

RESULTS:

During median follow-up of 2.2 years, the crude incidence rate of MFfirst (n = 835) was 23.7/1000 patient-years and that of hip fractures (n = 470) 13.3/1000 patient-years. The multivariate-adjusted fracture incidence rates increased gradually after dialysis initiation and were 47% higher among women. Female sex, higher age, comorbidity, and previous history of MF (MFprevious) were associated with increased risk for MFfirst, whereas peritoneal dialysis as compared to hemodialysis was associated with decreased risk. The adjusted fracture incidence rate of MFfirst during the first 90 days following dialysis initiation was higher in patients with MFprevious than in those without MFprevious. MFfirst independently predicted increased all-cause (sub-distribution hazard ratio, SHR, 1.67(95%CI 1.47-1.91)) and CVD (SHR 1.49 (95%CI 1.22-1.84)) mortality. Adjusted mortality rate following hip fractures was higher than for other types of MF. Spline curves showed that mortality following MFfirst was highest during the first 6 months of follow-up.

CONCLUSIONS:

MF are common and associated with increased mortality in incident dialysis patients.

KEYWORDS:

Dialysis; End-stage renal disease; Fracture; Mortality; Osteoporosis; Renal osteodystrophy

PMID:
31958531
DOI:
10.1016/j.bone.2020.115242

Conflict of interest statement

Declaration of competing interest BL is employed by Baxter Healthcare Corporation. None of the other authors declare any conflict of interest.

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