Original Report: Patient-Oriented, Translational Research American

Journal of

Nephrology

Received: June 6, 2014 Accepted: October 8, 2014 Published online: November 26, 2014

Am J Nephrol 2014;40:451–457 DOI: 10.1159/000369039

Increasing Hip Fractures in Patients Receiving Hemodialysis and Peritoneal Dialysis Anna T. Mathew a Azzour Hazzan a Kenar D. Jhaveri a Geoffrey A. Block b Shailaja Chidella a Lisa Rosen a John Wagner c Steve Fishbane a  

 

 

a

 

 

 

 

 

Hofstra NSLIJ School of Medicine, North Shore University Hospital and Long Island Jewish Medical Center, Great Neck, N.Y., b Denver Nephrologists, PC, Denver, Co., and c Kings County Hospital Center, College of Medicine, SUNY Downstate Medical Center, Brooklyn, N.Y., USA  

 

Key Words Dialysis · End stage renal disease · Fracture · Mineral and bone disorders

Abstract Background/Aims: Dialysis patients are at increased risk for hip fractures. Because changes in treatment of metabolic bone disease in this population may have impacted bone fragility, this study aims to analyze the longitudinal risk for fractures in hemodialysis (HD) and peritoneal dialysis (PD) patients. Methods: Using the United States Renal Data System database from 1992 to 2009, the temporal trend in hip fractures requiring hospitalization was analyzed using an overdispersed Poisson regression model. Generalized Estimating Equations were used to assess the adjusted effect of dialysis modality on hip fractures. Results: 842,028 HD and 87,086 PD patients were included. There was a significant temporal increase in hip fractures in both HD and PD with stabilization of rates after 2005. With stratification, the increase in fractures occurred in patients who were white and over 65 years of age. In adjusted analyses, HD patients had 1.6 times greater odds of hip fracture than PD patients (OR 1.60 95% CI 1.52, 1.68, p < 0.001). Conclusions: In contrast to the declining hip fracture rates in the general population, we identified a temporal rise in incidence of hip fractures in HD

© 2014 S. Karger AG, Basel 0250–8095/14/0405–0451$39.50/0 E-Mail [email protected] www.karger.com/ajn

and PD patients. HD patients were at a higher risk for hip fractures than PD patients after adjustment for recognized bone fragility risk factors. The increase in fracture rate over time was limited to older white patients in both HD and PD, the demographics being consistent with osteoporosis risk. Further research is indicated to better understand the longitudinal trend in hip fractures and the discordance between HD and PD. © 2014 S. Karger AG, Basel

Introduction

Patients with chronic kidney disease often have abnormal bone architecture and strength as a result of altered mineral metabolism. Broadly, the constellation of bone disease found in this population is traditionally termed renal osteodystrophy. Among the adverse consequences, one of the most important is bone fragility, resulting in an increased risk for fractures. The rate of fractures among hemodialysis patients has been reported to be 300–400% greater than the general population [1]. Fractures of the central skeleton cause substantial morbidity and are associated with an increased risk of mortality [2]. The significant focus on bone health in recent years has accompanied a progressively decreasing incidence of Steven Fishbane, MD Division of Kidney Diseases and Hypertension Hofstra North Shore-LIJ School of Medicine 100 Community Drive, 2nd Floor, Great Neck, NY 11021 (USA) E-Mail sfishbane @ nshs.edu

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Table 1. Patient demographics at 3-year intervals

Demographic characteristic

1994

1997

PD (n = 19,059)

HD (n = 119,884)

PD (n = 20,162)

HD (n = 143,194)

PD (n = 17,792)

HD (n = 166,671)

Mean age, years (SD) Age in years, %