Elsevier

Kidney International

Volume 85, Issue 1, January 2014, Pages 166-173
Kidney International

Clinical Investigation
High rates of death and hospitalization follow bone fracture among hemodialysis patients

https://doi.org/10.1038/ki.2013.279Get rights and content
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Altered bone structure and function contribute to the high rates of fractures in dialysis patients compared to the general population. Fracture events may increase the risk of subsequent adverse clinical outcomes. Here we assessed the incidence of post-fracture morbidity and mortality in an international cohort of 34,579 in-center hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS). We estimated country-specific rates of fractures requiring a hospital admission and associated length of stay in the hospital. Incidence rates of death and of a composite event of death/rehospitalization were estimated for 1 year after fracture. Overall, 3% of participants experienced a fracture. Fracture incidence varied across countries, from 12 events/1000 patient-years (PY) in Japan to 45/1000 PY in Belgium. In all countries, fracture rates were higher in the hemodialysis group compared to those reported for the general population. Median length of stay ranged from 7 to 37 days in the United States and Japan, respectively. In most countries, postfracture mortality rates exceeded 500/1000 PY and death/rehospitalization rates exceeded 1500/1000 PY. Fracture patients had higher unadjusted rates of death (3.7-fold) and death/rehospitalization (4.0-fold) compared to the overall DOPPS population. Mortality and hospitalization rates were highest in the first month after the fracture and declined thereafter. Thus, the high frequency of fractures and increased adverse outcomes following a fracture pose a significant health burden for dialysis patients. Fracture prevention strategies should be identified and applied broadly in nephrology practices.

Keywords

bone
chronic kidney disease
hemodialysis
hospitalization
mortality

Cited by (0)

The DOPPS is administered by Arbor Research Collaborative for Health and is supported by scientific research grants from Amgen (since 1996), Kyowa Hakko Kirin (since 1999, in Japan), Sanofi Renal (since 2009), AbbVie (since 2009), Baxter (since 2011), and Vifor Fresenius Renal Pharma (since 2011), without restrictions on publications. FT is supported in part by award number K01DK087762 from the National Institute of Diabetes and Digestive and Kidney Diseases. FT has received honoraria from Amgen, Dialysis Clinic, and Renal Research Institute. BMR has received speaker fees for Kyowa Hakko Kirin. RLP has received speaker fees from Amgen, Kyowa Hakko Kirin, and Vifor, has served as a consultant for Pursuit Vascular, and has served on an advisory panel for Merck. BDB and RDK work in the Center for Observational Research at Amgen. All the other authors declared no competing interests.