Abstract
BackgroundNephropathy associated metabolic disorder induces high incidence of fragility fracture in end-stage renal disease (ESRD) patients. As the risk factors and prognosis of fragility fracture in ESRD patients are unclear, more research is needed. This study aimed to evaluate various risk factors for ESRD-related fragility fractures, explore factors affecting the prognosis of patients with such fractures, and provide information for prevention and treatment of renal osteopathy to improve the prognosis of patients.MethodsIn this retrospective case-control study, the case notes of 521 ESRD patients who received maintenance dialysis for at least 3 months were examined. Finally, 44 patients diagnosed with fragility fractures were assigned to the fragility fracture (FF) group and 192 patients were included in the control group (CG). Demographic information, underlying diseases, nutritional, bone metabolism, and renal function parameters, along with the number and causes of any deaths, were recorded for multiple statistical analysis.ResultsThe FF group had increased incidences of essential hypertension and diabetes mellitus and higher serum calcium, corrected calcium, alkaline phosphatase, and hemoglobin levels. Immunoreactive parathyroid hormone (iPTH), total cholesterol (TC), and low density lipoprotein (LDL) levels were higher in the CG. Multivariate Cox regression analysis revealed that fragility fracture was an independent risk factor for all-cause mortality in ESRD patients (P < .001, RR: 4.877, 95% CI: 2.367–10.013).ConclusionsEssential hypertension and diabetes, high serum calcium and alkaline phosphatase levels, and reduced iPTH levels were risk factors for fragility fracture in ESRD patients. Maintaining iPTH and serum TC levels may protect against fragility fractures in them. Fragility fractures may yield poor prognosis and shorter lifespan. The presence of fragility fracture was an independent predictor of all-cause death in ESRD patients.
Highlights
Nephropathy associated metabolic disorder induces high incidence of fragility fracture in end-stage renal disease (ESRD) patients
Fracture in patients with ESRD Our study found that among 521 ESRD patients, 44 suffered fragility fractures during the follow-up period, with a rate of 8.4% and an annual average incidence of about 2.76‰
The average age of the fragility fracture (FF) group was Statistical analysis of the serum nutrition-related parameters and the mineral-bone metabolism disorder parameters In our study, the results showed that the FF patients had higher levels of hemoglobin than the control group (CG) patients (Fig. 1a)
Summary
Nephropathy associated metabolic disorder induces high incidence of fragility fracture in end-stage renal disease (ESRD) patients. This study aimed to evaluate various risk factors for ESRD-related fragility fractures, explore factors affecting the prognosis of patients with such fractures, and provide information for prevention and treatment of renal osteopathy to improve the prognosis of patients. Kidney Disease Improving Global Outcome (KDIGO) has defined Chronic Kidney Disease and Mineral Bone Disease (CKD-MBD) as a clinical syndrome encompassing mineral, bone, and calcific cardiovascular abnormalities that develop in patients with CKD They have recommended the desirable serum content of calcium, phosphorus, and intact iPTH [4]. The aim of this retrospective study was to evaluate the various risk factors of ESRDrelated fragility fractures, explore the factors affecting the prognosis of these patients, and provide information for clinical prevention and treatment of renal osteopathy to improve the prognosis of patients
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