Increased risk of mortality associated with hip fracture in the dialysis population

Abstract

Background: Patients with end-stage renal disease (ESRD) are at increased risk of bone loss and hip fracture. Although it is well known that hip fracture in the general population is associated with increased mortality, this relationship is not well elucidated in the ESRD population. The authors studied the association between hip fracture and mortality in dialysis patients. Methods: The authors used data from the United States Renal Data System to identify patients initiating dialysis between May 1, 1995, and December 31, 2000. Patients with hip fractures were identified using Medicare claims data. Each patient who experienced a hip fracture was matched to 3 nonfracture controls by age, history of cardiovascular disease (CVD), and dialysis duration. Proportional hazards models were used to estimate the risk of all-cause and cardiovascular mortality associated with hip fracture stratified by CVD history. Results: A total of 7,636 patients with a hip fracture and 22,896 matched controls were identified. Median survival time for patients with hip fracture was 289 days (95% confidence interval [CI]: 275, 302) compared with 714 days (95% CI: 697, 732) for those without a hip fracture. The average relative risk of mortality associated with hip fracture was 1.99 (95% CI: 1.91, 2.07; P < 0.001). Conclusion: Hip fracture is associated with an increased risk of all-cause mortality in the dialysis population. Background: Patients with end-stage renal disease (ESRD) are at increased risk of bone loss and hip fracture. Although it is well known that hip fracture in the general population is associated with increased mortality, this relationship is not well elucidated in the ESRD population. The authors studied the association between hip fracture and mortality in dialysis patients. Methods: The authors used data from the United States Renal Data System to identify patients initiating dialysis between May 1, 1995, and December 31, 2000. Patients with hip fractures were identified using Medicare claims data. Each patient who experienced a hip fracture was matched to 3 nonfracture controls by age, history of cardiovascular disease (CVD), and dialysis duration. Proportional hazards models were used to estimate the risk of all-cause and cardiovascular mortality associated with hip fracture stratified by CVD history. Results: A total of 7,636 patients with a hip fracture and 22,896 matched controls were identified. Median survival time for patients with hip fracture was 289 days (95% confidence interval [CI]: 275, 302) compared with 714 days (95% CI: 697, 732) for those without a hip fracture. The average relative risk of mortality associated with hip fracture was 1.99 (95% CI: 1.91, 2.07; P < 0.001). Conclusion: Hip fracture is associated with an increased risk of all-cause mortality in the dialysis population.