POS-349 WHICH PARAMETERS BEST PREDICT REHOSPITALIZATION FROM A SECOND HIP FRACTURE EVENT FOR PATIENTS LIVING WITH CKD ADMITTED FOLLOWING HIP FRACTURE? A 6-YEAR PROSPECTIVE ANALYSIS

Abstract

Greater frequency of falls and subsequent hip fractures are observed for people living with chronic kidney disease (CKD) compared to those without CKD. The cause of increased falls risk is multifactorial. Many patients living with CKD are frail, sarcopenic and have numerous medical co-morbidities. Fracture risks following a fall could be exacerbated by mineral bone disease secondary to CKD. There is usually a marked deterioration in functional status for patients living with CKD following hip fracture, even after rehabilitation. A reduced baseline function increases risk for further falls and hip fracture events. Worsened morbidity and mortality outcomes are expected in patients with CKD following recurrent trauma and rehospitalization. The most useful clinical assessment tool to predict for rehospitalization from a second hip fracture event amongst this patient group remains unestablished. Patients with CKD G3b-5 admitted from home to a tertiary hospital in North West UK with hip fracture between Jun 2013 and Dec 2019 were included. Individuals with previous hip fractures prior to study commencement were excluded. Parameters assessed on hospital admission for each patient included the Clinical Frailty Scale (CFS), Charlson’s Co-morbidity Index (CCI), Chronic Kidney Disease Frailty Index Laboratory Score (CKD FI-LAB), Karnofsky Performance Status Scale, Sernbo Score, Nottingham Hip Fracture Score, Estimated VO2 Peak, ASA Physical Status Classification System Score and Abbreviated Mental Test Score. Rehospitalization events from a second hip fracture during the study period were recorded. Receiver Operating Characteristic (ROC) curve analyses were performed to evaluate the ability of individual scoring tools to predict for rehospitalization from a second hip fracture event amongst patients with CKD admitted following their first hip fracture. A total of 397 patients met inclusion criteria of which 42 patients (10.6%) were receiving long-term dialysis. Mean Estimated Glomerular Filtration Rate (eGFR) for non-dialysis patients was 37.4±14.9mL/min/1.73m2. 37 patients (9.3%) sustained a second hip fracture leading to rehospitalization during the study period and the mean age difference between first and second hip fracture events is 1.4 yrs (p=0.032). Area under a curve (AUC) values from ROC curve analyses are shown in the table. Tabled 1PredictorAUC Value95% CIClinical Frailty Scale0.940.87-1.00Charlson's Co-morbidity Index0.900.84-0.97Chronic Kidney Disease Frailty Index Laboratory Score0.890.82-0.96Karnofsky Performance Status Scale0.840.77-0.91Sernbo Score0.820.75-0.88Nottingham Hip Fracture Score0.800.73-0.87Estimated VO2 Peak0.790.72-0.86ASA Physical Status Classification System Score0.700.63-0.76Abbreviated Mental Test Score0.630.56-0.70 Open table in a new tab Assessment tools evaluating frailty and co-morbidity status (CFS, CCI and CKD FI-LAB) displayed the strongest predictive ability for rehospitalization events from a second hip fracture in patients with CKD following initial hip fracture. Future studies should aim to optimize frailty needs and address medical co-morbidities in the CKD population during early phases of post-trauma rehabilitation. An effective multidisciplinary team input throughout this process may reduce further falls and fracture risks.