Abstract
PurposePeople living with chronic kidney disease (CKD) are at a higher risk of hip fracture with an associated increased mortality risk compared to individuals without CKD. Our study aimed to evaluate the clinical assessment tools that best predict mortality risk following hip fracture for patients with CKD.MethodsPatients with CKD G3b-5D admitted to Lancashire Teaching Hospitals NHS Foundation Trust, U.K. between June 2013 and Dec 2019 were included. The association between CKD and post-fracture mortality risk was evaluated. All patients were assessed using tools that evaluated frailty status, co-morbidity, pre-operative risk, functional status and cardiopulmonary fitness. Receiver operating characteristic curve analyses were performed to determine the prognostic accuracy of the assessment tools for 30 day and 1 year mortality following hip fracture in patients with CKD.Results397 patients fulfilled inclusion criteria with a mean age of 83.5 ± 9.2 years. Older age, female sex, intracapsular fracture and more severe CKD, co-morbidity and frailty status were all associated with an increased mortality risk. Patients with dialysis-dependent CKD and severe/very severe frailty had a hazard ratio for mortality of 2.55 (95% Cl 2.11–2.98) and 3.11 (95% Cl 2.47–3.93), respectively. The Clinical Frailty Scale demonstrated the best prognostic accuracy for both 30 day [Area Under the Curve (AUC) 0.91, 95% Cl 0.84–0.97] and 1 year mortality (AUC 0.93, 95% Cl 0.87–1.00).ConclusionPatients with advanced CKD and severe frailty have a high mortality risk following hip fracture. The Clinical Frailty Scale is an excellent prognostic tool for mortality in this setting and could be easily incorporated into routine clinical practice.
Highlights
IntroductionData collectionHip fracture presentations are a global public health burden [1]. There were an estimated 1.6 million hip fractures in 2000; this is projected to increase to 6.3 million by 2050 with a growing elderly population [2]
Data collectionHip fracture presentations are a global public health burden [1]
People living with chronic kidney disease (CKD) have a greater risk of falls leading to hip fracture [3]
Summary
Data collectionHip fracture presentations are a global public health burden [1]. There were an estimated 1.6 million hip fractures in 2000; this is projected to increase to 6.3 million by 2050 with a growing elderly population [2]. People living with chronic kidney disease (CKD) have a greater risk of falls leading to hip fracture [3]. Individuals with end-stage kidney disease (ESKD) are reported to have a risk of falls and hip fracture between 4 and 14 times greater than those without CKD [4, 5]. There are higher risks of poor health outcomes for patients living with CKD after sustaining hip fracture. A significant decline in functional status following acute trauma is frequently observed for patients with various comorbidities including CKD [9]. Due to this marked decline, rehabilitation following hip fracture is more difficult for patients with CKD compared to the general population [9]. Mortality outcomes are worse for patients with reduced functional status [10]
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