Major fractures after initiation of dialysis : Incidence, predictors and association with mortality
Copyright © 2020 Elsevier Inc. All rights reserved..
BACKGROUND: Major fractures (MF) are common in dialysis patients. We investigated incidence, predictors and clinical outcomes associated with first MF occurring after initiation of dialysis (MFfirst).
METHODS: In Swedish Renal Registry of 9714 incident (2005-2016) dialysis patients (age 68 years, 67% men), we identified all MFfirst in hip, spine, humerus and forearm. Using flexible parametric hazard models and Fine-Gray analysis, we estimated incidence, mortality rates and predictors of MFfirst, and, in time-dependent analysis, risk of all-cause and cardiovascular disease (CVD) mortality following MFfirst.
RESULTS: During median follow-up of 2.2 years, the crude incidence rate of MFfirst (n = 835) was 23.7/1000 patient-years and that of hip fractures (n = 470) 13.3/1000 patient-years. The multivariate-adjusted fracture incidence rates increased gradually after dialysis initiation and were 47% higher among women. Female sex, higher age, comorbidity, and previous history of MF (MFprevious) were associated with increased risk for MFfirst, whereas peritoneal dialysis as compared to hemodialysis was associated with decreased risk. The adjusted fracture incidence rate of MFfirst during the first 90 days following dialysis initiation was higher in patients with MFprevious than in those without MFprevious. MFfirst independently predicted increased all-cause (sub-distribution hazard ratio, SHR, 1.67(95%CI 1.47-1.91)) and CVD (SHR 1.49 (95%CI 1.22-1.84)) mortality. Adjusted mortality rate following hip fractures was higher than for other types of MF. Spline curves showed that mortality following MFfirst was highest during the first 6 months of follow-up.
CONCLUSIONS: MF are common and associated with increased mortality in incident dialysis patients.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2020 |
|---|---|
| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:133 |
|---|---|
| Enthalten in: |
Bone - 133(2020) vom: 04. Apr., Seite 115242 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Iseri, Ken [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Dialysis |
|---|
| Anmerkungen: |
Date Completed 17.06.2021 Date Revised 17.06.2021 published: Print-Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1016/j.bone.2020.115242 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM305565737 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM305565737 | ||
| 003 | DE-627 | ||
| 005 | 20231225121447.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231225s2020 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1016/j.bone.2020.115242 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1018.xml |
| 035 | |a (DE-627)NLM305565737 | ||
| 035 | |a (NLM)31958531 | ||
| 035 | |a (PII)S8756-3282(20)30022-3 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Iseri, Ken |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Major fractures after initiation of dialysis |b Incidence, predictors and association with mortality |
| 264 | 1 | |c 2020 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 17.06.2021 | ||
| 500 | |a Date Revised 17.06.2021 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2020 Elsevier Inc. All rights reserved. | ||
| 520 | |a BACKGROUND: Major fractures (MF) are common in dialysis patients. We investigated incidence, predictors and clinical outcomes associated with first MF occurring after initiation of dialysis (MFfirst) | ||
| 520 | |a METHODS: In Swedish Renal Registry of 9714 incident (2005-2016) dialysis patients (age 68 years, 67% men), we identified all MFfirst in hip, spine, humerus and forearm. Using flexible parametric hazard models and Fine-Gray analysis, we estimated incidence, mortality rates and predictors of MFfirst, and, in time-dependent analysis, risk of all-cause and cardiovascular disease (CVD) mortality following MFfirst | ||
| 520 | |a RESULTS: During median follow-up of 2.2 years, the crude incidence rate of MFfirst (n = 835) was 23.7/1000 patient-years and that of hip fractures (n = 470) 13.3/1000 patient-years. The multivariate-adjusted fracture incidence rates increased gradually after dialysis initiation and were 47% higher among women. Female sex, higher age, comorbidity, and previous history of MF (MFprevious) were associated with increased risk for MFfirst, whereas peritoneal dialysis as compared to hemodialysis was associated with decreased risk. The adjusted fracture incidence rate of MFfirst during the first 90 days following dialysis initiation was higher in patients with MFprevious than in those without MFprevious. MFfirst independently predicted increased all-cause (sub-distribution hazard ratio, SHR, 1.67(95%CI 1.47-1.91)) and CVD (SHR 1.49 (95%CI 1.22-1.84)) mortality. Adjusted mortality rate following hip fractures was higher than for other types of MF. Spline curves showed that mortality following MFfirst was highest during the first 6 months of follow-up | ||
| 520 | |a CONCLUSIONS: MF are common and associated with increased mortality in incident dialysis patients | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Dialysis | |
| 650 | 4 | |a End-stage renal disease | |
| 650 | 4 | |a Fracture | |
| 650 | 4 | |a Mortality | |
| 650 | 4 | |a Osteoporosis | |
| 650 | 4 | |a Renal osteodystrophy | |
| 700 | 1 | |a Carrero, Juan Jesús |e verfasserin |4 aut | |
| 700 | 1 | |a Evans, Marie |e verfasserin |4 aut | |
| 700 | 1 | |a Felländer-Tsai, Li |e verfasserin |4 aut | |
| 700 | 1 | |a Berg, Hans |e verfasserin |4 aut | |
| 700 | 1 | |a Runesson, Björn |e verfasserin |4 aut | |
| 700 | 1 | |a Stenvinkel, Peter |e verfasserin |4 aut | |
| 700 | 1 | |a Lindholm, Bengt |e verfasserin |4 aut | |
| 700 | 1 | |a Qureshi, Abdul Rashid |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Bone |d 1992 |g 133(2020) vom: 04. Apr., Seite 115242 |w (DE-627)NLM01297238X |x 1873-2763 |7 nnns |
| 773 | 1 | 8 | |g volume:133 |g year:2020 |g day:04 |g month:04 |g pages:115242 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1016/j.bone.2020.115242 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 133 |j 2020 |b 04 |c 04 |h 115242 | ||