Long-term excess mortality after hip fracture in hemodialysis patients: a nationwide cohort study in Japan
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ORIGINAL ARTICLE
Long‑term excess mortality after hip fracture in hemodialysis patients: a nationwide cohort study in Japan Minako Wakasugi1 · Junichiro James Kazama2 · Atsushi Wada3 · Takayuki Hamano3 · Ikuto Masakane3 · Ichiei Narita4 Received: 7 January 2020 / Accepted: 12 April 2020 © The Japanese Society Bone and Mineral Research and Springer Japan KK, part of Springer Nature 2020
Abstract Introduction Fracture dialysis patients have a higher risk of 1-year mortality compared with non-fracture dialysis patients. However, it is unclear whether excess mortality persists for more than a year. Materials and methods We conducted a nationwide cohort study in 162,360 hemodialysis patients in Japan. Study outcomes were 5-year all-cause mortality and cause-specific mortality. Cox proportional hazards regression was used to examine the association between hip fracture and mortality in two cohorts: the full cohort, which included potential confounders as covariates in multivariable-adjusted regression models, and the propensity score-matched cohort. Results Crude mortality rates for fracture patients were double those of non-fracture patients and persisted during the 5-year period. The association between hip fracture and mortality was significant even after adjusting for premorbid conditions (hazard ratio (HR) 1.22, 95% confidence interval (CI) 1.13–1.32). Similar findings were observed in the propensity scorematched cohort of 2410 patients (HR 1.20, 95% CI 1.05–1.36). While cause-specific mortality rates for all categories, with the exception of sudden deaths, were higher for fracture patients relative to non-fracture patients in the full unmatched cohort, only the mortality rate for heart disease was significantly higher for fracture patients relative to non-fracture patients in the propensity score-matched cohort. Conclusion Excess mortality persisted for many years after hip fracture in hemodialysis patients, and was still present after adjusting for several premorbid conditions and propensity score matching. Keywords Cardiovascular · Dialysis · End-stage kidney disease · Hip fracture · Mortality risk
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00774-020-01110-4) contains supplementary material, which is available to authorized users. * Minako Wakasugi [email protected]‑u.ac.jp 1
Division of Comprehensive Geriatrics in Community, Niigata University Graduate School of Medical and Dental Sciences, Asahimachi 1‑757, Chuo‑ku, Niigata 951‑8510, Japan
2
Departments of Nephrology and Hypertension, Fukushima Medical University, Fukushima, Japan
3
Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan
4
Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan
Many studies have shown that hip fracture is associated with increased short-term and long-term mortality in the general population [1, 2], although results from some lon
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