Hip fracture incidence and mortality in chronic kidney disease

the GLOMMS-II record linkage cohort study

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Abstract

Background Individuals on renal replacement therapy (RRT) have increased fracture risk, but risk in less advanced chronic kidney disease (CKD) is unclear.
Objective To investigate CKD associations with hip fracture incidence and mortality.
Design Record linkage cohort study (GLOMMS-II).
Setting Single health region in Scotland.
Participants All individuals (≥15 years) with sustained CKD stage 3-5 and those on RRT, and a 20% random sample of those with normal renal function, in the resident population in 2003.
Outcome measures Outcomes were (i) incident hip fracture measured with (a) admissions or (b) deaths, with at least 5.5 years follow-up; and (ii) post-hip fracture mortality. Unadjusted and adjusted, incident (IRR) and mortality (MRR) rate ratios, were calculated using Poisson regression.
Results Of 39 630 individuals identified in 2003 (41% males, mean age 63.3 years), 19 537 had CKD stage 3-5, 345 were on RRT, and 19 748 had normal eGFR. Hip fracture incidence, measured by admissions, was increased in CKD stage 3-5 (compared to normal eGFR), both overall (adjusted IRR 1.49 [95% CI, 1.24-1.79]) and for individual CKD stages 3a, 3b and 4. Hip fracture incidence, measured using deaths, was increased in those with CKD stage 3b and 4. Post-hip fracture mortality, was only increased in CKD stage 4. There was only a small number of individuals and events for CKD stage 5, resulting in insufficient statistical power.
Conclusion Hip fracture incidence was higher in CKD stage 3-5 compared to normal eGFR. Post-hip fracture mortality was only increased in CKD Stage 4. Reducing hip fracture incidence in CKD through regular fall and fracture risk review, should reduce overall deaths after hip fracture in the population.
Original languageEnglish
Article numbere020312
Pages (from-to)1-11
Number of pages11
JournalBMJ Open
Volume8
Issue number4
Early online date12 Apr 2018
DOIs
Publication statusPublished - Apr 2018

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Hip Fractures
Chronic Renal Insufficiency
Cohort Studies
Mortality
Incidence
Renal Replacement Therapy
Scotland
Population
Outcome Assessment (Health Care)
Kidney

Keywords

  • chronic kidney disease
  • cohort
  • death
  • hip fracture
  • incidence
  • mortality

Cite this

@article{a18845d512254dd9a3350254c76f9362,
title = "Hip fracture incidence and mortality in chronic kidney disease: the GLOMMS-II record linkage cohort study",
abstract = "Background Individuals on renal replacement therapy (RRT) have increased fracture risk, but risk in less advanced chronic kidney disease (CKD) is unclear.Objective To investigate CKD associations with hip fracture incidence and mortality.Design Record linkage cohort study (GLOMMS-II).Setting Single health region in Scotland.Participants All individuals (≥15 years) with sustained CKD stage 3-5 and those on RRT, and a 20{\%} random sample of those with normal renal function, in the resident population in 2003.Outcome measures Outcomes were (i) incident hip fracture measured with (a) admissions or (b) deaths, with at least 5.5 years follow-up; and (ii) post-hip fracture mortality. Unadjusted and adjusted, incident (IRR) and mortality (MRR) rate ratios, were calculated using Poisson regression.Results Of 39 630 individuals identified in 2003 (41{\%} males, mean age 63.3 years), 19 537 had CKD stage 3-5, 345 were on RRT, and 19 748 had normal eGFR. Hip fracture incidence, measured by admissions, was increased in CKD stage 3-5 (compared to normal eGFR), both overall (adjusted IRR 1.49 [95{\%} CI, 1.24-1.79]) and for individual CKD stages 3a, 3b and 4. Hip fracture incidence, measured using deaths, was increased in those with CKD stage 3b and 4. Post-hip fracture mortality, was only increased in CKD stage 4. There was only a small number of individuals and events for CKD stage 5, resulting in insufficient statistical power.Conclusion Hip fracture incidence was higher in CKD stage 3-5 compared to normal eGFR. Post-hip fracture mortality was only increased in CKD Stage 4. Reducing hip fracture incidence in CKD through regular fall and fracture risk review, should reduce overall deaths after hip fracture in the population.",
keywords = "chronic kidney disease, cohort, death, hip fracture, incidence, mortality",
author = "Lynn Robertson and Corrinda Black and Nick Fluck and Sharon Gordon and Rosemary Hollick and Huong Nguyen and Gordon Prescott and Angharad Marks",
note = "This work was supported by NHS Grampian Endowment [grant number 14/30]. A Chief Scientist Office for Scotland grant [grant number CZH/4/656] funded the set-up of the cohort.",
year = "2018",
month = "4",
doi = "10.1136/bmjopen-2017-020312",
language = "English",
volume = "8",
pages = "1--11",
journal = "BMJ Open",
issn = "2044-6055",
publisher = "BMJ Publishing Group",
number = "4",

}

TY - JOUR

T1 - Hip fracture incidence and mortality in chronic kidney disease

T2 - the GLOMMS-II record linkage cohort study

AU - Robertson, Lynn

AU - Black, Corrinda

AU - Fluck, Nick

AU - Gordon, Sharon

AU - Hollick, Rosemary

AU - Nguyen, Huong

AU - Prescott, Gordon

AU - Marks, Angharad

N1 - This work was supported by NHS Grampian Endowment [grant number 14/30]. A Chief Scientist Office for Scotland grant [grant number CZH/4/656] funded the set-up of the cohort.

PY - 2018/4

Y1 - 2018/4

N2 - Background Individuals on renal replacement therapy (RRT) have increased fracture risk, but risk in less advanced chronic kidney disease (CKD) is unclear.Objective To investigate CKD associations with hip fracture incidence and mortality.Design Record linkage cohort study (GLOMMS-II).Setting Single health region in Scotland.Participants All individuals (≥15 years) with sustained CKD stage 3-5 and those on RRT, and a 20% random sample of those with normal renal function, in the resident population in 2003.Outcome measures Outcomes were (i) incident hip fracture measured with (a) admissions or (b) deaths, with at least 5.5 years follow-up; and (ii) post-hip fracture mortality. Unadjusted and adjusted, incident (IRR) and mortality (MRR) rate ratios, were calculated using Poisson regression.Results Of 39 630 individuals identified in 2003 (41% males, mean age 63.3 years), 19 537 had CKD stage 3-5, 345 were on RRT, and 19 748 had normal eGFR. Hip fracture incidence, measured by admissions, was increased in CKD stage 3-5 (compared to normal eGFR), both overall (adjusted IRR 1.49 [95% CI, 1.24-1.79]) and for individual CKD stages 3a, 3b and 4. Hip fracture incidence, measured using deaths, was increased in those with CKD stage 3b and 4. Post-hip fracture mortality, was only increased in CKD stage 4. There was only a small number of individuals and events for CKD stage 5, resulting in insufficient statistical power.Conclusion Hip fracture incidence was higher in CKD stage 3-5 compared to normal eGFR. Post-hip fracture mortality was only increased in CKD Stage 4. Reducing hip fracture incidence in CKD through regular fall and fracture risk review, should reduce overall deaths after hip fracture in the population.

AB - Background Individuals on renal replacement therapy (RRT) have increased fracture risk, but risk in less advanced chronic kidney disease (CKD) is unclear.Objective To investigate CKD associations with hip fracture incidence and mortality.Design Record linkage cohort study (GLOMMS-II).Setting Single health region in Scotland.Participants All individuals (≥15 years) with sustained CKD stage 3-5 and those on RRT, and a 20% random sample of those with normal renal function, in the resident population in 2003.Outcome measures Outcomes were (i) incident hip fracture measured with (a) admissions or (b) deaths, with at least 5.5 years follow-up; and (ii) post-hip fracture mortality. Unadjusted and adjusted, incident (IRR) and mortality (MRR) rate ratios, were calculated using Poisson regression.Results Of 39 630 individuals identified in 2003 (41% males, mean age 63.3 years), 19 537 had CKD stage 3-5, 345 were on RRT, and 19 748 had normal eGFR. Hip fracture incidence, measured by admissions, was increased in CKD stage 3-5 (compared to normal eGFR), both overall (adjusted IRR 1.49 [95% CI, 1.24-1.79]) and for individual CKD stages 3a, 3b and 4. Hip fracture incidence, measured using deaths, was increased in those with CKD stage 3b and 4. Post-hip fracture mortality, was only increased in CKD stage 4. There was only a small number of individuals and events for CKD stage 5, resulting in insufficient statistical power.Conclusion Hip fracture incidence was higher in CKD stage 3-5 compared to normal eGFR. Post-hip fracture mortality was only increased in CKD Stage 4. Reducing hip fracture incidence in CKD through regular fall and fracture risk review, should reduce overall deaths after hip fracture in the population.

KW - chronic kidney disease

KW - cohort

KW - death

KW - hip fracture

KW - incidence

KW - mortality

U2 - 10.1136/bmjopen-2017-020312

DO - 10.1136/bmjopen-2017-020312

M3 - Article

VL - 8

SP - 1

EP - 11

JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

IS - 4

M1 - e020312

ER -