Fracture risk and mortality post‐kidney transplantation

Ferro, Charles J.; Arnold, Julia; Bagnall, David; Ray, Daniel; Sharif, Adnan

doi:10.1111/ctr.12621

Cited by 35 publications

(41 citation statements)

References 32 publications

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“…We hypothesized that a fracture prediction tool incorporating both general and transplant-specific risk factors may improve fracture prediction [11] . However, model updating may not be needed as the absolute fracture rate found in the current study was lower than previously reported, similar to other recently conducted studies [27,28] . Moreover, the strength of the transplant-specific risk factors was only moderate.…”

Section: Discussionsupporting

confidence: 85%

Risk factors for fracture in adult kidney transplant recipients

Naylor

Zou

Leslie

et al. 2016

WJT

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AIM:To determine the general and transplant-specific risk factors for fractures in kidney transplant recipients. METHODS:We conducted a cohort study of all adults who received a kidney-only transplant (n = 2723) in Ontario, Canada between 2002 and 2009. We used multivariable Cox proportional hazards regression to determine general and transplant-specific risk factors for major fractures (proximal humerus, forearm, hip, and clinical vertebral). The final model was established using the backward elimination strategy, selecting risk factors with a P -value ≤ 0.2 and forcing recipient age and sex into the model. We also assessed risk factors for other fracture locations (excluding major fractures, and fractures involving the skull, hands or feet). RESULTS:There were 132 major fractures in the follow-up (8.1 fractures per 1000 person-years). General risk factors associated with a greater risk of major fracture were older recipient age [adjusted hazard ratio (aHR) per 5-year increase 1.11, 95%CI: 1.03-1.19] and female sex (aHR = 1.81, 95%CI: 1.28-2.57). Transplant-specific risk factors associated with a greater risk of fracture included older donor age (5-year increase) (aHR = 1.09, 95%CI: 1.02-1.17) and end-stage renal disease (ESRD) caused by diabetes (aHR = 1.72, 95%CI: 1.09-2.72) or cystic kidney disease (aHR = 1.73, 95%CI: 1.08-2.78) (compared to glomerulonephritis as the reference cause). Risk factors across the two fracture locations were not consistent (major fracture locations vs other). Specifically, general risk factors associated with an increased risk of other fractures were diabetes and a fall with hospitalization prior to transplantation, while length of time on dialysis, and renal vascular disease and other causes of ESRD were the transplant-specific risk factors associated with a greater risk of other fractures. CONCLUSION:Both general and transplant-specific risk factors were associated with a higher risk of fractures in kidney transplant recipients. Results can be used for clinical prognostication. Core tip: We examined risk factors for major and other fractures in adult kidney transplant recipients. Increasing age and female sex were associated with an increased major fracture risk, while diabetes or cystic kidney disease as the cause of end-stage renal disease and increasing age of the kidney donor were the transplant-specific risk factors associated with an increased major fracture risk. Risk factors were variable across fracture locations (major vs other fractures).General and transplant-specific risk factors for fracture should be considered when assessing fracture risk in kidney transplant recipients. Different risk factors may need to be considered depending on the fracture location.

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Section: Discussionsupporting

confidence: 85%

Risk factors for fracture in adult kidney transplant recipients

Naylor

Zou

Leslie

et al. 2016

WJT

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“…The mean follow‐up ranged from 1 to 10 years. We found 18 studies that evaluated the risk of fracture in KT group, without a comparator in 14 studies, compared with the general population in 3 studies and compared with dialysis population in 1 study (Table ). Concerning dialysis population (HD and PD), 5 studies reported the risk of fracture, without a comparator in 2 studies, and compared with the general population in 3 studies .…”

Section: Resultsmentioning

confidence: 99%

“…Seven studies reported an incidence rate of overall fracture from an administrative database compared with 9 studies from a cohort or a clinical registry. From administrative databases, the incidences of overall fracture reported in 2 HD group studies were similar to those reported in 5 KT group studies (Fig. C ).…”

Section: Resultsmentioning

confidence: 99%

Fracture Risk in Dialysis and Kidney Transplanted Patients: A Systematic Review

et al. 2018

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Chronic kidney disease is associated with an increased risk of fracture and cardiovascular mortality. The risk of fracture in hemodialysis (HD), peritoneal dialysis (PD) and kidney transplant (KT) patients is higher when compared with the general population. However, there exists a knowledge gap concerning which group has the highest risk of fracture. We aimed to compare the risk of fracture in HD, PD, and KT populations. We conducted a systematic review of observational studies evaluating the risk of fracture in HD, PD, or KT patients. Eligible studies were searched using MEDLINE, Embase, Web of Science, and Cochrane Library from their inception to January 2016, and in grey literature. Incidences (cumulative and rate) of fracture were described together using the median, according to fracture sites, the data source (administrative database or cohort and clinical registry), and fracture diagnosis method. Prevalence estimates were described separately. We included 47 studies evaluating the risk of fracture in HD, PD, and KT populations. In administrative database studies, incidence of hip fracture in HD (median 11.45 per 1000 person‐years [p‐y]), range: 9.3 to 13.6 was higher than in KT (median 2.6 per 1000 p‐y; range 1.5 to 3.8) or in PD (median 5.2 per 1000 p‐y; range 4.1 to 6.3). In dialysis (HD+PD), three studies reported a higher incidence of hip fracture than in KT. Prevalent vertebral fracture (assessed by X‐rays or questionnaire) reported in HD was in a similar range as that reported in KT. Incidence of overall fracture was similar in HD and KT, from administrative databases studies, but lower in HD compared with KT, from cohorts or clinical registry studies. This systematic review suggests an important difference in fracture risk between HD, PD, and KT population, which vary according to the diagnosis method for fracture identification. © 2018 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.

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“…This trend partly reflects a significant reduction in cumulative glucocorticoid (GC) exposure, but this may not account for all of the reduction in fractures (10); other factors may be important, including improved management of CKD-MBD pretransplantation and bone protection strategies, such as vitamin D and bisphosphonates in kidney transplant recipients, as well as changes in lifestyle and physical activity. Despite the reduction in hip fracture rates, outcomes after hip fracture are poor, with a recent analysis of 21,769 kidney transplant recipients in the United Kingdom indicating that a hip fracture was independently associated with a threefold increase in mortality risk (11).…”

Section: Epidemiologymentioning

confidence: 99%

Bone Disease after Kidney Transplantation

Bouquegneau

Salam

Delanaye

et al. 2016

CJASN

127

109

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Bone and mineral disorders occur frequently in kidney transplant recipients and are associated with a high risk of fracture, morbidity, and mortality. There is a broad spectrum of often overlapping bone diseases seen after transplantation, including osteoporosis as well as persisting high-or low-turnover bone disease. The pathophysiology underlying bone disorders after transplantation results from a complex interplay of factors, including preexisting renal osteodystrophy and bone loss related to a variety of causes, such as immunosuppression and alterations in the parathyroid hormone-vitamin D-fibroblast growth factor 23 axis as well as changes in mineral metabolism. Management is complex, because noninvasive tools, such as imaging and bone biomarkers, do not have sufficient sensitivity and specificity to detect these abnormalities in bone structure and function, whereas bone biopsy is not a widely available diagnostic tool. In this review, we focus on recent data that highlight improvements in our understanding of the prevalence, pathophysiology, and diagnostic and therapeutic strategies of mineral and bone disorders in kidney transplant recipients.

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Fracture risk and mortality post‐kidney transplantation

Abstract: Fracture rates in English kidney transplant recipients are lower than previously reported in US cohorts. Sustaining a hip fracture is associated with an increased mortality risk. Our results can be used to power future fracture prevention trials.

Cited by 35 publications

References 32 publications

Risk factors for fracture in adult kidney transplant recipients

Risk factors for fracture in adult kidney transplant recipients

Fracture Risk in Dialysis and Kidney Transplanted Patients: A Systematic Review

Bone Disease after Kidney Transplantation

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