Morbidity and mortality of hospitalized hip fractures in chronic hemodialysis

Abstract

Abnormal bone architecture contributes to high incidence of hip fractures in chronichemodialysis (HD) patients. Their clinical epidemiology is incompletely described. We conducted a retrospective cohort study to assess the implications ofhospitalization with hip fracture in HD patients compared to the nonchronic kidney disease population. Thirty-three chronic HD patients admitted with hip fracture overfiveyears were age- and sex-matched on a 1:1 ratio with controls that had hip fracture and normal renal function. Demographic characteristics, deaths, and readmissions atsixmonths,hospitalization length, time to operation, and laboratory resultswere recorded from electronic health files. Datawere compared betweenthe two groups usingpairedt-test for continuous variables and McNemar's test for categoricalvariables. The compositeendpoint of deathand/or readmission at6 months was higher in HD patients (12.1% vs. 6.2%, P<0.001). Furthermore, mean time tooperationwas more delayed due to comorbidities (4.7 vs. 2.9 days, p = 0.04). HD patients had anemia more frequently at presentation (hemoglobin below 10 mg/dL, 32.1% vs. 12.5%, P = 0.003). Finally, they were more likely to be considered toofrail for surgery and not be operated (21.2% vs. 6.2%, P<0.001). Hip fractures are associated with increased morbidity and mortality and represent an important health-care burden for chronic HD patients. Future research is needed to identify definite predictors of adverse outcomes and to implement prevention strategies.