Perioperative Management and Outcomes of Hip Fracture Patients with Advanced Chronic Kidney Disease

Abstract

Aims To explore clinical characteristics, perioperative management and outcomes of Hip Fracture patients with advanced Chronic Kidney Disease (HF-aCKD) compared to the general Hip Fracture population without aCKD (HF-G) within a large volume tertiary hospital in Western Australia. Methods Retrospective chart review of patients admitted with hip fracture (HF) to a single large volume tertiary hospital registered on Australian and New Zealand Hip Fracture Registry (ANZHFR). We compared baseline demographic and clinical frailty scale (CFS) of HF-aCKD (n = 74), defined as eGFR < 30 mls/min/1.73 m2, with HF-G (n = 452) and determined their outcomes at 120 days. Results We identified 74 (6.97%) HF patients with aCKD. General demographics were similar in HF-aCKD and HF-G populations. 120-days mortality for HF-aCKD was double that of HF-G population (34% vs 17%, P = .001). For dialysis patients, 120-days mortality was triple that of HF-G population (57%). Except for the fit category of HF-aCKD group, higher CFS was associated with higher 120-days mortality in both groups. Of all HF-aCKD patients, 96% had operative intervention and 48% received blood transfusion. There were no new starts to dialysis peri-operatively. Each point reduction in eGFR below 12 mL/min/1.73 m2 was associated with 3% increased probability of death in hospital. Conclusions 120-days mortality was double in HF-aCKD and triple in HF-dialysis that of the HF-G within our institution. Clinical frailty scale can be useful in predicting mortality after HF in frail aCKD patients. High rate of blood transfusions was observed in HF-aCKD group. Further studies with larger HF-aCKD numbers are required to explore these associations in detail.

Chronic Kidney Disease in Patients with Hip Fracture: Prevalence and Outcomes

“…Te observation that more severe CKD stage was associated with a higher risk of mortality is in line with most published reports [13,26,28,60,61,[65][66][67][68][69][70][71][72][73][74] on 30-day and 1year mortality; a signifcantly higher LOS in HF patients with CKD was also reported [75]. Some authors, however, observed an increase of all-cause mortality only in patients with CKD stage G4 (but not with stages G3a, G3b, G5, G3-G5) [76] or stage G5 [75,77], in one study of HF patients (>65years of age) no signifcant association was observed between higher stages of impaired renal function and mortality [29], and in another study severity of CKD did not afect 1-year mortality rate and medical complications in patients with intertrochanteric fracture [77].…”