Risk of hip fracture in patients on dialysis or kidney transplant: a meta-analysis of 14 cohort studies

Abstract

PurposeWe aimed to conduct a meta-analysis of published cohort studies to evaluate the risk of hip fracture in patients undergoing dialysis or kidney transplantation (KT).MethodsWe identified relevant studies by searching PubMed, EMBASE and Google Scholar databases from their inception to December 31, 2017. Cohort studies evaluating risk of hip fractures in patients undergoing dialysis or KT were considered included. The methodological quality of the cohort studies was assessed using the modified Newcastle-Ottawa scale.ResultsIn our meta-analysis of 14 retrospective cohort studies, a total of more than 1.5 million patients undergoing dialysis or KT were included, of whom more than 30,000 had hip fractures. After the merger, the proportion of hip fractures was 1.92% (95% CI, 1.38%−2.46%) with significant heterogeneity (I2=99.9%, P=0.000) in all patients, and the incidence rate of hip fractures (per 1,000 person-years) was 8.95 (95% CI, 4.05–13.85) with significant heterogeneity (I2=99.9%, P=0.000). The pooled relative risks (RR) value for dialysis patients compared with the general population were 6.35 (95% CI, 4.53–8.88) for male and 5.57 (95% CI, 4.44–6.99) for female. The pooled RR value for hemodialysis (HD) patients compared with peritoneal dialysis (PD) patients was 1.39 (95% CI, 1.13–1.70) with no heterogeneity (I2=0.0%, P=0.763).ConclusionIn conclusion, the present meta-analysis reveals that about 2% of dialysis or KT patients go on to sustain a hip fracture during follow-up, with the overall hip fracture incidence rates being 8.95 per 1,000 person-years. The overall risk of hip fracture was more than 5-fold higher in dialysis patients than in the general population. Among patients on PD, HD, and KT, HD and KT patients had the highest and the lowest risk of hip fractures, respectively.

Characteristics of fracture in patients who firstly starts kidney replacement therapy in Korea: a retrospective population-based study

“…7 reported that the overall fracture IR was 62.8 per 1000 PY in all ESKD patients, 99.2 per 1000 PY for those exposed to HD, 57.6 per 1,000 PY for those treated with PD, and 37.6 per 1000 PY for those undergoing KT. As for the hip fractures, however, our data showed an IR of 8.7 per 1000 PY for all patients with ESKD, 9.7 per 1000 PY for patients treated with HD, which was comparable to data reported in previous studies 2,8 . Our data are consistent with other reports, showing a higher fracture IR in ESKD patients than in the general population 1,2,9,10 .…”

Interplay between gut microbiota, bone health and vascular calcification in chronic kidney disease

“… 29 The increased risk of fracture has also been observed among CKD patients after kidney transplantation. 32 , 33 Over the first 3 years following transplantation, the risk of a hip fracture is 34% higher than in dialysis patients, and over the first 5 years post‐transplant one‐fourth will have a fracture. 33 A recent meta‐analysis has disclosed an overall fracture incidence rate of 8.95 per 1,000 person‐years among dialysis patients and kidney transplant recipients (KTR).…”

“… 33 A recent meta‐analysis has disclosed an overall fracture incidence rate of 8.95 per 1,000 person‐years among dialysis patients and kidney transplant recipients (KTR). 32 …”

Chronic Kidney Disease Increases the Risk of Hip Fracture: A Prospective Cohort Study in Korean Adults

“…(1,2) Hemodialysis patients are known to have a higher risk of hip fracture than the general population. (3,4) However, it is less clear whether individuals with mild to moderate chronic kidney disease (CKD) are at increased risk for hip fracture. Ensrud and colleagues found that elderly women with an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73m 2 had a higher risk of hip fracture than women with normal kidney function.…”