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Chronic kidney disease and hip fracture-related mortality in older people in the UK
Dorothea Nitsch1, Adrian Mylne, Paul J Roderick
1Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. Dorothea.Nitsch@lshtm.ac.uk
Insights
Chronic kidney disease (CKD) in older adults is linked to higher hip fracture mortality. Specifically, an estimated glomerular filtration rate (eGFR) below 45 ml/min/1.73 m2 nearly doubles the risk of death from hip fractures.
Area of Science:
- Gerontology
- Nephrology
- Epidemiology
Background:
- Dialysis patients exhibit elevated hip fracture rates.
- Limited research exists on early-stage chronic kidney disease (CKD) and hip fractures in older adults.
- This study investigates the association between CKD and hip fracture mortality in the elderly.
Purpose of the Study:
- To determine if CKD in older individuals is associated with increased mortality following hip fractures.
- To quantify the risk of hip fracture-related death in relation to declining kidney function.
Main Methods:
- Analysis of a UK cohort of 13,177 individuals aged 75+ (1995-1998).
- Serum creatinine measured at baseline to calculate estimated glomerular filtration rate (eGFR) using MDRD formula.
- Mortality follow-up until November 2005, with propensity score-adjusted Cox regression models.
Main Results:
- 84 hip fracture-related deaths occurred during a median follow-up of 7.25 years.
- An eGFR < 45 ml/min/1.73 m2 was associated with a 1.98-fold increased hazard ratio for hip fracture-related death (age/sex-adjusted).
- In adjusted models, the hazard ratio for hip fracture-related death remained significantly elevated at 1.81 for eGFR < 45 ml/min/1.73 m2.
Conclusions:
- Reduced kidney function, indicated by an eGFR < 45 ml/min/1.73 m2, is a significant risk factor for hip fracture-related mortality in older adults.
- An eGFR < 45 ml/min/1.73 m2 is associated with an almost 2-fold increase in hip fracture-related mortality.
Background:
Dialysis patients have increased hip fracture rates when compared to the general population of the same age and sex. There have been few studies of the association of earlier stages of chronic kidney disease (CKD) with hip fractures amongst older people in the general population. The aim of this study was to examine whether CKD at older ages is associated with hip-fracture-related mortality.
Methods:
In a trial of health and social assessment of people aged 75 and over in the UK with baseline assessment between 1995 and 1998, there were 13,177 (87%) participants in 53 general practices who had a serum creatinine measured at baseline. Estimated glomerular filtration rate (eGFR) was derived from the modification of diet in renal disease formula (MDRD). Mortality follow-up using linkage to national mortality data was until the end of November 2005. We used propensity scores to adjust for potential confounders in Cox regression models.
Results:
There were 84 hip-fracture-related deaths over a median follow-up of 7.25 years (IQR 3.79-8.77). Compared to eGFR 60 ml/min/1.73 m2 and above, the age- and sex-adjusted hazard ratio (HR) for hip-fracture-related death was 1.06 (95% confidence interval: 0.71, 1.58) for eGFR 45-59 and 1.98 (1.12, 3.50) for eGFR < 45. In adjusted models, the HR for eGFR < 45 ml/min/1.73 m2 compared to above was 1.81 (1.11, 2.96).
Conclusions:
Amongst older people, an eGFR of <45 ml/ min/1.73 m2 is associated with an almost 2-fold increase in hip-fracture-related mortality.
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