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Updated: Nov 2, 2025
Treatment with Locking Intramedullary Nailing for Intertrochanteric Fracture of the Femur Utilizing a New Awl with a Distal Positioner
Published on: June 6, 2025
Chronic kidney disease patients with intertrochanteric fracture have a high mortality rate
Tae Woo Kim1, Sang-Min Lee1, Nam Hoon Moon2
1Department of Orthopedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
Insights
Patients with chronic kidney disease (CKD) and intertrochanteric fractures face high mortality and complication rates. CKD grade is a significant risk factor for one-year mortality after surgery.
Area of Science:
- Orthopedic Surgery
- Nephrology
- Geriatric Medicine
Background:
- Prognosis for patients with chronic kidney disease (CKD) undergoing surgery for intertrochanteric fractures remains unclear.
- Intertrochanteric fractures are common in elderly populations, often with co-existing chronic conditions like CKD.
Purpose of the Study:
- To analyze mortality and complication rates in CKD patients with intertrochanteric femoral fractures.
- To identify risk factors associated with one-year mortality following surgical treatment.
Main Methods:
- Retrospective cohort study of 49 patients with grades III-V CKD surgically treated for intertrochanteric fractures.
- Analysis of preoperative parameters, postoperative complications, and mortality rates.
- Logistic regression used to determine risk factors for one-year mortality.
Main Results:
- 16 out of 49 patients died within one year postoperatively; pneumonia was the most frequent complication.
- Significant differences in gender and CKD grade were observed between survivors and non-survivors at one year.
- Multivariate analysis identified septic shock, acute kidney injury, and CKD grade as significant risk factors for one-year mortality.
Conclusions:
- Mortality and complication rates are notably high in CKD patients with intertrochanteric fractures.
- The grade of CKD is a significant predictor of one-year postoperative mortality.
- CKD grade must be considered in developing strategies to enhance postoperative survival rates for these patients.
Aims:
The prognosis of patients with chronic kidney disease (CKD) and intertrochanteric fractures is unclear. This study was aimed to analyze the mortality and complication rates among CKD patients with intertrochanteric femoral fractures and the risk factors of one-year mortality after surgery.
Patients And Methods:
This retrospective cohort study included 49 patients diagnosed with grades III, IV, or V CKD who were surgically treated for an intertrochanteric fracture between January 2011 and February 2019 at a tertiary university hospital. Preoperative parameters, including age, gender, bone mineral density, follow-up period (mean: 8.6 months range: 1~82 months), underlying disease, American Society of Anesthesiologists classification, fracture classification, and grade of CKD were identified, and complications and mortality rates after surgery were examined. The patients were divided into two groups according to whether one-year mortality after surgery had occurred or not, and a logistic regression analysis was performed to analyze the risk factors of mortality.
Results:
Of the 49 total patients, 16 died <1 year postoperatively. Pneumonia (n = 11) was the most common postoperative complication. Twenty-one patients died during the follow-up period. Significant differences in gender (p = 0.006) and grade of CKD (p = 0.022) distributions were found between the two groups, divided according to whether one-year mortality had occurred or not. In a univariate analysis, CKD grade and postoperative septic shock were highly associated with one-year mortality. In a multivariate analysis, septic shock, acute kidney injury, and CKD grade were identified as the risk factors of one-year mortality.
Conclusion:
The mortality and complication rates were high among the CKD patients with intertrochanteric fractures. Grades of CKD significantly correlated with one-year mortality after surgery; therefore, they and an important factor that must be considered when developing a strategy to improve the postoperative survival rate of patients with CKD.
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