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Femoral artery calcification predicts hip fracture in maintenance hemodialysis patients
Shun-Neng Hsu1, Jhao-Jhuang Ding2, Ping-Huang Tsai1
1Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical University, No 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan.
Insights
Femoral artery calcification (FAC) predicts hip fractures in hemodialysis patients. Higher FAC scores indicate increased fracture risk and poorer survival, aiding risk assessment.
Area of Science:
- Nephrology
- Orthopedics
- Radiology
Background:
- Patients with end-stage renal disease on hemodialysis face elevated risks of vascular calcification and bone fractures.
- The link between femoral artery calcification (FAC) and hip fractures in this population requires further investigation.
Purpose of the Study:
- To investigate the association between femoral artery calcification (FAC) and fall-related hip fractures in patients undergoing hemodialysis.
- To determine if FAC is an independent predictor of hip fractures in hemodialysis patients.
Main Methods:
- Retrospective analysis of 130 hemodialysis patients who experienced falls.
- Calculation of FAC score using plain radiographs of the hip and femur.
- Logistic regression and ROC curve analysis to assess the association and predictive power of FAC.
Main Results:
- Higher FAC scores were significantly associated with hip fractures (0.47 vs. 0.00, p < 0.001).
- Independent risk factors for hip fractures included older age, heart failure with reduced ejection fraction, and higher FAC scores.
- Increased mortality was observed in patients with higher FAC scores and hip fractures.
Conclusions:
- Femoral artery calcification is a significant independent predictor of hip fractures in hemodialysis patients.
- Elevated FAC scores are linked to increased hip fracture risk and poorer survival outcomes.
- Radiographic assessment of FAC can improve risk stratification for hip fractures in this vulnerable group.
Abstract:
Femoral artery calcification (FAC) is a significant predictor of hip fractures in hemodialysis patients. A higher FAC score is associated with increased fracture risk and poor survival outcomes. Identifying FAC through radiographic assessment may improve fracture risk stratification and clinical management in this high-risk population.
Purpose:
Patients with end-stage renal disease (ESRD) on hemodialysis (HD) are at increased risk for vascular calcification (VC) and bone fractures. While previous studies have linked aortic calcification with hip fractures, the relationship between medium-caliber artery-femoral artery calcification (FAC) and fall-related hip fractures in HD patients remains unclear.
Methods:
We retrospectively analyzed 170 HD patients who experienced falls and sought treatment in the emergency department (ED) between 2007 and 2014. The FAC score, representing the severity of femoral artery calcification, was calculated as the ratio of the total length of calcification plaques to the length of the femoral vessel visible on plain radiographs of the hip and femur. A logistic regression model assessed the association between FAC score and hip fracture risk, and receiver operating characteristic curve analysis evaluated its predictive power.
Results:
Among the 130 patients meeting inclusion criteria, 55 had fall-related hip fractures. The incidence rate of hip fractures among dialysis patients was 6.18 cases per 1000 person-years by dividing the total number of hip fracture events by the cumulative dialysis duration (in years) of all enrolled patients. Fracture patients were older and had lower serum creatinine, sodium, and albumin levels but higher aspartate aminotransferase levels. The fracture group also had a higher FAC score (0.47 [IQR, 0.28 - 0.76] vs. 0.00 [IQR, 0.00 - 0.40], p < 0.001). Multivariable analysis identified old age, heart failure with reduced ejection fraction (EF), and higher FAC scores as independent risk factors for hip fractures. Survival curves showed increased mortality among patients with higher FAC scores and hip fractures (p < 0.01).
Conclusion:
High FAC scores were associated with an increased risk of hip fractures in HD patients, independent of traditional risk factors, and were linked to poor survival outcomes.
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