1] Division of Nephrology, Western University, London, Ontario, Canada [2] Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.
Institute for Clinical Evaluative Sciences (ICES), London, Ontario, Canada.
Kidney Int. 2014 Oct;86(4):810-8. doi: 10.1038/ki.2013.547. Epub 2014 Jan 15.
Knowing a person's fracture risk according to their kidney function, gender, and age may influence clinical management and decision-making. Using healthcare databases from Ontario, Canada, we conducted a cohort study of 679,114 adults of 40 years and over (mean age 62 years) stratified at cohort entry by estimated glomerular filtration rate ((eGFR) 60 and over, 45-59, 30-44, 15-29, and under 15 ml/min per 1.73 m(2)), gender, and age (40-65 and over 65 years). The primary outcome was the 3-year cumulative incidence of fracture (proportion of adults who fractured (hip, forearm, pelvis, or proximal humerus) at least once within 3-years of follow-up). Additional analyses examined the fracture incidence per 1000 person-years, hip fracture alone, stratification by prior fracture, stratification by eGFR and proteinuria, and 3-year cumulative incidence of falls with hospitalization. The 3-year cumulative incidence of fracture significantly increased in a graded manner in adults with a lower eGFR for both genders and both age groups. The 3-year cumulative incidence of fracture in women over 65 years of age across the 5 eGFR groups were 4.3%, 5.8%, 6.5%, 7.8%, and 9.6%, respectively. Corresponding estimates for men over 65 years were 1.6%, 2.0%, 2.7%, 3.8%, and 5.0%, respectively. Similar graded relationships were found for falls with hospitalization and additional analyses. Thus, many adults with chronic kidney disease will fall and fracture. Results can be used for prognostication and guidance of sample size requirements for fracture prevention trials.
根据肾功能、性别和年龄了解一个人的骨折风险可能会影响临床管理和决策。我们使用来自加拿大安大略省的医疗保健数据库，对 679114 名年龄在 40 岁及以上（平均年龄 62 岁）的成年人进行了队列研究，这些成年人在队列入组时根据估计肾小球滤过率（eGFR）分层（60 及以上、45-59、30-44、15-29 和 15ml/min/1.73m2 以下）、性别和年龄（40-65 和 65 岁以上）。主要结局是 3 年内骨折的累积发生率（在随访 3 年内至少发生一次骨折（髋部、前臂、骨盆或近端肱骨）的成年人比例）。额外的分析检查了每 1000 人年的骨折发生率、单独髋部骨折、按既往骨折分层、按 eGFR 和蛋白尿分层以及 3 年内因跌倒导致住院的累积发生率。对于男性和女性，在所有年龄组中，eGFR 较低的成年人骨折的 3 年累积发生率呈梯度增加。5 个 eGFR 组中 65 岁以上女性的 3 年骨折累积发生率分别为 4.3%、5.8%、6.5%、7.8%和 9.6%。65 岁以上男性的相应估计值分别为 1.6%、2.0%、2.7%、3.8%和 5.0%。对于因跌倒导致住院的情况，也发现了类似的分级关系和其他分析。因此，许多患有慢性肾脏病的成年人会跌倒和骨折。结果可用于预后和指导骨折预防试验的样本量要求。
