Lin Jeff Chien-Fu, Liang Wen-Miin
Department of Statistics, National Taipei University, Taipei, Taiwan.
Department of Orthopedic Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
BMC Nephrol. 2015 Jul 7;16:100. doi: 10.1186/s12882-015-0099-0.
Osteoporotic hip fractures cause high mortality and morbidity in elderly adults. Compared to the general population, subjects with end-stage renal disease and hemodialysis often develop mineral bone disorders and have a higher risk for hip fractures.
We conducted a matched cohort study design and used competing risk analysis to estimate the cumulative incidence of the complication rate. Subjects aged greater than 60 years with hip fracture were selected from Taiwan's National Health Insurance Research Database covering a period from 1997 to 2007, and these subjects were followed up until 2009. We used the Kaplan-Meier method to estimate the overall survival and used the log-rank test and multiple Cox proportional hazards model to explore the risk factors for survival. The cumulative incidence of the first complication was estimated using competing risk analysis.
Among hemodialysis subjects, the three-month, one-year, two-year and five-year mortality rates were 17.3 %, 37.2 %, 51.5 %, and 80.5 %, respectively; the one-year and five-year cumulative incidences of the first surgical complication were 14.2 % and 20.6 %, respectively; and the three-month cumulative incidence of the first medical complication was 24.1 %. Hemodialysis subjects presented a 2.32 times (95 % CI: 2.16-2.49) higher hazard ratio of overall death, 1.15 times (95 % CI: 1.01-1.30) higher sub-hazard ratio (sub-HR) of surgical complications, and 1.35 times (95 % CI: 1.21-1.52) higher sub-HR of the first medical complication than non-hemodialysis controls.
The overall mortality and complication rates of hemodialysis subjects after surgery for hip fracture were significantly higher than those of non-hemodialysis subjects. Further prospective studies which include important risk factors are necessary to more precisely quantify the adjusted effect of hemodialysis.
骨质疏松性髋部骨折在老年人群中导致高死亡率和高发病率。与普通人群相比，终末期肾病和接受血液透析的患者常发生矿物质骨病，且髋部骨折风险更高。
我们采用匹配队列研究设计，并使用竞争风险分析来估计并发症发生率的累积发病率。从涵盖1997年至2007年期间的台湾全民健康保险研究数据库中选取年龄大于60岁的髋部骨折患者，并对这些患者随访至2009年。我们使用Kaplan-Meier方法估计总体生存率，并使用对数秩检验和多重Cox比例风险模型来探索生存的危险因素。使用竞争风险分析估计首次并发症的累积发病率。
在血液透析患者中，三个月、一年、两年和五年的死亡率分别为17.3%、37.2%、51.5%和80.5%；首次手术并发症的一年和五年累积发病率分别为14.2%和20.6%；首次医疗并发症的三个月累积发病率为24.1%。与非血液透析对照组相比，血液透析患者的总体死亡风险比高2.32倍（95%可信区间：2.16 - 2.49），手术并发症的亚风险比高1.15倍（95%可信区间：1.01 - 1.30），首次医疗并发症的亚风险比高1.35倍（95%可信区间：1.21 - 1.52）。
髋部骨折手术后血液透析患者的总体死亡率和并发症发生率显著高于非血液透析患者。有必要进行进一步的前瞻性研究，纳入重要危险因素，以更精确地量化血液透析的调整效应。
