Ferro Charles J, Arnold Julia, Bagnall David, Ray Daniel, Sharif Adnan
Department of Nephrology, Queen Elizabeth Hospital, Birmingham, UK.
Department of Health Informatics, Queen Elizabeth Hospital, Birmingham, UK.
Clin Transplant. 2015 Nov;29(11):1004-12. doi: 10.1111/ctr.12621. Epub 2015 Oct 9.
Fractures are associated with high morbidity and economic costs. There is a paucity of information on fractures after kidney transplantation outside the United States.
Data were obtained from the Hospital Episode Statistics database on kidney transplants performed in England between 2001 and 2013 and post-transplant fracture-related hospitalization. Mortality data were obtained from the Office for National Statistics.
In total, 21 769 first kidney transplant procedures were analyzed with 112 512 patient-years follow-up. Overall, 836 (3.8%) kidney allograft recipients developed a fracture requiring hospitalization. Event rate was 9.99 for any fracture and 1.54 for a hip fracture per 1000 patient-years. Accounting for the competing risk of mortality, increasing age, female gender, white ethnicity, and a history of pre-transplant diabetes mellitus or previous fracture were associated with increased fracture risk post-kidney transplantation. Death occurred in 2407 (11.1%) kidney allograft recipients, with 173 deaths occurring post-fracture. In an extended Cox model, hip fracture as a time-varying factor was independently associated with an increased risk of death (hazard ratio, 3.288; 95% confidence intervals, 2.513-4.301; p < 0.001).
Fracture rates in English kidney transplant recipients are lower than previously reported in US cohorts. Sustaining a hip fracture is associated with an increased mortality risk. Our results can be used to power future fracture prevention trials.
骨折与高发病率和经济成本相关。在美国以外地区，关于肾移植后骨折的信息匮乏。
从医院事件统计数据库获取2001年至2013年在英格兰进行的肾移植及移植后骨折相关住院治疗的数据。死亡率数据来自国家统计局。
共分析了21769例首次肾移植手术，随访时间为112512患者年。总体而言，836例（3.8%）肾移植受者发生了需要住院治疗的骨折。每1000患者年的任何骨折事件发生率为9.99，髋部骨折为1.54。考虑到死亡的竞争风险，年龄增加、女性、白人种族以及移植前糖尿病史或既往骨折史与肾移植后骨折风险增加相关。2407例（11.1%）肾移植受者死亡，其中173例在骨折后死亡。在扩展的Cox模型中，髋部骨折作为一个随时间变化的因素与死亡风险增加独立相关（风险比，3.288；95%置信区间，2.513 - 4.301；p < 0.001）。
英国肾移植受者的骨折发生率低于美国队列先前报告的发生率。发生髋部骨折与死亡风险增加相关。我们的结果可用于为未来的骨折预防试验提供依据。
