Geriatric Research, Education and Clinical Center, Durham Veterans Affairs, Durham, North Carolina.
Division of Nephrology, Department of Medicine, Duke University Medical Center, Durham, North Carolina.
J Am Geriatr Soc. 2018 Mar;66(3):532-538. doi: 10.1111/jgs.15256. Epub 2018 Jan 10.
To examine whether chronic kidney disease (CKD) at any stage is associated with fracture risk after adjusting for competing mortality and to determine whether age or race modify the relationship between CKD and fracture risk.
Prospective cohort study.
Department of Veterans Affairs (VA) national healthcare system.
Men receiving VA primary care aged 65 and older with no history of fracture or osteoporosis therapy (N = 712, 918).
We determined CKD stage from baseline estimated glomerular filtration rate (eGFR). Participants were followed for up to 10 years for occurrence of any fracture or death. We ascertained fractures and covariates from VA medical records and Medicare claims.
Of the 356,459 older veterans with CKD (defined as eGFR <60 mL/min per 1.73 m ), 15.7% (n = 56,032) experienced a fracture, and 43.0% (n = 153,438) died over a median time at risk of 5.2 years. Veterans with CKD Stages 3 to 5 had a greater risk of death than those without CKD, which biased estimates from traditional survival models. Competing risk models showed that Stage 3 CKD was associated with greater hazard (adjusted subdistribution hazard ratio (sdHR) = 1.07, 95% confidence interval (CI) = 1.02-1.11) of fracture (than those without CKD) and a trend toward greater hazard for Stage 4 (sdHR = 1.07, 95% CI = 0.94-1.22) and Stage 5 (sdHR = 1.31, 95% CI = 0.97-1.77) CKD. Age, race, and bone mineral density did not modify the relationship between CKD and fracture risk.
In older male veterans, CKD, including Stage 3, is associated with a moderately greater fracture risk irrespective of age, race, or bone mineral density.
在调整了竞争死亡率后，研究任何阶段的慢性肾脏病（CKD）是否与骨折风险相关，并确定年龄或种族是否会改变 CKD 与骨折风险之间的关系。
前瞻性队列研究。
退伍军人事务部（VA）国家医疗保健系统。
年龄在 65 岁及以上、无骨折或骨质疏松症治疗史的接受 VA 初级保健的男性（N = 712,918）。
我们根据基线估算肾小球滤过率（eGFR）确定 CKD 分期。参与者在最长 10 年内接受任何骨折或死亡的随访。我们从 VA 病历和 Medicare 索赔中确定骨折和协变量。
在 356,459 名患有 CKD（定义为 eGFR <60 mL/min/1.73 m）的老年退伍军人中，15.7%（n = 56,032）发生骨折，43.0%（n = 153,438）在中位风险时间 5.2 年内死亡。患有 CKD 3 至 5 期的退伍军人死亡风险高于无 CKD 的退伍军人，这导致传统生存模型的估计值产生偏差。竞争风险模型显示，3 期 CKD 与更高的骨折风险相关（调整后的亚分布危险比（sdHR）= 1.07，95%置信区间（CI）= 1.02-1.11），且 4 期（sdHR = 1.07，95% CI = 0.94-1.22）和 5 期（sdHR = 1.31，95% CI = 0.97-1.77）CKD 呈趋势。年龄、种族和骨密度并未改变 CKD 与骨折风险之间的关系。
在老年男性退伍军人中，包括 3 期在内的 CKD 与骨折风险呈中度增加相关，而与年龄、种族或骨密度无关。
