Robertson Lynn, Black Corrinda, Fluck Nick, Gordon Sharon, Hollick Rosemary, Nguyen Huong, Prescott Gordon, Marks Angharad
Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland.
The Farr Institute of Health Informatics Research, University of Aberdeen, Aberdeen, Scotland.
BMJ Open. 2018 Apr 12;8(4):e020312. doi: 10.1136/bmjopen-2017-020312.
Individuals on renal replacement therapy (RRT) have increased fracture risk, but risk in less advanced chronic kidney disease (CKD) is unclear.
To investigate CKD associations with hip fracture incidence and mortality.
Record linkage cohort study Grampian Laboratory Outcomes Mortality and Morbidity Study II.
Single health region in Scotland.
All individuals (≥15 years) with sustained CKD stages 3-5 and those on RRT, and a 20% random sample of those with normal renal function, in the resident population in 2003.
Outcomes were (1) incident hip fracture measured with (A) admissions or (B) deaths, with at least 5.5 years follow-up and (2) post-hip fracture mortality. Unadjusted and adjusted, incident rate ratios (IRRs) and mortality rate ratios were calculated using Poisson regression.
Of 39 630 individuals identified in 2003 (41% males, mean age 63.3 years), 19 537 had CKD stages 3-5, 345 were on RRT and 19 748 had normal estimated glomerular filtration rate (eGFR). Hip fracture incidence, measured by admissions, was increased in CKD stages 3-5 (compared with normal eGFR), both overall (adjusted IRR 1.49 (95% CI 1.24 to 1.79)) and for individual CKD stages 3a, 3b and 4. Hip fracture incidence, measured using deaths, was increased in those with CKD stages 3b and 4. Post-hip fracture mortality was only increased in CKD stage 4. There was only a small number of individuals and events for CKD stage 5, resulting in insufficient statistical power.
Hip fracture incidence was higher in CKD stages 3-5 compared with normal eGFR. Post-hip fracture mortality was only increased in CKD stage 4. Reducing hip fracture incidence in CKD through regular fall and fracture risk review should reduce overall deaths after hip fracture in the population.
接受肾脏替代治疗（RRT）的个体骨折风险增加，但在不太严重的慢性肾脏病（CKD）阶段的风险尚不清楚。
调查CKD与髋部骨折发生率及死亡率之间的关联。
记录链接队列研究——格兰扁实验室结局、死亡率和发病率研究II。
苏格兰的一个单一健康区域。
2003年常住人口中所有患有3 - 5期持续性CKD的个体（≥15岁）、接受RRT的个体以及20%肾功能正常个体的随机样本。
结局为（1）通过（A）入院或（B）死亡来衡量的髋部骨折发生率，随访至少5.5年，以及（2）髋部骨折后死亡率。使用泊松回归计算未调整和调整后的发病率比（IRR）及死亡率比。
2003年确定的39630名个体中（41%为男性，平均年龄63.3岁），19537人患有3 - 5期CKD，345人接受RRT，19748人估计肾小球滤过率（eGFR）正常。通过入院情况衡量，3 - 5期CKD患者的髋部骨折发生率（与正常eGFR相比）总体上有所增加（调整后的IRR为1.49（95%CI 1.24至1.79）），3a、3b和4期CKD个体也是如此。通过死亡情况衡量，3b和4期CKD患者的髋部骨折发生率增加。髋部骨折后死亡率仅在4期CKD中增加。5期CKD的个体和事件数量较少，导致统计效力不足。
与正常eGFR相比，3 - 5期CKD患者的髋部骨折发生率更高。髋部骨折后死亡率仅在4期CKD中增加。通过定期进行跌倒和骨折风险评估来降低CKD患者的髋部骨折发生率，应能降低该人群髋部骨折后的总体死亡率。
