Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States.
Instituto de Investigaciones Metabólicas, Universidad del Salvador, Buenos Aires, Argentina.
Bone. 2019 Oct;127:556-562. doi: 10.1016/j.bone.2019.07.029. Epub 2019 Jul 27.
Chronic prolonged hyponatremia (CPH) is a risk factor for hip fracture in the general population. Whether CPH increases hip fracture risk in chronic kidney disease (CKD) patients is unknown.
Case-control study in patients over 60 years of age with stage 3 or greater CKD. Patients who had a hip fracture were referred to as cases (n = 1236) and controls had no hip fracture (n = 4515). Patients were classified as having CPH if serum sodium was <135 mEq/L on at least two occasions separated by a minimum of 90 days prior to the diagnosis of hip fracture (cases) or at any time during the study period (controls). Conditional logistic regression models were used to test the association between CPH and hip fracture. Analyses were conducted for patients with and without osteoporosis and falls and for patients with age >70 years versus ≤70 years.
CPH was present in 21% of cases and 10% of controls (p < 0.001; sodium level: 131-134 mEq/L). In univariate logistic regression analysis, CPH was associated with higher odds of hip fracture (odds ratio [OR] 2.44, (95% [CI] 2.07-2.89). In a multivariate model adjusted for comorbidities, medications and laboratory parameters CPH association with higher odds of Hip fracture was attenuated but remained significant (OR 1.36, 95% CI 1.04-1.78). The association between CPH and risk of hip fracture was consistent in patients with or without osteoporosis and falls and across the age strata.
Chronic prolonged hyponatremia is a risk factor for hip fracture in CKD patients older than 60 years of age.
慢性迁延性低钠血症（CPH）是普通人群髋部骨折的一个危险因素。CPH 是否会增加慢性肾脏病（CKD）患者髋部骨折的风险尚不清楚。
这是一项针对 60 岁以上且患有 3 期或更高级别 CKD 的患者的病例对照研究。患有髋部骨折的患者被视为病例（n=1236），而无髋部骨折的患者被视为对照（n=4515）。如果血清钠在发生髋部骨折（病例）前至少 90 天内至少两次且两次间隔至少 90 天，或在研究期间的任何时间，血清钠均<135mEq/L，则患者被分类为 CPH。采用条件逻辑回归模型来检验 CPH 与髋部骨折之间的相关性。分析针对伴有和不伴有骨质疏松症和跌倒的患者以及年龄>70 岁与≤70 岁的患者进行。
21%的病例和 10%的对照存在 CPH（p<0.001；钠水平：131-134mEq/L）。在单变量逻辑回归分析中，CPH 与髋部骨折的发生风险较高相关（比值比 [OR] 2.44，95%置信区间 [CI] 2.07-2.89）。在调整了合并症、药物和实验室参数的多变量模型中，CPH 与髋部骨折发生风险较高的相关性减弱，但仍具有统计学意义（OR 1.36，95%CI 1.04-1.78）。在伴有或不伴有骨质疏松症和跌倒以及在各个年龄组中，CPH 与髋部骨折风险之间的相关性均一致。
CPH 是 60 岁以上 CKD 患者髋部骨折的一个危险因素。
