Centre de recherche Hôpital Maisonneuve-Rosemont, Montréal, Canada.
Service de néphrologie, Hôpital Maisonneuve-Rosemont, 5415, boul. de l'Assomption, Montréal, Québec, H1T 2M4, Canada.
BMC Nephrol. 2020 Jul 9;21(1):261. doi: 10.1186/s12882-020-01916-4.
Patients receiving chronic hemodialysis treatments are at a higher risk of fracture compared to the general population. While the use of heparin during dialysis is crucial to avoid thrombosis of the extracorporeal circuit, the association of unfractionated heparin (UFH) and the risk of osteoporotic fracture has been shown for many years. However, this association was not as clear for low-molecular-weight heparin (LMWH) and the few collected data originated from studies among pregnant women. Our aim was to measure osteoporotic fracture rate among hemodialysis patients and to evaluate the association of LMWH compared to UFH in hemodialysis.
A retrospective cohort study was conducted on data extracted from the RAMQ and Med-Echo databases from January 2007 to March 2013 with patients chronically hemodialyzed in 21 participating centers. Incidence rates for each fracture sites were measured per 1000 patient-year (p-y) and their 95% confidence intervals (CI). Osteoporotic fracture risk for a first event with LMWH compared to UFH was estimated using a cox proportional hazard model using demographics, comorbidities and drug use as covariates.
4796 patients undergoing chronic hemodialysis were identified. The incidence rate for all fracture sites was 22.7 /1000 p-y (95% CI: 19.6-26.1) and 12.8 /1000 p-y (95% CI: 10.5-15.4) for hip and femur fractures. We found a similar risk of osteoporotic fracture for LMWH compared to UFH (adjusted HR = 1.01; 95%CI: 0.72-1.42). Age and malignancy increased the risk of fracture while cerebrovascular disease decreased the risk of fracture.
Compared to UFH, LMWH did not change the risk of osteoporotic fracture when used for the extracorporeal circuit anticoagulation in chronic hemodialysis.
与普通人群相比，接受慢性血液透析治疗的患者骨折风险更高。虽然在透析过程中使用肝素对于避免体外回路血栓形成至关重要，但多年来已证明普通肝素（UFH）与骨质疏松性骨折风险之间存在关联。然而，对于低分子肝素（LMWH）而言，这种关联并不明显，而且收集到的少数数据源自孕妇研究。我们的目的是测量血液透析患者的骨质疏松性骨折发生率，并评估与 UFH 相比 LMWH 在血液透析中的作用。
对 2007 年 1 月至 2013 年 3 月期间从 RAMQ 和 Med-Echo 数据库中提取的数据进行回顾性队列研究，这些患者在 21 个参与中心接受慢性血液透析。每 1000 患者-年（p-y）测量每个骨折部位的发生率及其 95%置信区间（CI）。使用 Cox 比例风险模型，根据人口统计学、合并症和药物使用情况作为协变量，评估 LMWH 与 UFH 相比首次发生骨质疏松性骨折的风险。
共确定了 4796 例接受慢性血液透析的患者。所有骨折部位的发生率为 22.7 /1000 p-y（95%CI：19.6-26.1），髋部和股骨骨折的发生率为 12.8 /1000 p-y（95%CI：10.5-15.4）。我们发现 LMWH 与 UFH 相比，骨质疏松性骨折的风险相似（调整后的 HR=1.01；95%CI：0.72-1.42）。年龄和恶性肿瘤增加了骨折风险，而脑血管疾病降低了骨折风险。
与 UFH 相比，在慢性血液透析中用于体外回路抗凝时，LMWH 并未改变骨质疏松性骨折的风险。
