Cheikh Hassan Hicham I, Mulholland Bridie S, McAlister Brendan, Lambert Kelly, Murali Karumathil M, Moules Stephen, Mullan Judy
School of Medicine, Lebanese American University, Beirut, Lebanon.
Department of Renal Medicine, Wollongong Hospital, Wollongong, NSW, Australia.
Clin Kidney J. 2024 Sep 9;17(10):sfae282. doi: 10.1093/ckj/sfae282. eCollection 2024 Oct.
Acute kidney injury (AKI) is common. An AKI episode may disrupt the normal mineral bone balance maintained by normal kidney function, thereby modifying the risk of developing bone fractures. However, it remains unclear whether an AKI episode is associated with the risk of bone fractures.
Using retrospective cohort study from an Australian Local Health District, we examined the association between an AKI episode and bone fractures using patient data between 2008 and 2017. Time-varying Cox proportional hazards and propensity-matched analysis were used to examine the association. Sensitivity analyses were undertaken to capture the impact of confirmed AKI status and AKI severity.
Of 123 426 included patients, 14 549 (12%) had an AKI episode and 12 505 (10%) had a bone fracture. In the unadjusted analysis, AKI was associated with bone fractures [hazard ratio (HR) 1.99, 95% confidence interval (CI) 1.88-2.11]. This association persisted in the adjusted analysis (HR 1.50, 95% CI 1.41-1.59) and propensity-matched dataset (HR 1.71, 95% CI 1.59-1.83). The sensitivity analysis yielded similar results, with the AKI patients having a higher risk of fractures compared with no AKI patients in the adjusted analysis (HR 1.34, 95% CI 1.25-1.43) and in the propensity-matched dataset (HR 1.44, 95% CI 1.33-1.55). Similar results were seen in the subsidiary sensitivity analysis excluding patients without baseline creatinine. We did not find an increased risk of bone fractures with increasing AKI severity (= .7). Interaction tests demonstrated a significant association between sex and age category with AKI status and fractures, but not CKD stage or osteoporosis.
AKI is associated with a greater risk of bone fractures. This could have implications for managing and screening for bone disease in patients post-AKI episode. This association should be examined in other cohorts and populations for verification.
急性肾损伤（AKI）很常见。一次AKI发作可能会扰乱由正常肾功能维持的正常矿物质骨平衡，从而改变发生骨折的风险。然而，AKI发作是否与骨折风险相关仍不清楚。
利用澳大利亚一个地方卫生区的回顾性队列研究，我们使用2008年至2017年期间的患者数据，研究了一次AKI发作与骨折之间的关联。采用时变Cox比例风险模型和倾向匹配分析来研究这种关联。进行敏感性分析以了解确诊的AKI状态和AKI严重程度的影响。
在纳入的123426例患者中，14549例（12%）有一次AKI发作，12505例（10%）发生了骨折。在未调整分析中，AKI与骨折相关[风险比（HR）1.99，9５%置信区间（CI）1.88-2.11]。这种关联在调整分析（HR 1.50，95%CI 1.41-1.59）和倾向匹配数据集（HR 1.71，95%CI 1.59-1.83）中持续存在。敏感性分析得出了类似结果，在调整分析中，与无AKI的患者相比，AKI患者发生骨折的风险更高（HR 1.34，95%CI 1.25-1.43），在倾向匹配数据集中也是如此（HR 1.44，95%CI 1.33-1.55）。在排除无基线肌酐患者的辅助敏感性分析中也观察到了类似结果。我们没有发现随着AKI严重程度增加骨折风险增加（=0.7）。交互作用检验表明，性别和年龄类别与AKI状态和骨折之间存在显著关联，但与慢性肾脏病阶段或骨质疏松症无关。
AKI与更高的骨折风险相关。这可能对AKI发作后患者的骨病管理和筛查有影响。这种关联应在其他队列和人群中进行检验以验证。
