Mortality and complications after hip fracture among elderly patients undergoing hemodialysis

Jeff Chien Fu Lin, Wen Miin Liang

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Abstract Background: Osteoporotic hip fractures cause high mortality and morbidity in elderly adults. Compared to the general population, subjects with end-stage renal disease and hemodialysis often develop mineral bone disorders and have a higher risk for hip fractures. Methods: We conducted a matched cohort study design and used competing risk analysis to estimate the cumulative incidence of the complication rate. Subjects aged greater than 60 years with hip fracture were selected from Taiwan's National Health Insurance Research Database covering a period from 1997 to 2007, and these subjects were followed up until 2009. We used the Kaplan-Meier method to estimate the overall survival and used the log-rank test and multiple Cox proportional hazards model to explore the risk factors for survival. The cumulative incidence of the first complication was estimated using competing risk analysis. Results: Among hemodialysis subjects, the three-month, one-year, two-year and five-year mortality rates were 17.3%, 37.2%, 51.5%, and 80.5%, respectively; the one-year and five-year cumulative incidences of the first surgical complication were 14.2% and 20.6%, respectively; and the three-month cumulative incidence of the first medical complication was 24.1%. Hemodialysis subjects presented a 2.32 times (95% CI: 2.16-2.49) higher hazard ratio of overall death, 1.15 times (95% CI: 1.01-1.30) higher sub-hazard ratio (sub-HR) of surgical complications, and 1.35 times (95% CI: 1.21-1.52) higher sub-HR of the first medical complication than non-hemodialysis controls. Conclusions: The overall mortality and complication rates of hemodialysis subjects after surgery for hip fracture were significantly higher than those of non-hemodialysis subjects. Further prospective studies which include important risk factors are necessary to more precisely quantify the adjusted effect of hemodialysis.

Original languageEnglish
Article number99
JournalBMC Nephrology
Volume16
Issue number1
DOIs
Publication statusPublished - Jul 7 2015

Fingerprint

Hip Fractures
Renal Dialysis
Mortality
Incidence
Osteoporotic Fractures
Survival
National Health Programs
Taiwan
Proportional Hazards Models
Chronic Kidney Failure
Minerals
Cohort Studies
Databases
Prospective Studies
Morbidity
Bone and Bones
Research
Population

Keywords

  • Elderly patient
  • End-stage renal disease
  • Hemodialysis
  • Medical complication
  • Mortality
  • Osteoporotic hip fracture
  • Surgical complication

ASJC Scopus subject areas

  • Nephrology

Cite this

Mortality and complications after hip fracture among elderly patients undergoing hemodialysis. / Lin, Jeff Chien Fu; Liang, Wen Miin.

In: BMC Nephrology, Vol. 16, No. 1, 99, 07.07.2015.

Research output: Contribution to journalArticle

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title = "Mortality and complications after hip fracture among elderly patients undergoing hemodialysis",
abstract = "Abstract Background: Osteoporotic hip fractures cause high mortality and morbidity in elderly adults. Compared to the general population, subjects with end-stage renal disease and hemodialysis often develop mineral bone disorders and have a higher risk for hip fractures. Methods: We conducted a matched cohort study design and used competing risk analysis to estimate the cumulative incidence of the complication rate. Subjects aged greater than 60 years with hip fracture were selected from Taiwan's National Health Insurance Research Database covering a period from 1997 to 2007, and these subjects were followed up until 2009. We used the Kaplan-Meier method to estimate the overall survival and used the log-rank test and multiple Cox proportional hazards model to explore the risk factors for survival. The cumulative incidence of the first complication was estimated using competing risk analysis. Results: Among hemodialysis subjects, the three-month, one-year, two-year and five-year mortality rates were 17.3{\%}, 37.2{\%}, 51.5{\%}, and 80.5{\%}, respectively; the one-year and five-year cumulative incidences of the first surgical complication were 14.2{\%} and 20.6{\%}, respectively; and the three-month cumulative incidence of the first medical complication was 24.1{\%}. Hemodialysis subjects presented a 2.32 times (95{\%} CI: 2.16-2.49) higher hazard ratio of overall death, 1.15 times (95{\%} CI: 1.01-1.30) higher sub-hazard ratio (sub-HR) of surgical complications, and 1.35 times (95{\%} CI: 1.21-1.52) higher sub-HR of the first medical complication than non-hemodialysis controls. Conclusions: The overall mortality and complication rates of hemodialysis subjects after surgery for hip fracture were significantly higher than those of non-hemodialysis subjects. Further prospective studies which include important risk factors are necessary to more precisely quantify the adjusted effect of hemodialysis.",
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AU - Liang, Wen Miin

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N2 - Abstract Background: Osteoporotic hip fractures cause high mortality and morbidity in elderly adults. Compared to the general population, subjects with end-stage renal disease and hemodialysis often develop mineral bone disorders and have a higher risk for hip fractures. Methods: We conducted a matched cohort study design and used competing risk analysis to estimate the cumulative incidence of the complication rate. Subjects aged greater than 60 years with hip fracture were selected from Taiwan's National Health Insurance Research Database covering a period from 1997 to 2007, and these subjects were followed up until 2009. We used the Kaplan-Meier method to estimate the overall survival and used the log-rank test and multiple Cox proportional hazards model to explore the risk factors for survival. The cumulative incidence of the first complication was estimated using competing risk analysis. Results: Among hemodialysis subjects, the three-month, one-year, two-year and five-year mortality rates were 17.3%, 37.2%, 51.5%, and 80.5%, respectively; the one-year and five-year cumulative incidences of the first surgical complication were 14.2% and 20.6%, respectively; and the three-month cumulative incidence of the first medical complication was 24.1%. Hemodialysis subjects presented a 2.32 times (95% CI: 2.16-2.49) higher hazard ratio of overall death, 1.15 times (95% CI: 1.01-1.30) higher sub-hazard ratio (sub-HR) of surgical complications, and 1.35 times (95% CI: 1.21-1.52) higher sub-HR of the first medical complication than non-hemodialysis controls. Conclusions: The overall mortality and complication rates of hemodialysis subjects after surgery for hip fracture were significantly higher than those of non-hemodialysis subjects. Further prospective studies which include important risk factors are necessary to more precisely quantify the adjusted effect of hemodialysis.

AB - Abstract Background: Osteoporotic hip fractures cause high mortality and morbidity in elderly adults. Compared to the general population, subjects with end-stage renal disease and hemodialysis often develop mineral bone disorders and have a higher risk for hip fractures. Methods: We conducted a matched cohort study design and used competing risk analysis to estimate the cumulative incidence of the complication rate. Subjects aged greater than 60 years with hip fracture were selected from Taiwan's National Health Insurance Research Database covering a period from 1997 to 2007, and these subjects were followed up until 2009. We used the Kaplan-Meier method to estimate the overall survival and used the log-rank test and multiple Cox proportional hazards model to explore the risk factors for survival. The cumulative incidence of the first complication was estimated using competing risk analysis. Results: Among hemodialysis subjects, the three-month, one-year, two-year and five-year mortality rates were 17.3%, 37.2%, 51.5%, and 80.5%, respectively; the one-year and five-year cumulative incidences of the first surgical complication were 14.2% and 20.6%, respectively; and the three-month cumulative incidence of the first medical complication was 24.1%. Hemodialysis subjects presented a 2.32 times (95% CI: 2.16-2.49) higher hazard ratio of overall death, 1.15 times (95% CI: 1.01-1.30) higher sub-hazard ratio (sub-HR) of surgical complications, and 1.35 times (95% CI: 1.21-1.52) higher sub-HR of the first medical complication than non-hemodialysis controls. Conclusions: The overall mortality and complication rates of hemodialysis subjects after surgery for hip fracture were significantly higher than those of non-hemodialysis subjects. Further prospective studies which include important risk factors are necessary to more precisely quantify the adjusted effect of hemodialysis.

KW - Elderly patient

KW - End-stage renal disease

KW - Hemodialysis

KW - Medical complication

KW - Mortality

KW - Osteoporotic hip fracture

KW - Surgical complication

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