Dr Jo-wai Douglas Wang1,3, Dr Shyan Goh2, Associate Professor Alexander Fisher1,2,3
1Department of Geriatric Medicine, The Canberra Hospital, Canberra, Australia, 2Department of Orthopaedic Surgery, The Canberra Hospital, Canberra, Australia, 3Australian National University Medical School, Canberra, Australia
Background
Information on CKD patients with hip fractures (HF) regarding morbidity, mortality and osteoporotic treatment is scarce.
Aim
We aimed to explore the prevalence, clinical characteristics, pre-fracture anti-osteoporotic treatment and hospital outcomes in CKD patients experiencing HF.
Methods
In 3623 consecutive HF patients aged≥65 years (mean age 83.4±7.50 [SD] years; 74.4% females), prospectively collected clinical data were analysed. CKD was defined as estimated glomerular filtration rate (eGFR)<60 ml/min/1.73m2.
Results
In our HF cohort, 1444 (39.9%) patients had CKD, of whom stage 3a comprised 716 (49.6%), stage 3b – 465 (32.2%), stage 4 – 217 (15.0%) and stage 5 – 46 (3.2%). Among HF patients CKD prevalence was 9.5 times higher than in the general population aged≥75 years (43.6% vs. 4.6%). CKD patients compared to the non-CKD were older (+4.1 years), had a greater prevalence of hypertension (62.1% vs. 52.6%), anaemia (51.3% vs. 36.3%), coronary artery disease (36.9% vs. 24.7%), history of myocardial infarction (10.3% vs. 6.3%), atrial fibrillation (23.1% vs. 16.9%), type 2 diabetes mellitus (17.1% vs. 10.7%) and dementia (33.1% vs. 29.3%), as well as significantly higher mortality rate (8.2% vs. 3.3%, p<0.001) and prolonged admission (LOS>10 days: 60.3% vs. 54.2%, p=0.04). Of 189 HF patients who died 118 (62.4%) had CKD. CKD increased mortality risk by 180% (OR 2.8; 95%CI 2.06 – 3.76) and LOS>10 days by 30%; the effects were strongest for stage 5 (ORs 4.6 and 2.5, respectively). A 1ml/min/1.73m2 decrease in eGFR increased mortality risk 3%. Only 10.2% of CKD patients received osteoporotic drugs (bisphosphonates, denosumab) pre-HF.
Conclusions
Among HF patients, CKD is highly prevalent contributing to excess morbidity, mortality and prolonged LOS, but rarely treated for osteoporosis.
Biography:
Bio to come