Abstract: TH-PO784

Fracture Rates and Post-Discharge Outcomes Among Patients Undergoing Hemodialysis Across Etiologies of Kidney Diseases

Session Information

Category: Dialysis

  • 607 Dialysis: Epidemiology, Outcomes, Clinical Trials - Non-Cardiovascular

Authors

  • Gitomer, Berenice Y., Div. Renal Diseases and Hypertension,, Aurora, Colorado, United States
  • Dalrymple, Lorien S., Fresenius Medical Care NA, Waltham, Massachusetts, United States
  • You, Zhiying, UC Denver, Aurora, Colorado, United States
  • Ofsthun, Norma J., Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Maddux, Franklin W., Fresenius Medical Care, Waltham, Massachusetts, United States
  • Isakova, Tamara, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
  • Salusky, Isidro B., Mattel Children's Hospital, Los Angeles, California, United States
  • Wolf, Myles S., Duke University, Durham, North Carolina, United States
  • Chonchol, Michel, University of Colorado, Aurora, Colorado, United States
Background

We have previously identified a low bone turnover state in patients with autosomal dominant polycystic kidney disease (ADPKD) and normal kidney function based on histomorphometric measurements. This is indicated by both decreased indices of bone formation and resorption measured in trabecular bone. However, the rates and risk of fracture have not been characterized in ADPKD patients compared to other etiologies of kidney disease among hemodialysis patients.

Methods

The cohort included incident in-center hemodialysis patients aged 18–100 years with kidney disease secondary to diabetes, hypertension, glomerulonephritis (GN) or ADPKD starting hemodialysis at Fresenius Medical Care Norh America 2000-2013. Cohort was followed through 2014 for the first fracture-related hospitalization and up to one additional year for post-fracture mortality. Fractures were identified using ICD-9-CM diagnosis codes. Fracture rates were calculated within strata of etiology of kidney disease. Among patients with complete data, one year mortality following hospital discharge was examined using Cox regression models.

Results

A total of 10,131 fracture-related hospitalizations were observed during follow-up. Age, gender, and race adjusted fracture rates per 1,000 person-years (PYs) varied across etiology of kidney disease: patients with ADPKD had the lowest rate (8.1, 95% CI 6.6-10.0) and patients with diabetes had the highest rate (12.3, 95% CI 11.4-13.4). Patients with hypertension and GN had fracture rates of 8.8 (95% CI 8.1-9.6) and 8.9 (95% 7.9-9.9), respectively. Patients with ADPKD had a significantly lower adjusted incident rate ratio (aIRR) of fractures compared with patients with diabetes [aIRR: 0.66 (053, 0.82); p=0.0002]. After adjustment for demographics, vintage, comorbidities, albumin and measures of mineral metabolism, the mortality in the first year post-discharge for a fracture-related hospitalization was lower in patients with ADPKD compared to patients with diabetes (HR 0.65 95% CI 0.46-0.92; p=0.01).

Conclusion

The decrease in bone formation rate observed in patients with early ADPKD does not appear to increase the risk of fracture or portend a worse prognosis among those who survive hospitalization when compared to other etiologies of kidney disease.

Funding

  • NIDDK Support