Kidney Week

Abstract: SA-PO715

Factors Associated with Fractures in Octogenarian Patients with CKD

Session Information

• Geriatric Nephrology
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Geriatric Nephrology

• 1100 Geriatric Nephrology

Authors

• Carvalho Goncalves, Flávia Leticia, HCFMUSP - SP - BRASIL, BRASILIA, Distrito federal, Brazil

Flávia Leticia Carvalho Goncalves,

• Coelho, Venceslau Antonio, HCFMUSP - SP - BRASIL, BRASILIA, Distrito federal, Brazil

Venceslau Antonio Coelho,

• Veloso, Mariana Pigozzi, HCFMUSP - SP - BRASIL, BRASILIA, Distrito federal, Brazil

Mariana Pigozzi Veloso,

• Vasco, Raquel F. V., HCFMUSP - SP - BRASIL, BRASILIA, Distrito federal, Brazil

Raquel F. V. Vasco,

• Moyses, Rosa M.A., HCFMUSP - SP - BRASIL, BRASILIA, Brazil

Rosa M.A. Moyses,

• Elias, Rosilene M., HCFMUSP - SP - BRASIL, BRASILIA, Distrito federal, Brazil

Rosilene M. Elias,

Background

Fracture risk is increased in chronic kidney disease (CKD), and is associated with a higher mortality rate, mainly in the elderly patients. However, little is known regarding the factors associated with fracture risk in octogenarian patients with CKD

Methods

This study investigates the associations among bone turnover markers, cognition, comorbidities and prevalent fractures in a cohort of octogenarian CKD patients. The comprehensive geriatric assessment was applied by a geriatric and nephrologist team, and data obtained in two occasions were extracted from electronic charts including estimated glomerular filtration rate (eGFR) based on CKD-EPI equation, biochemical and demographic data, modified mini-mental state examination (MMSE), and Charlson Comorbidity Index (CCI). The median time between assessments was 174 days.

Results

The fracture prevalence was 26.5% in a sample of 49 patients (67% men, age 83±7 years). We did not find differences regarding age, gender, eGFR, proteinuria, calcium, phosphate PTH, serum vitamin D, supplementation of cholecalciferol, use of omeprazole, diuretic and calcitriol between those with and without fractures (p>0.05). However, patients who had fracture had higher comorbidity - CCI >7 (92% vs. 8%; p=0.031) and lower MMSE scores (15±9 vs. 23±5; p=0.018). During the follow-up, we observed that patients with fracture had a rapid loss of renal function (eGFR -0.016 ± 0.040 vs. 0.019 ± 0.052 ml/min/1.73m²/month, p=0.017).

Conclusion

Elderly patients with CKD who experience fractures are usually marked by more comorbidities, more cognitive deficits, and greater loss of renal function. A closing monitoring of falls and a multidisciplinary care is warranted to minimize fractures and understand the mechanisms of deteriorating renal function.