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Kidney Week

Abstract: PO1690

Predictors of Functional Status Change in Patients with CKD Between Two Hip Fracture Events: A 6-Year Prospective Study

Session Information

Category: Geriatric Nephrology

  • 1100 Geriatric Nephrology

Authors

  • Wu, Henry, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, United Kingdom
  • Van Mierlo, Rene, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, United Kingdom
  • Dhaygude, Ajay Prabhakar, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, United Kingdom
  • Mitra, Sandip, The University of Manchester, Manchester, Manchester, United Kingdom
  • Nixon, Andrew Christopher, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, United Kingdom
Background

Patients with chronic kidney disease (CKD) are susceptible to recurrent hip fractures (Hip#). Functional status decline after Hip# is transient, exacerbated by frailty, sarcopenia and co-morbidities. We studied the prognostic value of clinical and laboratory parameters for functional status change in CKD after recurrent Hip#.

Methods

Patients with CKD G3b-5 admitted with 2 separate Hip# events between June 2013 and Dec 2019 in a North West UK tertiary care hospital were included. Difference in Karnovsky Performance Status (KPS) Scale between 1st and 2nd Hip# admission determined functional status change. KPS is a linear scale between 0 (dead) and 100 (normally active). Parameters assessed include Clinical Frailty Scale (CFS), Hopkins Frailty Score (HFS), CKD FI-LAB, Sernbo Score, Charlson's Co-morbidity Index, Nottingham Hip Fracture Score, ASA Score and Abbreviated Mental Test Score. Differences in each parameter score between 1st and 2nd Hip# admission were recorded. ROC curve analyses was performed to assess discriminative ability between individual scoring tools.

Results

37 patients met inclusion criteria (F:M 1.8:1; mean age 84.5+10.2 yrs). 10 were receiving long-term dialysis, whilst non-dialysis CKD patients had a mean eGFR 33+15 mL/min/1.73m2. Mean age difference between Hip# is 1.4 yrs (p=0.032). Mean KPS difference between Hip# is -10.6 (p=0.028). AUC values from ROC analyses are shown in Table 1.

Conclusion

There was a significant decline in functional status between Hip#. Frailty assessment tools (CFS, HFS and CKD FI-LAB) had the best predictive performance for functional status change. Frailty measures may be utilized as risk prediction tools of functional status change from first Hip# admission. Further Research is needed on post-Hip# interventions that aim to maintain functional status and reduce subsequent fracture risk.

Table 1
PredictorsAUC Value (95%Cl)
Clinical Frailty Scale 0.96 (0.90-1.00)
Hopkins Frailty Score0.95 (0.89-1.00)
CKD FI-LAB 0.91 (0.83-0.99)
Sernbo Score0.85 (0.77-0.93)
Charlson's Co-morbidity Index0.78 (0.69-0.88)
Nottingham Hip Fracture Score0.74 (0.66-0.82)
ASA Score0.67 (0.59-0.75)
Abbreviated Mental Test Score 0.56 (0.51-0.61)

Funding

  • Government Support - Non-U.S.