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Abstract: SA-PO181

Association Between Cause of Kidney Failure and Fracture Incidence in a National US Dialysis Population Cohort Study

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical

Authors

  • Ziolkowski, Susan, Stanford University, Stanford, California, United States
  • Liu, Sai, Stanford University, Stanford, California, United States
  • Montez-Rath, Maria E., Stanford University, Stanford, California, United States
  • Denburg, Michelle, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
  • Winkelmayer, Wolfgang C., Baylor Scott & White Health, Dallas, Texas, United States
  • Chertow, Glenn, Stanford University, Stanford, California, United States
  • O'Shaughnessy, Michelle M., Cork University Hospital, Cork, Cork, Ireland
Background

Whether fracture rates, overall and by fracture site, vary by cause of kidney failure in patients receiving dialysis is unknown.

Methods

Using the US Renal Data System (USRDS), we compared fracture rates across seven causes of kidney failure in patients who started dialysis between 1997 and 2014. We computed unadjusted and multivariable adjusted proportional sub-distribution hazard models, with fracture events (overall, and by site) as the outcome and IgA nephropathy as the reference group. Kidney transplantation and death were competing events.

Results

Among 491,496 individuals, with a median follow-up of 2.0 (0.9-3.9) years, 62,954 (12.8%) experienced at least one fracture. Patients with diabetic nephropathy, vasculitis, or autosomal polycystic kidney disease (ADPKD) had the highest (50, 46, and 40 per 1000 person-years, respectively), and patient with lupus nephritis had the lowest (20 per 1000 person years) fracture rates. After multivariable adjustment, diabetic nephropathy (HR 1.43, 95% CI 1.33-1.53), ADPKD (HR 1.37, 1.26- 1.48), vasculitis (HR 1.22, 1.09-1.34), membranous nephropathy (HR 1.16, 1.02-1.30), or FSGS (HR 1.13, 1.02-1.24) were associated with a significantly higher, and lupus nephritis with a significantly lower (HR 0.85, 0.71-0.98) fracture hazard. The hazards for upper extremity and lower leg fractures were significantly higher in diabetic nephropathy, ADPKD, FSGS, and membranous nephropathy, while the hazard for vertebral fracture was significantly higher in vasculitis.

Conclusion

Fracture risk, overall and by fracture site, varies by cause of ESKD. Future work to determine underlying pathogenic mechanisms contributing to differential risks might inform more tailored treatment strategies.

Funding

  • NIDDK Support