Abstract: FR-PO106
AKI Increase the Risk of Fractures: A Retrospective Cohort Study of an Australian Health District
Session Information
- AKI: Outcomes, RRT
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Cheikh Hassan, Hicham I., University of Wollongong Faculty of Science Medicine and Health, Wollongong, New South Wales, Australia
- Murali, Karumathil, University of Wollongong Faculty of Science Medicine and Health, Wollongong, New South Wales, Australia
- Lambert, Kelly, University of Wollongong, Wollongong, New South Wales, Australia
- Moules, Stephen, University of Wollongong, Wollongong, New South Wales, Australia
- Mcalister, Brendan J., Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
- Mulholland, Bridie S., University of Wollongong Faculty of Science Medicine and Health, Wollongong, New South Wales, Australia
- Mullan, Judy, University of Wollongong Faculty of Science Medicine and Health, Wollongong, New South Wales, Australia
Background
Kidneys play an important role in maintaining bone mineral balance and bone health. However, this may be disrupted following an acute kidney injury (AKI), affecting bone health. We hypothesized that AKI increases the risk of fractures and investigated this association.
Methods
Retrospective cohort study utilising adult (>18 years of age) patient-data (January 2008-December 2017), from an Australian Local Health District. AKI was based on serum creatinine measurements consistent with Kidney Disease Improving Global Outcome (KDIGO) AKI definition or international classification of disease (ICD) 10AM AKI code. Demographics, comorbidities and fractures were also extracted from ICD codes. Adjusted time-varying (time to AKI) Cox proportional hazards was used to determine the risk for future fractures (hazard ratio [HR], 95% confidence intervals [CI]) after AKI uring no AKI history as a reference. Variables in multivariable analysis included those associated with fractures such as age, gender, history of chronic kidney disease, hypertension, diabetes, cardiac history, cancer and osteoprosis. Sensitivity analysis using only biochemistry confirmed AKI was also undertaken.
Results
Of 139,080 patients; 19,188 (13.8%) had AKI; 14,914 (10.7%) experienced a fracture. Median time to fracture following AKI was 4.2 [Interquartile range 2.3,6.6] years. Crude fracture incidence for the cohort was 27.9/1,000 patient-years (95% CI 27.5-28.3). Fracture incidence was higher in the AKI group (44.5, 95% CI 42.6-46.5) compared to the non-AKI group (26.6, 95% CI 26.2-27.1) (P<0.001). In unadjusted analysis AKI was significantly associated with a risk of fracture (HR 2.1, 95% CI 2.0-2.2,P<0.001), which persisted in multivariate analysis (HR 1.2, 95%CI 1.1-1.3,P<0.001). Sensitivity analysis showed similar estimates (univariate analysis HR 1.4, 95% CI 1.4-1.5, P<0.001 and multivariate analysis HR 1.1, 95%CI 1.0-1.2, P=0.007).
Conclusion
In a large cohort of patients representing an Australian local health district, AKI was found to be associated with an increased risk of fractures. This association should be further examined and verified in other patient cohorts.