Kidney Week

Abstract: SA-PO0915

Loss of Ambulation After Fracture-Related Hospitalization Is Associated with Increased Mortality in Patients Undergoing Hemodialysis: A Multicenter, Risk-Set-Matched Study

Session Information

• Health Maintenance, Nutrition, and Metabolism
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Health Maintenance, Nutrition, and Metabolism

• 1500 Health Maintenance, Nutrition, and Metabolism

Authors

• Watanabe, Takaaki, Tokyo Iryo Gakuin Daigaku, Tama, Tokyo, Japan

Takaaki Watanabe, DrMed, PhD

• Harada, Manae, Sagami Junkanki Clinic, Sagamihara, Kanagawa Prefecture, Japan

Manae Harada, PhD

• Suzuki, Yuta, Kokuritsu Hoken Iryo Kagakuin, Wako, Saitama Prefecture, Japan

Yuta Suzuki

• Yoshikoshi, Shun, Tsukuba Daigaku, Tsukuba, Ibaraki Prefecture, Japan

Shun Yoshikoshi, PhD

• Yamabe, Sachi, Nihon Iryo Daigaku, Sapporo, Hokkaido Prefecture, Japan

Sachi Yamabe, PhD

• Matsuzawa, Ryota, Hyogo Ika Daigaku, Nishinomiya, Hyogo Prefecture, Japan

Ryota Matsuzawa, PhD

• Tsujimoto, Naoyuki, Hyogo Ika Daigaku, Nishinomiya, Hyogo Prefecture, Japan

Naoyuki Tsujimoto, MS

• Amano, Akira, Sosei Byoin, Kadoma, Osaka Prefecture, Japan

Akira Amano, MS

• Abe, Yoshifumi, Dokkyo Ika Daigaku, Shimotsuga District, Tochigi Prefecture, Japan

Yoshifumi Abe, PhD

• Matsunaga, Yusuke, Kanazawa Ika Daigaku, Kahoku District, Ishikawa Prefecture, Japan

Yusuke Matsunaga, PhD

• Matsumoto, Naoto, Tokyo Iryo Gakuin Daigaku, Tama, Tokyo, Japan

Naoto Matsumoto, MSc, PhD

• Akiho, Mitsutoshi, Tokyo Iryo Gakuin Daigaku, Tama, Tokyo, Japan

Mitsutoshi Akiho, PhD

• Matsunaga, Atsuhiko, Kitasato Daigaku Iryo Eisei Gakubu, Sagamihara, Kanagawa Prefecture, Japan

Atsuhiko Matsunaga, PhD

Background

Fragility fractures requiring hospitalization are common among patients undergoing hemodialysis (HD) and are associated with increased mortality. However, the prognostic impact of ambulatory recovery remains unclear.

Methods

This multicenter retrospective cohort study included patients undergoing HD from six centers in Japan. Among 1,443 patients treated between March 2007 and February 2024, those with fragility fractures (vertebrae, proximal femur, distal radius, proximal humerus, and pelvis) hospitalized were identified. The index date was defined as the fracture-related hospitalization date for cases and the corresponding matched date for controls, and follow-up began from this date. Controls were selected using risk-set matching for age, sex, and dialysis vintage. All patients were ambulatory before fracture. Ambulatory status was assessed within one year post-discharge and categorized as independent or non-independent. The outcome was all-cause mortality. Kaplan–Meier curves truncated at 5 years were constructed, and cox models estimated hazard ratios (HRs).

Results

The cohort included 152 patients (17 non-ambulatory, 59 ambulatory, 76 controls). During 3.2 years median follow-up, mortality was 65%, 34%, and 27%. Kaplan–Meier curves showed lower survival in non-ambulatory patients (Figure 1). Compared with controls non-ambulatory patients had higher mortality (HR 3.3, 95% CI 1.4–7.4), whereas ambulatory patients did not (HR 1.4, 95% CI 0.7–2.8). Among fracture patients, non-ambulatory status was associated with higher mortality (HR 2.3, 95% CI 1.0–4.9).

Conclusion

Failure to regain ambulation after fracture-related hospitalization is associated with higher mortality in patients undergoing HD. Post-fracture ambulatory status may serve as a prognostic marker reflecting vulnerability and a potential target for rehabilitation.

Figure 1. Kaplan–Meier curves by ambulatory status (5-year follow-up).

Funding

• Government Support – Non-U.S.