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Chronic kidney disease predicts a lower probability of improvement in patient-reported experience measures among patients with fractures: a prospective multicenter cohort study

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Abstract

Summary

Patient-reported experience measures (PREMs) are integral component of care for fracture patients. Using a multicenter cohort, we showed that the presence of chronic kidney disease (CKD) attenuated the probability of PREM improvement in fracture patients.

Introduction

Assessing PREM can assist physicians in improving patients’ experiences. Patients with CKD are at an increased risk of exhibiting poor PREM and developing fractures. We aimed to assess whether CKD influences the probability of PREM improvement during follow-up among patients with fractures.

Methods

We prospectively enrolled patients with hip or vertebral fractures from different institutes into a fracture liaison service program. After registering clinical histories, they received a baseline PREM assessment based on EuroQol group–5 dimension content, including self-care, daily activity, and pain severity using a 5-point Likert scale. A follow-up PREM assessment was arranged 4 months later, and we evaluated whether baseline CKD was predictive of PREM improvement.

Results

Among 593 fracture patients (18% with CKD), 37.3% and 62.7% presented with hip and vertebral fractures, respectively. Self-care, daily activity, and pain severity improved after follow-up in 32%, 27%, and 43% participants; those with CKD exhibited worse self-care ability and daily activity than those without. Multivariate logistic regression analyses showed that baseline CKD was significantly associated with lower possibility of improvement in daily activity (odds ratio [OR] 0.58, p = 0.049) and pain severity (OR 0.52, p = 0.01), and an insignificant change in the possibility of improvement in self-care ability (OR 0.61, p = 0.09).

Conclusions

The presence of CKD predicts a significantly lower probability of PREM improvement among fracture patients. An early emphasis on renal function during fracture care should be considered.

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Abbreviations

BMD:

bone mineral density

BMI:

body mass index

CI:

confidence interval

CKD:

chronic kidney disease

eGFR:

estimated glomerular filtration rate

DM:

diabetes mellitus

EQ-5D:

EuroQol Group–5 dimensions

FLS:

fracture liaison service

KDIGO:

Kidney Disease Improving Global Outcomes

OR:

odds ratio

PREM:

patient-reported experience measure

SERM:

selective estrogen receptor modulator

SF-36:

short-form 36

VCF:

vertebral compression fracture

WHO-QOL:

World Health Organization–quality of life

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Funding

The study is financially sponsored by internal research fund from National Taiwan University Hospital.

Author information

Authors and Affiliations

  1. Department of Medicine, National Taiwan University Hospital Bei-Hu branch, Taipei, Taiwan

    Chia-Ter Chao & Jen-Kuei Peng

  2. Department of Medicine, National Taiwan University Hospital Jin-Shan branch, New Taipei City, Taiwan

    Chia-Ter Chao

  3. Graduate Institute of Toxicology, School of Medicine, National Taiwan University, Taipei, Taiwan

    Chia-Ter Chao

  4. Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan

    Chia-Ter Chao, Wei-Yih Chiu, Kun-Pei Lin & Ding-Cheng Chan

  5. Department of Orthopedics, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan

    Rong-Sen Yang, Li-Wei Hung, Chung-Hsun Chang & Chen-Ti Wang

  6. Superintendent Office, Far Eastern Polyclinic, Taipei, Taiwan

    Keh-Sung Tsai

  7. Department of Geriatrics and Gerontology, National Taiwan University Hospital, NO. 7, Zhong-Shan South Road, Taipei, 100, Taiwan

    Kun-Pei Lin, Chiung-Jung Wen & Ding-Cheng Chan

  8. Superintendent Office, National Taiwan University Hospital Chu-Tung Branch, Hsin-Chu, Taiwan

    Ding-Cheng Chan

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  1. Chia-Ter Chao
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Contributions

Study design: CTC, RSY, DCC; data analysis: CTC, DCC; article drafting: CTC, LWH, KST, JKP, CHC, WYC, KPL, CTW, CJW, DCC; article approval: all authors.

Corresponding author

Correspondence to Ding-Cheng Chan.

Ethics declarations

The current study has been approved by the local institutional review board (National Taiwan University Hospital, NO. 201311048RINC), which allowed recruitment of suitable candidates from its main facility and branches. All participants provided written informed consent on enrollment. The study protocol adhered to the declaration of Helsinki.

Conflict of interest

None.

Sponsor’s role

The sponsors have no role in the study design, data collection, analysis, and result interpretation of this study.

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Chao, CT., Yang, RS., Hung, LW. et al. Chronic kidney disease predicts a lower probability of improvement in patient-reported experience measures among patients with fractures: a prospective multicenter cohort study. Arch Osteoporos 13, 126 (2018). https://doi.org/10.1007/s11657-018-0539-0

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