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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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.
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.
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.
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).
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.
KeywordsChronic kidney disease EQ-5D Fracture Pain Patient-reported experiences
bone mineral density
body mass index
chronic kidney disease
estimated glomerular filtration rate
EuroQol Group–5 dimensions
fracture liaison service
Kidney Disease Improving Global Outcomes
patient-reported experience measure
selective estrogen receptor modulator
vertebral compression fracture
World Health Organization–quality of life
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.
The study is financially sponsored by internal research fund from National Taiwan University Hospital.
Compliance with ethical standards
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
The sponsors have no role in the study design, data collection, analysis, and result interpretation of this study.
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