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Long-term excess mortality after hip fracture in hemodialysis patients: a nationwide cohort study in Japan

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Abstract

Introduction

Fracture dialysis patients have a higher risk of 1-year mortality compared with non-fracture dialysis patients. However, it is unclear whether excess mortality persists for more than a year.

Materials and methods

We conducted a nationwide cohort study in 162,360 hemodialysis patients in Japan. Study outcomes were 5-year all-cause mortality and cause-specific mortality. Cox proportional hazards regression was used to examine the association between hip fracture and mortality in two cohorts: the full cohort, which included potential confounders as covariates in multivariable-adjusted regression models, and the propensity score-matched cohort.

Results

Crude mortality rates for fracture patients were double those of non-fracture patients and persisted during the 5-year period. The association between hip fracture and mortality was significant even after adjusting for premorbid conditions (hazard ratio (HR) 1.22, 95% confidence interval (CI) 1.13–1.32). Similar findings were observed in the propensity score-matched cohort of 2410 patients (HR 1.20, 95% CI 1.05–1.36). While cause-specific mortality rates for all categories, with the exception of sudden deaths, were higher for fracture patients relative to non-fracture patients in the full unmatched cohort, only the mortality rate for heart disease was significantly higher for fracture patients relative to non-fracture patients in the propensity score-matched cohort.

Conclusion

Excess mortality persisted for many years after hip fracture in hemodialysis patients, and was still present after adjusting for several premorbid conditions and propensity score matching.

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References

  1. Haentjens P, Magaziner J, Colón-Emeric CS, Vanderschueren D, Milisen K, Velkeniers B, Boonen S (2010) Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med 152:380–390

    Article  Google Scholar 

  2. Hung LW, Tseng WJ, Huang GS, Lin J (2014) High short-term and long-term excess mortality in geriatric patients after hip fracture: a prospective cohort study in Taiwan. BMC Musculoskelet Disord 15:151

    Article  Google Scholar 

  3. LeBlanc ES, Hillier TA, Pedula KL, Rizzo JH, Cawthon PM, Fink HA, Cauley JA, Bauer DC, Black DM, Cummings SR, Browner WS (2011) Hip fracture and increased short-term but not long-term mortality in healthy older women. Arch Intern Med 171:1831–1837

    Article  Google Scholar 

  4. Coco M, Rush H (2000) Increased incidence of hip fractures in dialysis patients with low serum parathyroid hormone. Am J Kidney Dis 36:1115–1121

    Article  CAS  Google Scholar 

  5. Beaubrun AC, Kilpatrick RD, Freburger JK, Bradbury BD, Wang L, Brookhart MA (2013) Temporal trends in fracture rates and postdischarge outcomes among hemodialysis patients. J Am Soc Nephrol 24:1461–1469

    Article  Google Scholar 

  6. Tentori F, McCullough K, Kilpatrick RD, Bradbury BD, Robinson BM, Kerr PG, Pisoni RL (2014) High rates of death and hospitalization follow bone fracture among hemodialysis patients. Kidney Int 85:166–173

    Article  Google Scholar 

  7. Mittalhenkle A, Gillen DL, Stehman-Breen CO (2004) Increased risk of mortality associated with hip fracture in the dialysis population. Am J Kidney Dis 44:672–679

    Article  Google Scholar 

  8. Wakasugi M, Kazama JJ, Yamamoto S, Kawamura K, Narita I (2013) Cause-specific excess mortality among dialysis patients: comparison with the general population in Japan. Ther Apher Dial 17:298–304

    Article  Google Scholar 

  9. Yoshino M, Kuhlmann MK, Kotanko P, Greenwood RN, Pisoni RL et al (2006) International differences in dialysis mortality reflect background general population atherosclerotic cardiovascular mortality. J Am Soc Nephrol 17:3510–3519

    Article  Google Scholar 

  10. Nakai S, Iseki K, Itami N, Ogata S, Kazama JJ et al (2012) Overview of regular dialysis treatment in Japan (as of 31 December 2009). Ther Apher Dial 16:11–53

    Article  Google Scholar 

  11. Masakane I, Taniguchi M, Nakai S, Tsuchida K, Goto S, Wada A, Ogata S, Hasegawa T, Hamano T, Hanafusa N, Hoshino J, Minakuchi J, Nakamoto H, on behalf of the Japanese Society for Dialysis Therapy Renal Data Registry Committee (2018) Annual dialysis data report 2015, JSDT renal data registry. Ren Replace Ther 4:19. https://doi.org/10.1186/s41100-018-0149-8

    Article  Google Scholar 

  12. Wakasugi M, Kazama JJ, Wada A, Hamano T, Masakane I, Narita I (2018) Hip fracture trends in Japanese dialysis patients, 2008–2013. Am J Kidney Dis 71:173–181

    Article  Google Scholar 

  13. Sakaguchi Y, Hamano T, Wada A, Hoshino J, Masakane I (2018) Magnesium and risk of hip fracture among patients undergoing hemodialysis. J Am Soc Nephrol 29:991–999

    PubMed  CAS  Google Scholar 

  14. Wakasugi M, Kazama JJ, Taniguchi M, Wada A, Iseki K, Tsubakihara Y, Narita I (2013) Increased risk of hip fracture among Japanese hemodialysis patients. J Bone Miner Metab 31:315–321

    Article  Google Scholar 

  15. Wakasugi M, Kazama JJ, Wada A, Taniguchi M, Iseki K, Tsubakihara Y, Narita I (2014) Regional variation in hip fracture incidence among Japanese hemodialysis patients. Ther Apher Dial 18:162–166

    Article  Google Scholar 

  16. Wakasugi M, Kazama JJ, Kikuchi K, Yasuda K, Wada A, Hamano T, Masakane I, Narita I (2019) Hemodialysis product and hip fracture in hemodialysis patients: a nationwide cohort study in Japan. Ther Apher Dial 23:507–517

    Article  CAS  Google Scholar 

  17. Nakai S, Iseki K, Itami N, Ogata S, Kazama JJ et al (December 2010) (2012)An overview of regular dialysis treatment in Japan (as of 31. Ther Apher Dial 16:483–521

    Article  Google Scholar 

  18. Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, Carbone PP (1982) Toxicity and response criteria of the Eastern cooperative oncology group. Am J Clinical Oncol 5:649–655

    Article  CAS  Google Scholar 

  19. Cancer Therapy Evaluation Program (1999) Common Toxicity Criteria, Version 2.0. Publish Date April 30. https://ctep.cancer.gov/protocolDevelopment/electronic_applications/docs/ctcv20_4-30-992.pdf. Accessed Nov 5 2019.

  20. Wakasugi M, Kazama J, Wada A, Hamano T, Masakane I, Narita I (2019) Functional impairment attenuates the association between high serum phosphate and mortality in dialysis patients: a nationwide cohort study. Nephrol Dial Transplant 34:1207–1216

    Article  Google Scholar 

  21. Shinzato T, Nakai S, Fujita Y, Takai I, Morita H, Nakane K, Maeda K (1994) Determination of Kt/V and protein catabolic rate using pre- and postdialysis blood urea nitrogen concentrations. Nephron 67:280–290

    Article  CAS  Google Scholar 

  22. Fukagawa M, Yokoyama K, Koiwa F, Taniguchi M, Shoji T, et al. (2013) Clinical practice guideline for the management of chronic kidney disease-mineral and bone disorder. Ther Apher Dial 17:247–288

    Article  Google Scholar 

  23. Austin PC (2009) Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat Med 28:3083–3107

    Article  Google Scholar 

  24. Schacht A, Bogaerts K, Bluhmki E, Lesaffre E (2008) A new nonparametric approach for baseline covariate adjustment for two-group comparative studies. Biometrics 64:1110–1116

    Article  Google Scholar 

  25. Tanko LB, Christiansen C, Cox DA, Geiger MJ, McNabb MA, Cummings SR (2005) Relationship between osteoporosis and cardiovascular disease in postmenopausal women. J Bone Miner Res 20:1912–1920

    Article  Google Scholar 

  26. Chiang CH, Liu CJ, Chen PJ, Huang CC, Hsu CY, Chen ZY, Chan WL, Huang PH, Chen TJ, Chung CM, Lin SJ, Chen JW, Leue HB (2013) Hip fracture and risk of acute myocardial infarction: a nationwide study. J Bone Miner Res 28:404–411

    Article  Google Scholar 

  27. Paccou J, D'Angelo S, Rhodes A, Curtis EM, Raisi-Estabragh Z, Edwards M, Walker-Bone K, Cooper C, Petersen SE, Harvey NC (2018) Prior fragility fracture and risk of incident ischaemic cardiovascular events: results from UK Biobank. Osteoporos Int 29:1321–1328

    Article  CAS  Google Scholar 

  28. Kaneko TM, Foley RN, Gilbertson DT, Collins AJ (2007) Clinical epidemiology of long-bone fractures in patients receiving hemodialysis. Clin Orthop Relat Res 457:188–193

    PubMed  Google Scholar 

  29. Kurella M, Mapes DL, Port FK, Chertow GM (2006) Correlates and outcomes of dementia among dialysis patients: the dialysis outcomes and practice patterns study. Nephrol Dial Transplant 21:2543–2548

    Article  Google Scholar 

  30. McAdams-DeMarco MA, Daubresse M, Bae S, Gross AL, Carlson MC, Segev DL (2018) Dementia, Alzheimer's disease, and mortality after hemodialysis initiation. Clin J Am Soc Nephrol 13:1339–1347

    Article  Google Scholar 

  31. Wang PW, Li YZ, Zhuang HF, Yu HM, Cai SQ, Xu H, Chen ZH, Lin JK, Yao XD (2019) Anti-osteoporosis medications associated with decreased mortality after hip fracture. Orthop Surg 11:777–783

    Article  Google Scholar 

  32. Bliuc D, Tran T, van Geel T, Adachi JD, Berger C, van den Bergh J, Eisman JA, Geusens P, Goltzman D, Hanley DA, Josse R, Kaiser S, Kovacs CS, Langsetmo L, Prior JC, Nguyen TV, Center JR, CaMOS Research Group (2019) Reduced bone loss is associated with reduced mortality risk in subjects exposed to nitrogen bisphosphonates: a mediation analysis. J Bone Miner Res 34:2001–2011

    Article  CAS  Google Scholar 

Download references

Acknowledgments

We thank the Committee of the Renal Data Registry of the Japanese Society for Dialysis Therapy (JSDT) for permission to use their data. The opinions reflected in this manuscript are those of the authors alone and do not reflect the official position of JSDT.

Funding

None.

Author information

Authors and Affiliations

  1. Division of Comprehensive Geriatrics in Community, Niigata University Graduate School of Medical and Dental Sciences, Asahimachi 1-757, Chuo-ku, Niigata, 951-8510, Japan

    Minako Wakasugi

  2. Departments of Nephrology and Hypertension, Fukushima Medical University, Fukushima, Japan

    Junichiro James Kazama

  3. Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan

    Atsushi Wada, Takayuki Hamano & Ikuto Masakane

  4. Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan

    Ichiei Narita

Authors
  1. Minako Wakasugi
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  2. Junichiro James Kazama
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  3. Atsushi Wada
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  4. Takayuki Hamano
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  5. Ikuto Masakane
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  6. Ichiei Narita
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by MW, AW, TH, and IM. The first draft of the manuscript was written by MW and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Minako Wakasugi.

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Conflict of interest

Dr. Hamano received grants and personal fees from Chugai Pharmaceutical Company, Torii Pharmaceutical Company, Kyowa Kirin Company, Kissei Pharmaceutical Company, and Bayer, outside the submitted work. The other authors declare that they have no other relevant financial interests to disclose.

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Wakasugi, M., Kazama, J.J., Wada, A. et al. Long-term excess mortality after hip fracture in hemodialysis patients: a nationwide cohort study in Japan. J Bone Miner Metab 38, 718–729 (2020). https://doi.org/10.1007/s00774-020-01110-4

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  • DOI: https://doi.org/10.1007/s00774-020-01110-4

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