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- Title
Long-term excess mortality after hip fracture in hemodialysis patients: a nationwide cohort study in Japan.
- Authors
Wakasugi, Minako; Kazama, Junichiro James; Wada, Atsushi; Hamano, Takayuki; Masakane, Ikuto; Narita, Ichiei
- Abstract
<bold>Introduction: </bold>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.<bold>Materials and Methods: </bold>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.<bold>Results: </bold>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.<bold>Conclusion: </bold>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.
- Subjects
JAPAN; HEMODIALYSIS patients; CARDIOVASCULAR system; CHRONIC kidney failure; MORTALITY risk factors; HIP fractures; PROPENSITY score matching; CAUSES of death; KAPLAN-Meier estimator; HEMODIALYSIS; PROPORTIONAL hazards models; PROBABILITY theory; LONGITUDINAL method
- Publication
Journal of Bone & Mineral Metabolism, 2020, Vol 38, Issue 5, p718
- ISSN
0914-8779
- Publication type
journal article
- DOI
10.1007/s00774-020-01110-4