Relative hypoparathyroidism and hypoalbuminemia are associated with hip fracture in hemodialysis patients.
OBJECTIVE
Patients with end-stage renal disease treated by hemodialysis are at an increased risk of hip fracture. In the general population, hip fractures are associated with increased morbidity and mortality. The objective of this study was to assess the predictors and outcomes of hip fracture in the hemodialysis population, including quality of life post hip fracture.


METHODS
A case-control study from 1999 to 2005 included 29 adult hemodialysis patients with hip fracture and 55 controls, matched on age, gender and number of years on hemodialysis. A logistic regression model was used to derive predictors of hip fracture. The association between time to death post hip fracture and parathyroid hormone was analyzed using a Kaplan-Meier curve. The ability to live independently 1 year after hip fracture was used as a measure of quality of life.


RESULTS
Variables associated with hip fracture were a reduction in serum parathyroid hormone by 100 pg/ml (OR = 1.65, 95% CI 1.10, 2.46) and a decrease in serum albumin by 1 g/l (OR = 1.18, 95% CI 1.00, 1.39). 40% of the cases died within the first year post hip fracture. Median survival time in patients with hip fracture and a serum PTH value < 100 pg/ml was 17 days (95% CI 0, 37 days) as compared with 280 days (95% CI 103, 471 days) for those with a PTH value > 100 pg/ml (p < 0.02). Among the patients who survived, 53% were subsequently discharged to a long-term care facility.


CONCLUSIONS
Relative hypoparathyroidism and hypoalbuminemia are associated with an increased risk of hip fracture in hemodialysis patients. There is also a significant reduction in quality of life in patients sustaining a hip fracture.
Division of Nephrology, McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada.
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Al Helal
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Churchill
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Gangji
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006620:Hip Fractures / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D034141:Hypoalbuminemia / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D007011:Hypoparathyroidism / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D009864:Ontario / Q000453:epidemiology; D010281:Parathyroid Hormone / Q000097:blood; D011379:Prognosis; D006435:Renal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends
D010281:Parathyroid Hormone