The impact of acute kidney injury with temporary dialysis on the risk of fracture.
Acute kidney injury (AKI) has a negative impact on long-term renal function and prognosis. However, the association between acute renal dysfunction and long-term effects on bone disorders has not yet been characterized. Using a population-based cohort study, we aimed to evaluate associations between AKI and long-term effects on bone fractures. We identified relevant data of all hospitalized patients aged >18 years with histories of dialysis-requiring AKI, with subsequent recovery and discharge, from the claim records of the Taiwan National Health Insurance database between 2000 and 2008. We determined long-term de novo bone fracture and all-cause mortality after patients' index-hospitalization discharge using propensity score-adjusted Cox proportional hazard model. Varying-time models were used to adjust for long-term effects of end-stage renal disease (ESRD) on main outcomes. Among 448 AKI patients who had dialysis and survived 90 days after index-hospitalization discharge without reentering dialysis, 273 were male (60.9%) with a mean age of 61.4 ± 16.6 years. Controls included 1792 hospitalized patients without AKI, dialysis, or bone fracture history. In the AKI recovery group, bone fracture incidence was 320 per 10,000 person-years and hazard ratio (HR) of long-term bone fracture was 1.25 (p = 0.049) compared with the control group, independent of subsequent ESRD status (HR = 1.55; p = 0.01). Both AKI recovery status (HR = 2.31; p < 0.001) and time varying factor of bone fracture (HR = 1.43; p < 0.001) were independent predictors of mortality compared with controls. In conclusion, AKI requiring temporary dialysis independently increases long-term risk of bone fracture, regardless of subsequent progression to ESRD. Long-term bone fractures may negatively impact patient mortality.
Department of Internal Medicine, Tao-Yuan General Hospital, Tao-Yuan County, Taiwan.
Wei-Jie
WJ
Wang
Chia-Ter
CT
Chao
Yu-Chin
YC
Huang
Cheng-Yi
CY
Wang
Chia-Hsui
CH
Chang
Tao-Min
TM
Huang
Chun-Fu
CF
Lai
Hui-Yu
HY
Huang
Chih-Chung
CC
Shiao
Tzong-Shinn
TS
Chu
Yung-Ming
YM
Chen
Vin-Cent
VC
Wu
Wen-Je
WJ
Ko
Kwan-Dun
KD
Wu
D058186:Acute Kidney Injury / Q000150:complications* / Q000628:therapy; D000368:Aged; D005260:Female; D050723:Fractures, Bone / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D006435:Renal Dialysis; D013624:Taiwan
ACUTE KIDNEY INJURY; BONE FRACTURE; DIALYSIS; POPULATION