Temporal trends in the incidence, treatment and outcomes of hip fracture after first kidney transplantation in the United States.
It is currently unknown whether any secular trends exist in the incidence and outcomes of hip fracture in kidney transplant recipients (KTR). We identified first-time KTR (1997-2010) who had >1 year of Medicare coverage and no recorded history of hip fracture. New hip fractures were identified from corresponding diagnosis and surgical procedure codes. Outcomes studied included time to hip fracture, type of surgery received and 30-day mortality. Of 69,740 KTR transplanted in 1997-2010, 597 experienced a hip fracture event during 155,341 person-years of follow-up for an incidence rate of 3.8 per 1000 person-years. While unadjusted hip fracture incidence did not change, strong confounding by case mix was present. Using year of transplantation as a continuous variable, the hazard ratio (HR) for hip fracture in 2010 compared with 1997, adjusted for demographic, dialysis, comorbid and most transplant-related factors, was 0.56 (95% confidence interval [CI]: 0.41-0.77). Adjusting for baseline immunosuppression modestly attenuated the HR (0.68; 95% CI: 0.47-0.99). The 30-day mortality was 2.2 (95% CI: 1.3-3.7) per 100 events. In summary, hip fractures remain an important complication after kidney transplantation. Since 1997, case-mix adjusted posttransplant hip fracture rates have declined substantially. Changes in immunosuppressive therapy appear to be partly responsible for these favorable findings.
Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA.
S Sukumaran
SS
Nair
Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA.
C R
CR
Lenihan
Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA.
M E
ME
Montez-Rath
Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, Stanford University School of Medicine, Palo Alto, CA.
D W
DW
Lowenberg
Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA.
G M
GM
Chertow
Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA.|Department of Health Research and Policy, Stanford University School of Medicine, Palo Alto, CA.
W C
WC
Winkelmayer
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006620:Hip Fractures / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000601:surgery; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D006278:Medicare; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D011379:Prognosis; D012307:Risk Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology
Bone disease; fracture; kidney transplant; mortality; outcomes