title: Decreased glomerular filtration rate estimated by 2009 CKD-EPI equation predicts mortality in older hip fracture population.
abstract: OBJECTIVE
  We examined estimated glomerular filtration rate using the Chronic Kidney Disease Epidemiology equation (eGFRCDK-EPI), removal of urinary catheter during hospitalization and polypharmacy as predictors of mortality in older hip fracture patients.
  
  
  METHODS
  Population-based prospective data were collected on 1425 consecutive hip fracture patients aged ≥65 years. Outcome was mortality at one year. Independent variables were age, sex, body mass index, fracture type, American Society of Anesthesiology score, delay to surgery, urinary catheter removal during acute hospitalization, eGFRCDK-EPI, number of daily medications, diagnosis of memory disorder, prefracture mobility and living arrangements.
  
  
  RESULTS
  Of the 1425 patients, 567 (40%) had renal dysfunction on admission, 526 (37%) had their urinary catheters removed during hospitalization and 1177 (83%) were taking ≥4 medications regularly before the fracture. In the multivariate analyses with the Cox proportional hazards model adjusted simultaneously for all the independent variables, eGFRCDK-EPI 30-44ml/min/1.73m(2) (HR 1.91, 95% CI 1.44-2.52) and <30ml/min/1.73m(2) (HR 1.95, 95% CI 1.36-2.78), non-removal of the urinary catheter (HR 1.45, 95% CI 1.12-1.88) and large number of daily medications (4-10 HR 1.81, 95% CI 1.78-2.79, >10 HR 2.21, 95% CI 1.38-3.54) were associated with mortality.
  
  
  CONCLUSIONS
  In older hip fracture patients, moderate to severe level renal dysfunction measured by eGFRCDK-EPI, non-removal of urinary catheter before discharge and polypharmacy increase mortality after hip fracture. Careful assessment of renal function and medications and following the care protocols on urinary catheter removal are essential in the care of geriatric hip fracture patients.
authors.affiliation: Department of Geriatric Medicine, Seinäjoki Central Hospital, Finland. Electronic address: hanna.pajulammi@fimnet.fi.
authors.forename: Hanna M
authors.initials: HM
authors.lastname: Pajulammi
authors.affiliation: Science Center, Pirkanmaa Hospital District, Finland; School of Health Sciences, University of Tampere, Finland.
authors.forename: Tiina H
authors.initials: TH
authors.lastname: Luukkaala
authors.affiliation: Division of Orthopedics and Traumatology, Seinäjoki Central Hospital, Finland; University of Tampere, Seinäjoki, Finland.
authors.forename: Harri K
authors.initials: HK
authors.lastname: Pihlajamäki
authors.affiliation: Department of Geriatric Medicine, Seinäjoki Central Hospital, Finland. Electronic address: maria.nuotio@epshp.fi.
authors.forename: Maria S
authors.initials: MS
authors.lastname: Nuotio
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D015897:Comorbidity; D005260:Female; D005387:Finland / Q000453:epidemiology; D015577:Geriatric Assessment; D005919:Glomerular Filtration Rate; D006620:Hip Fractures / Q000150:complications / Q000401:mortality* / Q000503:physiopathology / Q000601:surgery*; D006760:Hospitalization; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000401:mortality* / Q000503:physiopathology / Q000601:surgery; D011446:Prospective Studies; D020127:Recovery of Function; D051437:Renal Insufficiency / Q000150:complications* / Q000401:mortality* / Q000503:physiopathology; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D014546:Urinary Catheterization / Q000009:adverse effects / Q000706:statistics & numerical data
keywords: CKD-EPI; Geriatric patients; Hip fracture; Mortality; Polypharmacy; Renal dysfunction; Urinary catheter