title: Acute and chronic kidney disease in elderly patients with hip fracture: prevalence, risk factors and outcome with development and validation of a risk prediction model for acute kidney injury.
abstract: Hip fracture is a common injury in older people with a high rate of postoperative morbidity and mortality. This patient group is also at high risk of acute kidney injury (AKI) and chronic kidney disease (CKD), but little is known of the impact of kidney disease on outcome following hip fracture.
  
  
  
  An observational cohort of consecutive patients with hip fracture in a large UK secondary care hospital. Predictive modelling of outcomes using development and validation datasets. Inclusion: all patients admitted with hip fracture with sufficient serum creatinine measurements to define acute kidney injury. Main outcome measures - development of acute kidney injury during admission; mortality (in hospital, 30-365 day and to follow-up); length of hospital stay.
  
  
  
  Data were available for 2848 / 2959 consecutive admissions from 2007-2011; 776 (27.2%) male. Acute kidney injury occurs in 24%; development of acute kidney injury is independently associated with male sex (OR 1.48 (1.21 to 1.80), premorbid chronic kidney disease stage 3B or worse (OR 1.52 (1.19 to 1.93)), age (OR 3.4 (2.29 to 5.2) for >85 years) and greater than one major co-morbidities (OR 1.61 (1.34 to 1.93)). Acute kidney injury of any stage is associated with an increased hazard of death, and increased length of stay (Acute kidney injury: 19.1 (IQR 13 to 31) days; no acute kidney injury 15 (11 to 23) days). A simplified predictive model containing Age, CKD stage (3B-5), two or more comorbidities, and male sex had an area under the ROC curve of 0.63 (0.60 to 0.67).
  
  
  
  Acute kidney injury following hip fracture is common and associated with worse outcome and greater hospital length of stay. With the number of people experiencing hip fracture predicted to rise, recognition of risk factors and optimal perioperative management of acute kidney injury will become even more important.
authors.affiliation: Renal and Transplant Unit, Nottingham University Hospitals NHS Trust, Nottingham, NG5 1PB, UK.
authors.forename: Christine J
authors.initials: CJ
authors.lastname: Porter
authors.affiliation: Anaesthesia and Critical Care, Division of Clinical Neuroscience, University of Nottingham, Nottingham, NG7 2RD, UK. Iain.moppett@nottingham.ac.uk.|Department of Anaesthesia, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK. Iain.moppett@nottingham.ac.uk.
authors.forename: Iain K
authors.initials: IK
authors.lastname: Moppett
authors.affiliation: Information and Computer Technology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: Irene
authors.initials: I
authors.lastname: Juurlink
authors.affiliation: Department of Orthopaedic Trauma, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: Jessica
authors.initials: J
authors.lastname: Nightingale
authors.affiliation: Department of Orthopaedic Trauma, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Moran
authors.affiliation: Renal and Transplant Unit, Nottingham University Hospitals NHS Trust, Nottingham, NG5 1PB, UK.
authors.forename: Mark A J
authors.initials: MA
authors.lastname: Devonald
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000453:epidemiology*; D000368:Aged; D000369:Aged, 80 and over; D003404:Creatinine / Q000097:blood; D005260:Female; D006620:Hip Fractures / Q000453:epidemiology / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000097:blood / Q000453:epidemiology*; D015995:Prevalence; D016016:Proportional Hazards Models; D020127:Recovery of Function; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000453:epidemiology*; D018570:Risk Assessment; D012307:Risk Factors; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D003404:Creatinine
keywords: Acute kidney injury (AKI); Hip fracture; Hospital length of stay; KDIGO creatinine criteria; Kidney function; Mortality; Postoperative AKI; Surgery; Surgical complication