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Osteoporotic fracture rates in chronic hemodialysis and effect of heparin exposure: a retrospective cohort study
BACKGROUND: Patients receiving chronic hemodialysis treatments are at a higher risk of fracture compared to the general population. While the use of heparin during dialysis is crucial to avoid thrombosis of the extracorporeal circuit, the association of unfractionated heparin (UFH) and the risk of o...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7350680/ https://www.ncbi.nlm.nih.gov/pubmed/32646504 http://dx.doi.org/10.1186/s12882-020-01916-4 |
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author | Harrak, Hind René, Emilie Alsalemi, Noor Elftouh, Naoual Lafrance, Jean-Philippe |
author_facet | Harrak, Hind René, Emilie Alsalemi, Noor Elftouh, Naoual Lafrance, Jean-Philippe |
author_sort | Harrak, Hind |
collection | PubMed |
description | BACKGROUND: Patients receiving chronic hemodialysis treatments are at a higher risk of fracture compared to the general population. While the use of heparin during dialysis is crucial to avoid thrombosis of the extracorporeal circuit, the association of unfractionated heparin (UFH) and the risk of osteoporotic fracture has been shown for many years. However, this association was not as clear for low-molecular-weight heparin (LMWH) and the few collected data originated from studies among pregnant women. Our aim was to measure osteoporotic fracture rate among hemodialysis patients and to evaluate the association of LMWH compared to UFH in hemodialysis. METHODS: A retrospective cohort study was conducted on data extracted from the RAMQ and Med-Echo databases from January 2007 to March 2013 with patients chronically hemodialyzed in 21 participating centers. Incidence rates for each fracture sites were measured per 1000 patient-year (p-y) and their 95% confidence intervals (CI). Osteoporotic fracture risk for a first event with LMWH compared to UFH was estimated using a cox proportional hazard model using demographics, comorbidities and drug use as covariates. RESULTS: 4796 patients undergoing chronic hemodialysis were identified. The incidence rate for all fracture sites was 22.7 /1000 p-y (95% CI: 19.6–26.1) and 12.8 /1000 p-y (95% CI: 10.5–15.4) for hip and femur fractures. We found a similar risk of osteoporotic fracture for LMWH compared to UFH (adjusted HR = 1.01; 95%CI: 0.72–1.42). Age and malignancy increased the risk of fracture while cerebrovascular disease decreased the risk of fracture. CONCLUSIONS: Compared to UFH, LMWH did not change the risk of osteoporotic fracture when used for the extracorporeal circuit anticoagulation in chronic hemodialysis. |
format | Online Article Text |
id | pubmed-7350680 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-73506802020-07-14 Osteoporotic fracture rates in chronic hemodialysis and effect of heparin exposure: a retrospective cohort study Harrak, Hind René, Emilie Alsalemi, Noor Elftouh, Naoual Lafrance, Jean-Philippe BMC Nephrol Research Article BACKGROUND: Patients receiving chronic hemodialysis treatments are at a higher risk of fracture compared to the general population. While the use of heparin during dialysis is crucial to avoid thrombosis of the extracorporeal circuit, the association of unfractionated heparin (UFH) and the risk of osteoporotic fracture has been shown for many years. However, this association was not as clear for low-molecular-weight heparin (LMWH) and the few collected data originated from studies among pregnant women. Our aim was to measure osteoporotic fracture rate among hemodialysis patients and to evaluate the association of LMWH compared to UFH in hemodialysis. METHODS: A retrospective cohort study was conducted on data extracted from the RAMQ and Med-Echo databases from January 2007 to March 2013 with patients chronically hemodialyzed in 21 participating centers. Incidence rates for each fracture sites were measured per 1000 patient-year (p-y) and their 95% confidence intervals (CI). Osteoporotic fracture risk for a first event with LMWH compared to UFH was estimated using a cox proportional hazard model using demographics, comorbidities and drug use as covariates. RESULTS: 4796 patients undergoing chronic hemodialysis were identified. The incidence rate for all fracture sites was 22.7 /1000 p-y (95% CI: 19.6–26.1) and 12.8 /1000 p-y (95% CI: 10.5–15.4) for hip and femur fractures. We found a similar risk of osteoporotic fracture for LMWH compared to UFH (adjusted HR = 1.01; 95%CI: 0.72–1.42). Age and malignancy increased the risk of fracture while cerebrovascular disease decreased the risk of fracture. CONCLUSIONS: Compared to UFH, LMWH did not change the risk of osteoporotic fracture when used for the extracorporeal circuit anticoagulation in chronic hemodialysis. BioMed Central 2020-07-09 /pmc/articles/PMC7350680/ /pubmed/32646504 http://dx.doi.org/10.1186/s12882-020-01916-4 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Article Harrak, Hind René, Emilie Alsalemi, Noor Elftouh, Naoual Lafrance, Jean-Philippe Osteoporotic fracture rates in chronic hemodialysis and effect of heparin exposure: a retrospective cohort study |
title | Osteoporotic fracture rates in chronic hemodialysis and effect of heparin exposure: a retrospective cohort study |
title_full | Osteoporotic fracture rates in chronic hemodialysis and effect of heparin exposure: a retrospective cohort study |
title_fullStr | Osteoporotic fracture rates in chronic hemodialysis and effect of heparin exposure: a retrospective cohort study |
title_full_unstemmed | Osteoporotic fracture rates in chronic hemodialysis and effect of heparin exposure: a retrospective cohort study |
title_short | Osteoporotic fracture rates in chronic hemodialysis and effect of heparin exposure: a retrospective cohort study |
title_sort | osteoporotic fracture rates in chronic hemodialysis and effect of heparin exposure: a retrospective cohort study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7350680/ https://www.ncbi.nlm.nih.gov/pubmed/32646504 http://dx.doi.org/10.1186/s12882-020-01916-4 |
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