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Association between cause of kidney failure and fracture incidence in a national US dialysis population cohort study

BACKGROUND: Whether fracture rates, overall and by fracture site, vary by cause of kidney failure in patients receiving dialysis is unknown. METHODS: Using the US Renal Data System, we compared fracture rates across seven causes of kidney failure in patients who started dialysis between 1997 and 201...

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Autores principales: Ziolkowski, Susan, Liu, Sai, Montez-Rath, Maria E, Denburg, Michelle, Winkelmayer, Wolfgang C, Chertow, Glenn M, O'Shaughnessy, Michelle M
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2022
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9664571/
https://www.ncbi.nlm.nih.gov/pubmed/36381373
http://dx.doi.org/10.1093/ckj/sfac193
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author Ziolkowski, Susan
Liu, Sai
Montez-Rath, Maria E
Denburg, Michelle
Winkelmayer, Wolfgang C
Chertow, Glenn M
O'Shaughnessy, Michelle M
author_facet Ziolkowski, Susan
Liu, Sai
Montez-Rath, Maria E
Denburg, Michelle
Winkelmayer, Wolfgang C
Chertow, Glenn M
O'Shaughnessy, Michelle M
author_sort Ziolkowski, Susan
collection PubMed
description BACKGROUND: Whether fracture rates, overall and by fracture site, vary by cause of kidney failure in patients receiving dialysis is unknown. METHODS: Using the US Renal Data System, we compared fracture rates across seven causes of kidney failure in patients who started dialysis between 1997 and 2014. We computed unadjusted and multivariable adjusted proportional sub-distribution hazard models, with fracture events (overall, and by site) as the outcome and immunoglobulin A nephropathy as the reference group. Kidney transplantation and death were competing events. RESULTS: Among 491 496 individuals, with a median follow-up of 2.0 (25%, 75% range 0.9–3.9) years, 62 954 (12.8%) experienced at least one fracture. Patients with diabetic nephropathy, vasculitis or autosomal polycystic kidney disease (ADPKD) had the highest (50, 46 and 40 per 1000 person-years, respectively), and patient with lupus nephritis had the lowest (20 per 1000 person-years) fracture rates. After multivariable adjustment, diabetic nephropathy [hazard ratio (HR) 1.43, 95% confidence interval 1.33–1.53], ADPKD (HR 1.37, 1.26–1.48), vasculitis (HR 1.22, 1.09–1.34), membranous nephropathy (HR 1.16, 1.02–1.30) and focal segmental glomerulosclerosis (FSGS) (HR 1.13, 1.02–1.24) were associated with a significantly higher, and lupus nephritis with a significantly lower (HR 0.85, 0.71–0.98) fracture hazard. The hazards for upper extremity and lower leg fractures were significantly higher in diabetic nephropathy, ADPKD, FSGS and membranous nephropathy, while the hazard for vertebral fracture was significantly higher in vasculitis. Our findings were limited by the lack of data on medication use and whether fractures were traumatic or non-traumatic, among other factors. CONCLUSIONS: Fracture risk, overall and by fracture site, varies by cause of end-stage kidney disease. Future work to determine underlying pathogenic mechanisms contributing to differential risks might inform more tailored treatment strategies. Our study was limited by lack of data regarding numerous potential confounders or mediators including medications and measures or bone biomarkers.
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spelling pubmed-96645712022-11-14 Association between cause of kidney failure and fracture incidence in a national US dialysis population cohort study Ziolkowski, Susan Liu, Sai Montez-Rath, Maria E Denburg, Michelle Winkelmayer, Wolfgang C Chertow, Glenn M O'Shaughnessy, Michelle M Clin Kidney J Original Article BACKGROUND: Whether fracture rates, overall and by fracture site, vary by cause of kidney failure in patients receiving dialysis is unknown. METHODS: Using the US Renal Data System, we compared fracture rates across seven causes of kidney failure in patients who started dialysis between 1997 and 2014. We computed unadjusted and multivariable adjusted proportional sub-distribution hazard models, with fracture events (overall, and by site) as the outcome and immunoglobulin A nephropathy as the reference group. Kidney transplantation and death were competing events. RESULTS: Among 491 496 individuals, with a median follow-up of 2.0 (25%, 75% range 0.9–3.9) years, 62 954 (12.8%) experienced at least one fracture. Patients with diabetic nephropathy, vasculitis or autosomal polycystic kidney disease (ADPKD) had the highest (50, 46 and 40 per 1000 person-years, respectively), and patient with lupus nephritis had the lowest (20 per 1000 person-years) fracture rates. After multivariable adjustment, diabetic nephropathy [hazard ratio (HR) 1.43, 95% confidence interval 1.33–1.53], ADPKD (HR 1.37, 1.26–1.48), vasculitis (HR 1.22, 1.09–1.34), membranous nephropathy (HR 1.16, 1.02–1.30) and focal segmental glomerulosclerosis (FSGS) (HR 1.13, 1.02–1.24) were associated with a significantly higher, and lupus nephritis with a significantly lower (HR 0.85, 0.71–0.98) fracture hazard. The hazards for upper extremity and lower leg fractures were significantly higher in diabetic nephropathy, ADPKD, FSGS and membranous nephropathy, while the hazard for vertebral fracture was significantly higher in vasculitis. Our findings were limited by the lack of data on medication use and whether fractures were traumatic or non-traumatic, among other factors. CONCLUSIONS: Fracture risk, overall and by fracture site, varies by cause of end-stage kidney disease. Future work to determine underlying pathogenic mechanisms contributing to differential risks might inform more tailored treatment strategies. Our study was limited by lack of data regarding numerous potential confounders or mediators including medications and measures or bone biomarkers. Oxford University Press 2022-09-12 /pmc/articles/PMC9664571/ /pubmed/36381373 http://dx.doi.org/10.1093/ckj/sfac193 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of the ERA. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Original Article
Ziolkowski, Susan
Liu, Sai
Montez-Rath, Maria E
Denburg, Michelle
Winkelmayer, Wolfgang C
Chertow, Glenn M
O'Shaughnessy, Michelle M
Association between cause of kidney failure and fracture incidence in a national US dialysis population cohort study
title Association between cause of kidney failure and fracture incidence in a national US dialysis population cohort study
title_full Association between cause of kidney failure and fracture incidence in a national US dialysis population cohort study
title_fullStr Association between cause of kidney failure and fracture incidence in a national US dialysis population cohort study
title_full_unstemmed Association between cause of kidney failure and fracture incidence in a national US dialysis population cohort study
title_short Association between cause of kidney failure and fracture incidence in a national US dialysis population cohort study
title_sort association between cause of kidney failure and fracture incidence in a national us dialysis population cohort study
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9664571/
https://www.ncbi.nlm.nih.gov/pubmed/36381373
http://dx.doi.org/10.1093/ckj/sfac193
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