Fractures in Dialysis Patients Have High Morbidity and Mortality

Hemodialysis patients experience a high incidence of fractures and resulting adverse outcomes, reports a study in Kidney International.

The incidences of fracture events and postfracture morbidity and mortality were evaluated in an international cohort of 34,579 hemodialysis patients from the Dialysis Outcomes and Practice Patterns study. Fractures requiring hospital treatment occurred in 3 percent of participants overall, including 491 hip fractures and 643 other fractures. The incidence of fracture ranged from 12 per 1000 patient-years in Japan to 45 per 1000 patient-years in Belgium; the rate in the United States was 30 per 1000 patient-years.

Across countries, fracture rates were higher in hemodialysis patients than in the general population. With some variation between countries, postfracture mortality was greater than 500 per 1000 patient-years, and the combined rates of death and rehospitalization exceeded 1500 per 1000 patient-years. In comparison with hemodialysis patients without fracture, those sustaining fractures had a 3.7-fold increase in risk of death and a fourfold increase in the combined risk of death and rehospitalization. The rates of mortality and rehospitalization were highest in the month after fracture.

Relatively few studies have examined fracture rates and outcomes in the frail dialysis population. The new results show a high incidence of fractures in hemodialysis patients around the world, with high resulting rates of death and rehospitalization. “Fracture prevention strategies should be identified and applied broadly in nephrology practices,” the researchers conclude [Tentori F, et al. High rates of death and hospitalization follow bone fracture among hemodialysis patients. Kidney Int 2013; 85:166–173].