Hip fractures in hemodialysis patients

Abstract

Introduction: Hip fractures (HF) have a high incidence in the general population over 50 years old. They are more frequent in women and they cause high morbidity and mortality. There are factors in dialysis patients that exacerbate this problem. In Argentina there are epidemiological studies in the general population but not on dialysis. Methods: Here we analyzed the incidence of HF in Hemodialysis patients; we identify the fracture-related factors, to prevent this event, and the twelve months’s evolution. Nine institutions from the Regional Association of Dialysis and Transplant of Buenos Aires city and Buenos Aires province participated in this study. The centres identified all patients who have suffered a hip fracture between 1977 and 2007 (11 years). Results: Clinical data from the fractured patients were identified: age, sex, habits, social and medical coverage, BMI and Karnovsky Index, concomitant diseases, surgery interventions, laboratory results, previous medication and evolution after a year. 50 patients with HF were identified on a total of 4361 patients/year of follow-up (2430 men and 1931 women). The rate resulted to be of 11.47 patients fractured per 1000 HD patients/year. The rate in men was of 8.64 and in women 15.02 fractures/1000 per year (p<0.01). The mean age was 62.88 (± 16.7). In the 6 months previous 52% of them received anti-hypertensive drugs and 22% use psychotropic drugs. 72% presented cardiovascular disease, 38% previous falls, 26% visual disturbances, and 16% previous fractures. Place of the fracture incident was home at a 78%. Surgical treatment was performed in 80% of the cases and the survival one year after the treatment was of 70%. Conclusion: Comparing national studies, rates in HD patients are between 5 and 10 times higher than the general population older than 50 th. Mortality after a year is 50% higher in fractured patients than in prevalent patients at the same age on dialysis (30% vs. 19.5%). The increased occurrence at home, shows the need of prevention from falls for all those patients with high risk factors. It is not worthless that 10% of these falls are related to the treatment (6% at the centre and 4% at the transport). Physical aptitude data prior to the fracture (as measured by Karnovsky index) were similar to those of incident patients on dialysis, according to the Argentine Registry.

How to cite this article:

Lavorato CA, Pérez Loredo J, Del Amo M, Caputo F, Gasparini Rainoldi C, López M, Masso R, Osso J, Roland S, Soraire E. [Hip fractures in hemodialysis patients]. Rev Nefrol Dial Traspl. 2009;29(3):137-44.