Nov 27

Increasing Hip Fractures in Patients Receiving Hemodialysis and Peritoneal Dialysis / Incremento de fracturas de cadera en pacientes que reciben hemodiálisis y la diálisis peritoneal

De:
Am J Nephrol 2014;40:451-457
(DOI:10.1159/000369039)

Increasing Hip Fractures in Patients Receiving Hemodialysis and Peritoneal Dialysis

Mathew A.T. · Hazzan A. · Jhaveri K.D. · Block G.A. · Chidella S. · Rosen L. · Wagner J. · Fishbane S.aHofstra NSLIJ School of Medicine, North Shore University Hospital and Long Island Jewish Medical Center, Great Neck, N.Y., bDenver Nephrologists, PC, Denver, Co., and cKings County Hospital Center, College of Medicine, SUNY Downstate Medical Center, Brooklyn, N.Y., USA

Usted puede leer un resumen del artículo en:
http://www.karger.com/Article/Abstract/369039

Abstract

Background/Aims: Dialysis patients are at increased risk for hip fractures. Because changes in treatment of metabolic bone disease in this population may have impacted bone fragility, this study aims to analyze the longitudinal risk for fractures in hemodialysis (HD) and peritoneal dialysis (PD) patients. Methods: Using the United States Renal Data System database from 1992 to 2009, the temporal trend in hip fractures requiring hospitalization was analyzed using an overdispersed Poisson regression model. Generalized Estimating Equations were used to assess the adjusted effect of dialysis modality on hip fractures. Results: 842,028 HD and 87,086 PD patients were included. There was a significant temporal increase in hip fractures in both HD and PD with stabilization of rates after 2005. With stratification, the increase in fractures occurred in patients who were white and over 65 years of age. In adjusted analyses, HD patients had 1.6 times greater odds of hip fracture than PD patients (OR 1.60 95% CI 1.52, 1.68, p < 0.001). Conclusions: In contrast to the declining hip fracture rates in the general population, we identified a temporal rise in incidence of hip fractures in HD and PD patients. HD patients were at a higher risk for hip fractures than PD patients after adjustment for recognized bone fragility risk factors. The increase in fracture rate over time was limited to older white patients in both HD and PD, the demographics being consistent with osteoporosis risk. Further research is indicated to better understand the longitudinal trend in hip fractures and the discordance between HD and PD.
Resumen:

Antecedentes / Objetivos: Los pacientes en diálisis están en mayor riesgo de fracturas de cadera. Debido a cambios en el tratamiento de la enfermedad ósea metabólica en esta población pueden haber impactado la fragilidad ósea, este estudio tiene como objetivo analizar el riesgo longitudinal para las fracturas en hemodiálisis (HD) y diálisis peritoneal (DP) de los pacientes. Métodos: Utilizando la base de datos de Estados Unidos Sistema Renal Dato de 1992 a 2009, se analizó la tendencia temporal de las fracturas de cadera que requieren hospitalización utilizando un modelo de regresión de Poisson overdispersed. Generalizadas ecuaciones de estimación se utilizaron para evaluar el efecto ajustado de la modalidad de diálisis en fracturas de cadera. Resultados: 842 028 HD y 87.086 PD pacientes fueron incluidos. Hubo un aumento temporal significativa de las fracturas de cadera en ambos HD y DP con la estabilización de las tasas después de 2005. Con la estratificación, el aumento de las fracturas ocurrieron en pacientes que eran blancos y de más de 65 años de edad. En análisis ajustados, los pacientes en HD tenían 1,6 veces mayor probabilidad de fractura de cadera que los pacientes con EP (OR 1.60 IC 95%: 1,52, 1,68, p <0,001). Conclusiones: En contraste con las tasas de fracturas de cadera en declive en la población general, hemos identificado un aumento temporal en la incidencia de fracturas de cadera en pacientes en HD y DP. Pacientes en HD se encontraban en mayor riesgo de fracturas de cadera que los pacientes con EP después de ajustar por factores de riesgo de la fragilidad ósea reconocido. El aumento de la tasa de fractura con el tiempo se limitó a pacientes blancos mayores, tanto en HD y DP, la demografía ser consistente con el riesgo de osteoporosis. La investigación adicional está indicado para comprender mejor la tendencia longitudinal en fracturas de cadera y la discordancia entre HD y DP.

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