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Temporal trends in the incidence, treatment, and outcomes of hip fracture in older patients initiating dialysis in the United States.

Publication ,  Journal Article
Nair, SS; Mitani, AA; Goldstein, BA; Chertow, GM; Lowenberg, DW; Winkelmayer, WC
Published in: Clin J Am Soc Nephrol
August 2013

BACKGROUND AND OBJECTIVES: Patients with ESRD experience a fivefold higher incidence of hip fracture than the age- and sex-matched general population. Despite multiple changes in the treatment of CKD mineral bone disorder, little is known about long-term trends in hip fracture incidence, treatment patterns, and outcomes in patients on dialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Fourteen annual cohorts (1996-2009) of older patients (≥67 years) initiating dialysis in the United States were studied. Eligible patients had Medicare fee-for-service coverage for ≥2 years before dialysis initiation and were followed for ≤3 years for a first hip fracture. Type of treatment (internal fixation or partial or total hip replacement) was ascertained along with 30-day mortality. Cox and modified Poisson regressions were used to describe trends in study outcomes. RESULTS: This study followed 409,040 patients over 607,059 person-years, during which time 17,887 hip fracture events were recorded (29.3 events/1000 person-years). Compared with patients incident for ESRD in 1996, adjusted hip fracture rates increased until the 2004 cohort (+41%) and declined thereafter. Surgical treatment included internal fixation in 56%, partial hip replacement in 29%, and total hip replacement in 2%, which remained essentially unchanged over time; 30-day mortality after hip fracture declined from 20% (1996) to 16% (2009). CONCLUSIONS: Hip fracture incidence rates remain higher today than in patients reaching ESRD in 1996, despite multiple purported improvements in the management of CKD mineral bone disorder. Although recent declines in incidence and steady declines in associated short-term mortality are encouraging, hip fractures remain among the most common and consequential noncardiovascular complications of ESRD.

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Published In

Clin J Am Soc Nephrol

DOI

EISSN

1555-905X

Publication Date

August 2013

Volume

8

Issue

8

Start / End Page

1336 / 1342

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • United States
  • Treatment Outcome
  • Renal Dialysis
  • Proportional Hazards Models
  • Male
  • Kidney Failure, Chronic
  • Incidence
  • Humans
  • Hip Fractures
 

Citation

APA
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Nair, S. S., Mitani, A. A., Goldstein, B. A., Chertow, G. M., Lowenberg, D. W., & Winkelmayer, W. C. (2013). Temporal trends in the incidence, treatment, and outcomes of hip fracture in older patients initiating dialysis in the United States. Clin J Am Soc Nephrol, 8(8), 1336–1342. https://doi.org/10.2215/CJN.10901012
Nair, Sumi Sukumaran, Aya A. Mitani, Benjamin A. Goldstein, Glenn M. Chertow, David W. Lowenberg, and Wolfgang C. Winkelmayer. “Temporal trends in the incidence, treatment, and outcomes of hip fracture in older patients initiating dialysis in the United States.Clin J Am Soc Nephrol 8, no. 8 (August 2013): 1336–42. https://doi.org/10.2215/CJN.10901012.
Nair SS, Mitani AA, Goldstein BA, Chertow GM, Lowenberg DW, Winkelmayer WC. Temporal trends in the incidence, treatment, and outcomes of hip fracture in older patients initiating dialysis in the United States. Clin J Am Soc Nephrol. 2013 Aug;8(8):1336–42.
Nair, Sumi Sukumaran, et al. “Temporal trends in the incidence, treatment, and outcomes of hip fracture in older patients initiating dialysis in the United States.Clin J Am Soc Nephrol, vol. 8, no. 8, Aug. 2013, pp. 1336–42. Pubmed, doi:10.2215/CJN.10901012.
Nair SS, Mitani AA, Goldstein BA, Chertow GM, Lowenberg DW, Winkelmayer WC. Temporal trends in the incidence, treatment, and outcomes of hip fracture in older patients initiating dialysis in the United States. Clin J Am Soc Nephrol. 2013 Aug;8(8):1336–1342.

Published In

Clin J Am Soc Nephrol

DOI

EISSN

1555-905X

Publication Date

August 2013

Volume

8

Issue

8

Start / End Page

1336 / 1342

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • United States
  • Treatment Outcome
  • Renal Dialysis
  • Proportional Hazards Models
  • Male
  • Kidney Failure, Chronic
  • Incidence
  • Humans
  • Hip Fractures