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The impact of acute kidney injury with temporary dialysis on the risk of fracture.

Authors
  • Wang, Wei-Jie
  • Chao, Chia-Ter
  • Huang, Yu-Chin
  • Wang, Cheng-Yi
  • Chang, Chia-Hsui
  • Huang, Tao-Min
  • Lai, Chun-Fu
  • Huang, Hui-Yu
  • Shiao, Chih-Chung
  • Chu, Tzong-Shinn
  • Chen, Yung-Ming
  • Wu, Vin-Cent
  • Ko, Wen-Je
  • Wu, Kwan-Dun
Type
Published Article
Journal
Journal of Bone and Mineral Research
Publisher
Wiley
Publication Date
Mar 01, 2014
Volume
29
Issue
3
Pages
676–684
Identifiers
DOI: 10.1002/jbmr.2061
PMID: 23929760
Source
Medline
Keywords
License
Unknown

Abstract

Acute kidney injury (AKI) has a negative impact on long-term renal function and prognosis. However, the association between acute renal dysfunction and long-term effects on bone disorders has not yet been characterized. Using a population-based cohort study, we aimed to evaluate associations between AKI and long-term effects on bone fractures. We identified relevant data of all hospitalized patients aged >18 years with histories of dialysis-requiring AKI, with subsequent recovery and discharge, from the claim records of the Taiwan National Health Insurance database between 2000 and 2008. We determined long-term de novo bone fracture and all-cause mortality after patients' index-hospitalization discharge using propensity score-adjusted Cox proportional hazard model. Varying-time models were used to adjust for long-term effects of end-stage renal disease (ESRD) on main outcomes. Among 448 AKI patients who had dialysis and survived 90 days after index-hospitalization discharge without reentering dialysis, 273 were male (60.9%) with a mean age of 61.4 ± 16.6 years. Controls included 1792 hospitalized patients without AKI, dialysis, or bone fracture history. In the AKI recovery group, bone fracture incidence was 320 per 10,000 person-years and hazard ratio (HR) of long-term bone fracture was 1.25 (p = 0.049) compared with the control group, independent of subsequent ESRD status (HR = 1.55; p = 0.01). Both AKI recovery status (HR = 2.31; p < 0.001) and time varying factor of bone fracture (HR = 1.43; p < 0.001) were independent predictors of mortality compared with controls. In conclusion, AKI requiring temporary dialysis independently increases long-term risk of bone fracture, regardless of subsequent progression to ESRD. Long-term bone fractures may negatively impact patient mortality.

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