髋部骨折患者的慢性肾病:发病率和结果

IF 2.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL International Journal of Clinical Practice Pub Date : 2024-05-09 DOI:10.1155/2024/4456803
Alexander Fisher, Jo-Wai Douglas Wang, Paul N. Smith
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引用次数: 0

摘要

目的。尽管慢性肾脏病(CKD)与骨质疏松性骨折之间的关系已得到证实,但有关慢性肾脏病合并髋部骨折(HF)的数据却很少且存在争议。我们旨在评估髋部骨折患者中慢性肾脏病的患病率、其对住院死亡率和住院时间(LOS)的影响,并确定慢性肾脏病在预测住院结果方面的预后价值。研究方法对连续收集的 3623 名年龄≥65 岁的高血压患者(平均年龄为 83.4 ± 7.50 [标准差]岁;74.4% 为女性)的临床数据进行了前瞻性分析。结果慢性肾功能衰竭在老年心房颤动患者中的发病率很高(39.9%),具有不同的临床特征,死亡率高出 2.5 倍,延长 LOS 的风险高出 40%。高龄(80 岁)是导致不良预后的最大风险因素。如果合并慢性疾病,尤其是冠状动脉疾病、贫血、甲状旁腺功能亢进和心房颤动,死亡风险会大幅增加;仅基于三个变量--KKD 分期、年龄 80 岁和是否存在特定慢性疾病--的模型可以预测院内死亡,具有良好的区分能力(AUC ≥ 0.700)和合理的准确性,预测所需人数在 5.7 到 14.5 之间。只有 12% 的高血压患者在骨折前服用了骨质疏松药物。结论在患有慢性肾脏病的高血压患者中,不良预后的风险随着肾功能的恶化而增加,尤其是与合并症同时出现时;基于三个入院变量的模型可预测致命预后。评估肾功能对预防骨质疏松性骨折至关重要。
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Chronic Kidney Disease in Patients with Hip Fracture: Prevalence and Outcomes

Objective. Although the association between chronic kidney disease (CKD) and osteoporotic fractures is well established, data on CKD combined with hip fracture (HF) are scarce and controversial. We aimed to assess in patients with HF the prevalence of CKD, its impact on hospital mortality and length of stay (LOS) and to determine the prognostic value of CKD to predict hospital outcomes. Methods. Prospectively collected clinical data were analysed in 3623 consecutive HF patients aged ≥65 years (mean age 83.4 ± 7.50 [standard deviation] years; 74.4% females). Results. CKD among older patients with HF is highly prevalent (39.9%), has different clinical characteristics, a 2.5-fold higher mortality rate, and 40% greater risk of prolonged LOS. The strongest risk for a poor outcome was advanced age (>80 years). The risk of death substantially increases in combination with chronic disorders, especially coronary artery disease, anaemia, hyperparathyroidism, and atrial fibrillation; models based only on three variables—CKD stage, age >80, and presence of a specific chronic condition—predicted in-hospital death with good discrimination capability (AUC ≥ 0.700) and reasonable accuracy, the number needed to predict ranged between 5.7 and 14.5. Only 12% of HF patients received osteoporotic drugs prefracture. Conclusion. In HF patients with CKD, the risk of adverse outcomes largely increases in parallel with worsening kidney function and, especially, in combination with comorbidities; models based on three admission variables predict a fatal outcome. Assessment of renal function is essential to preventing osteoporotic fractures.

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来源期刊
CiteScore
5.30
自引率
0.00%
发文量
274
审稿时长
3-8 weeks
期刊介绍: IJCP is a general medical journal. IJCP gives special priority to work that has international appeal. IJCP publishes: Editorials. IJCP Editorials are commissioned. [Peer reviewed at the editor''s discretion] Perspectives. Most IJCP Perspectives are commissioned. Example. [Peer reviewed at the editor''s discretion] Study design and interpretation. Example. [Always peer reviewed] Original data from clinical investigations. In particular: Primary research papers from RCTs, observational studies, epidemiological studies; pre-specified sub-analyses; pooled analyses. [Always peer reviewed] Meta-analyses. [Always peer reviewed] Systematic reviews. From October 2009, special priority will be given to systematic reviews. [Always peer reviewed] Non-systematic/narrative reviews. From October 2009, reviews that are not systematic will be considered only if they include a discrete Methods section that must explicitly describe the authors'' approach. Special priority will, however, be given to systematic reviews. [Always peer reviewed] ''How to…'' papers. Example. [Always peer reviewed] Consensus statements. [Always peer reviewed] Short reports. [Always peer reviewed] Letters. [Peer reviewed at the editor''s discretion] International scope IJCP publishes work from investigators globally. Around 30% of IJCP articles list an author from the UK. Around 30% of IJCP articles list an author from the USA or Canada. Around 45% of IJCP articles list an author from a European country that is not the UK. Around 15% of articles published in IJCP list an author from a country in the Asia-Pacific region.
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