Purpose People living with chronic kidney disease (CKD) are at a higher risk of hip fracture with an associated increased mortality risk compared to individuals without CKD. Our study aimed to evaluate the clinical assessment tools that best predict mortality risk following hip fracture for patients with CKD. Methods Patients with CKD G3b-5D admitted to Lancashire Teaching Hospitals NHS Foundation Trust, U.K. between June 2013 and Dec 2019 were included. The association between CKD and post-fracture mortality risk was evaluated. All patients were assessed using tools that evaluated frailty status, co-morbidity, pre-operative risk, functional status and cardiopulmonary fitness. Receiver operating characteristic curve analyses were performed to determine the prognostic accuracy of the assessment tools for 30 day and 1 year mortality following hip fracture in patients with CKD. Results 397 patients fulfilled inclusion criteria with a mean age of 83.5 ± 9.2 years. Older age, female sex, intracapsular fracture and more severe CKD, co-morbidity and frailty status were all associated with an increased mortality risk. Patients with dialysis-dependent CKD and severe/very severe frailty had a hazard ratio for mortality of 2.55 (95% Cl 2.11–2.98) and 3.11 (95% Cl 2.47–3.93), respectively. The Clinical Frailty Scale demonstrated the best prognostic accuracy for both 30 day [Area Under the Curve (AUC) 0.91, 95% Cl 0.84–0.97] and 1 year mortality (AUC 0.93, 95% Cl 0.87–1.00). Conclusion Patients with advanced CKD and severe frailty have a high mortality risk following hip fracture. The Clinical Frailty Scale is an excellent prognostic tool for mortality in this setting and could be easily incorporated into routine clinical practice.
Thirty patients from across Canada participated in the pilot testing from April to May 2020. Approximately half were male (53%) and less than 50 years of age (40%). Approximately 40% had an estimated glomerular filtration rate (eGFR) <30mls/min/1.73m 2 , and the rest had an eGFR $30 mls/min/1.73m 2 or did not know their eGFR. Internal consistency reliability (Cronbach's alpha) was 0.915. Participants were satisfied with the content, wording and design. A common comment was need for a question that more explicitly addressed mental health; consequently, we included an additional item relating to mental health in the final instrument. Conclusions: We used self-management theories, patient-identified selfmanagement needs, expert review, and conducted preliminary psychometric testing to finalize an early-stage CKD self-management questionnaire (esCKD-SM). Results from stage 4 (additional internal consistency measurements, test-retest reliability, and convergent validity) will be available in February 2021. Once finalized, the esCKD-SM questionnaire has the potential to contribute to our understanding of self-management among those in the earliest stages of CKD.
Background and Aims Patients living with chronic kidney disease (CKD) are at greater susceptibility of sustaining hip fractures compared to those without CKD due to higher falls risk. Post-trauma clinical outcomes for patients living with CKD are exacerbated by frailty, co-morbidities and sarcopenia. Patients living with CKD may require lengthy hospitalization following hip fracture, considering the additional indications for extensive treatment and rehabilitation. A long hospital stay may bring greater risks of contracting COVID-19, given the magnitude of this current global pandemic. Complications from COVID-19 significantly increase mortality risks for older patients living with CKD after acute trauma, as a considerable proportion will have a poor baseline health and functional status. Our study aims to determine the most useful clinical and laboratory assessment tools to predict for a positive COVID-19 status following hospitalization with hip fracture in patients living with CKD. Method Patients with CKDG3b-5 admitted from home to a tertiary hospital in North West UK with hip fracture between Feb and Dec 2020 were included. Each patient included in this study received at least one COVID-19 nasopharyngeal swab during their hospitalization. Parameters assessed on hospital admission for each patient included Clinical Frailty Scale (CFS), Charlson’s Co-morbidity Index (CCI), Chronic Kidney Disease Frailty Index Laboratory Score (CKD FI-LAB), Estimated VO2 Peak, Karnofsky Performance Status Scale, Sernbo Score, Nottingham Hip Fracture Score, ASA Physical Status Classification System Score and Abbreviated Mental Test Score. Receiver Operating Characteristic (ROC) curve analyses were performed to evaluate the ability of individual parameters to predict for a positive COVID-19 status following hip fracture in patients living with CKD. Events of 30-day mortality were recorded. Results 92 patients met study inclusion criteria. The mean age was 84.6±7.8 years and the female:male ratio was 1.6:1. 7 patients (7.6%) were on long-term dialysis and the mean eGFR amongst non-dialysis patients was 36.5±13.8 ml/min/1.73m2. The median length of hospitalization was 17 days. 22 patients (23.9%) tested positive for COVID-19. Area under a Curve (AUC) values from ROC analyses are shown in Table 1. The difference in 30-day mortality rate between patients who tested positive for COVID-19 and those who tested negative was +6.8% (p<0.001). Conclusion Frailty and co-morbidity assessment tools (CFS, CCI and CKD FI-LAB) displayed the best predictive ability for positive COVID-19 status following hip fracture in patients living with CKD. A continuous, holistic multi-disciplinary team approach during hospitalization for comprehensive geriatric assessment and optimization of medical co-morbidities may improve outcomes, in anticipation of a potential lengthy hospital stay. To improve prognosis, research efforts should continue to explore avenues on reducing COVID-19 rates within this patient population.
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