Characteristics and complications of fracture in older adults with chronic kidney disease: a cross-sectional study

Abstract

Background The aim of this study was to analyze the clinical characteristics of older fracture patients with chronic kidney disease (CKD) and to determine the risk factors of perioperative cardiovascular complications. Methods We retrospectively reviewed clinical data of older fracture patients with CKD admitted to the Third Hospital of Hebei Medical University from January 2016 to October 2021. The data we collected included baseline characteristics and complications. We finally determined the risk factors of perioperative cardiovascular complications by using logistic regression. Results We ended up enrolling 224 patients, and there were 91 (40.6%) males and 133 (59.4%) females, with a median age of 79 years. 80–84 years old was the age group with high incidence of fracture. The majority of fracture occurred indoors (130 cases, 58.0%) and morning (98 cases, 43.8%). Hip fracture was most common (183 cases, 81.7%), of which femoral neck fracture (101 cases, 45.0%) was the most prevalent. The most common comorbid condition was hypertension (171 cases, 76.3%), and anemia was the most common complication (148 cases, 66.1%). Age ≥ 80 years (OR = 2.023, 95% CI 1.110–3.688), previously combined with cardiovascular calcification (OR = 1.901, 95% CI 1.047–3.451) and admission hemoglobin level < 100 g/L (OR = 3.191, 95% CI 1.744–5.838) were independent risk factors of perioperative cardiovascular disease (CVD). Conclusion It was especially necessary to enhance fracture prevention for CKD. Patients whose age older than 80, hemoglobin less than 100 g/L on admission and have previous cardiovascular calcification are more likely to develop perioperative CVD. Such patients require reasonable decisions during the perioperative period to avoid the occurrence of CVD.

Characteristics of Preoperative Acute Myocardial Infarction in Elderly Hip Fracture Patients and Construction of a Clinical Prediction Model: A Retrospective Cohort Study

“…The studies documented that anemia or low hemoglobin levels on admission increased the risk of CVD and fracture in older adults. 32 , 33 Anemia is more likely to cause T2MI, 34 and we obtained the same results in patients with AMI after fracture. Hypoalbuminemia occurs in nearly 50% of elderly hip fracture patients and is associated with the development of perioperative complications and an increased risk of mortality.…”

Chronic Kidney Disease in Patients with Hip Fracture: Prevalence and Outcomes

“…In individuals with CKD, the IRRs for a lethal outcome were also 1.8-7.8-times higher when one of the following signs occurred (combined efect): trochanteric fracture, walking aid use, being a PRCF resident or being an active smoker, whereas presence of T2DM increased the IRR for prolonged LOS. Our fndings are in accordance with the literature showing a signifcantly higher mortality rate in HF patients with CKD of advanced age [26,27,29,70,75,99]. Male gender was also reported as a signifcant risk factor for a fatal outcome [26,29,99], although females who represent nearly 3/4 among HF A simplifed schematic illustrating the multidirectional interactions (direct and indirect) between CKD, musculoskeletal and other chronic systemic organ diseases contributing to falls, frailty, osteosarcopaenia, fractures, and poor outcomes.…”

“…In disease states, abnormalities in any of these systems can initiate and perpetuate structural and functional dysfunction in other organs. Not surprisingly, renal impairment, abnormalities in mineral-bone metabolism, numerous diseases encompassing T2DM, CAD, hypertension, heart failure, anaemia, dementia, COPD, etc., activate each other (via the autocrine, paracrine and nervous systems), creating metabolic dysregulation and vicious cycles of damage [11,27,78,79], leading to multimorbidity (i.e., renal osteodystrophy [80], cardiorenal syndrome [81], brainkidney axis/cross-talk [82][83][84][85][86][87]; CKD-COPD interaction [78,88]) which is strongly associated with falls and fractures (Figure 2). Clearly, in the elderly multiple chronic diseases, falls and fractures are competing events that cluster, and CKD is a risk factor for abovementioned conditions, death, and other adverse outcomes.…”

“…Although kidney-related mechanisms involved in maintenance of musculoskeletal health [14,[17][18][19][20][21] have been intensively researched for decades and the association between CKD and osteoporotic fractures (OF) is well established [22,23], studies on CKD combined with HF, the most devastating complication of osteoporosis (OP), are relatively rare [13,24,25]. Te relationship between kidney function and postoperative outcomes in hip fracture (HF) patients has not been systematically investigated, and the few studies that evaluated the input of CKD on HF outcomes have yielded conficting results [25][26][27][28][29]. Despite the great interest in predicting the risk of fracture and identifying people who will beneft from therapeutic interventions, data on the use, effectiveness, and safety of anti-osteoporotic drugs in patients with diferent stages of CKD is also scarce and uncertain [9,12,[30][31][32][33][34][35][36].…”