Hemodialysis Product and Hip Fracture in Hemodialysis Patients: A Nationwide Cohort Study in Japan

Abstract

Some have raised concerns that longer and more frequent hemodialysis (HD) would be associated with bone fractures due to excess phosphate removal. We examined the effects of hemodialysis product (HDP) on hip fracture incidence among Japanese HD patients using registry data of the Japanese Society for Dialysis Therapy. During a 1‐year study period, 1411 hip fractures occurred among 135 984 patients. After adjusting for demographic and clinical factors, patients with a high HDP did not show a significant risk of hip fracture. Interestingly, patients with polycystic kidney disease had a lower risk of hip fracture. Our findings did not support the hypothesis that patients undergoing longer and more frequent HD would face a higher risk of hip fracture than those undergoing shorter and less frequent HD. Polycystic kidney disease was identified as a new significant factor for hip fracture; relative to glomerulonephritis, this condition was associated with a lower risk of hip fracture.

Lower Geriatric Nutritional Risk Index (GNRI) Is Associated with Higher Risk of Fractures in Patients Undergoing Hemodialysis

“…A low albumin level is reportedly one of many factors associated with fractures [ 18 ], while an association between a low BMI and fractures remains controversial. One previous study showed that a low BMI is significantly associated with fractures [ 18 ], although other studies found no such association [ 3 , 11 ].…”

“…A previous study showed that low serum albumin is associated with new fractures [ 10 ]. However, the association between a low BMI and fractures remains controversial [ 3 , 10 , 11 ]. We hypothesized that malnutrition is associated with fracture, and that the GNRI , as an indicator of malnutrition, can predict the risk of fractures.…”