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Journal of Bone and Mineral Metabolism

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01-09-2020 | Original Article

Long-term excess mortality after hip fracture in hemodialysis patients: a nationwide cohort study in Japan

Authors: Minako Wakasugi, Junichiro James Kazama, Atsushi Wada, Takayuki Hamano, Ikuto Masakane, Ichiei Narita

Published in: Journal of Bone and Mineral Metabolism | Issue 5/2020

Abstract

Introduction

Fracture dialysis patients have a higher risk of 1-year mortality compared with non-fracture dialysis patients. However, it is unclear whether excess mortality persists for more than a year.

Materials and methods

We conducted a nationwide cohort study in 162,360 hemodialysis patients in Japan. Study outcomes were 5-year all-cause mortality and cause-specific mortality. Cox proportional hazards regression was used to examine the association between hip fracture and mortality in two cohorts: the full cohort, which included potential confounders as covariates in multivariable-adjusted regression models, and the propensity score-matched cohort.

Results

Crude mortality rates for fracture patients were double those of non-fracture patients and persisted during the 5-year period. The association between hip fracture and mortality was significant even after adjusting for premorbid conditions (hazard ratio (HR) 1.22, 95% confidence interval (CI) 1.13–1.32). Similar findings were observed in the propensity score-matched cohort of 2410 patients (HR 1.20, 95% CI 1.05–1.36). While cause-specific mortality rates for all categories, with the exception of sudden deaths, were higher for fracture patients relative to non-fracture patients in the full unmatched cohort, only the mortality rate for heart disease was significantly higher for fracture patients relative to non-fracture patients in the propensity score-matched cohort.

Conclusion

Excess mortality persisted for many years after hip fracture in hemodialysis patients, and was still present after adjusting for several premorbid conditions and propensity score matching.

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Title: Long-term excess mortality after hip fracture in hemodialysis patients: a nationwide cohort study in Japan
Authors: Minako Wakasugi
Junichiro James Kazama
Atsushi Wada
Takayuki Hamano
Ikuto Masakane
Ichiei Narita
Publication date: 01-09-2020
Publisher: Springer Singapore
Published in: Journal of Bone and Mineral Metabolism / Issue 5/2020
Print ISSN: 0914-8779
Electronic ISSN: 1435-5604
DOI: https://doi.org/10.1007/s00774-020-01110-4

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Abstract

Introduction

Materials and methods

Results

Conclusion

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