The Relationship Between Fracture and Mortality in a Chinese Maintenance Hemodialysis Patients Cohort

Figures & data

Figure 1 The proportion of fracture sites in MHD patients. A total of 57 fractures occurred in 47 patients, including 20 rib fractures (35.09%), 10 vertebral fractures (17.54%), 7 humeral fractures (12.28%), 5 Hip fractures (8.77%), and 15 other fractures (26.32%, including phalanx, metatarsal bone, ulna, etc).

Figure 2 The prevalence of fractures by age (Black: Total; Blue: Male; Red: Female). In people over 50 years of age, the incidence of fractures increases with age and is higher in women than in men. More than half of all women over 80 experienced fractures.

Table 1 Demographic and Clinical Parameters of the Patients with and without Fractures

	Patients with Fracture (n=47)	Patients Without Fracture (n=135)	P value
Sex, women, n (%)	24(51.1)	47(34.8)	0.039
Age, years	66.0±13.6	62.1±12.3	0.002
Diabetic nephropathy (%)	34.0	25.2
Chronic glomerulonephritis (%)	27.7	40.0
Hypertensive nephropathy (%)	21.3	18.5
Polycystic kidney disease (%)	10.6	6.7
Duration of dialysis, (months)	(8.4, 111.6)	(11.8, 95.8)	0.903
CVC (%)	31.7	15.5
AVF (%)	65.9	81.9
AVG (%)	2.4	2.6
Blood Flow (mL/min)	229±20	229±22	0.500
spKt/V	1.52±0.63	1.47±0.42	0.789
URR	69.21±8.51	70.02±9.36	0.607
Hemoglobin, g/L	100.2±17.1	104.4±15.1	0.016
CRP, mg/L	(2.61, 8.77)	(1.86, 6.98)	0.251
Albumin, g/L	36.86±3.93	37.80±6.07	0.017
Potassium, mmol/L	3.93±0.79	4.23±0.91	0.006
Calcium, mmol/L	2.19±0.20	2.19±0.29	0.745
Phosphorus, mmol/L	1.85±0.52	1.68±0.50	0.048
PTH, ng/L	(136.78, 387.53)	(113.88, 486.63)	0.761
Vitamin D, nmol/L	33.38±17.76	32.32±21.92	0.292
Fe, umol/L	13.35±7.70	12.27±4.68	0.806
Ferritin, μg/L	(197.20, 673.35)	(192.90, 632.28)	0.498
Uric acid, umol/L, umol/L	399.51±79.52	411.22±81.54	0.174
CO2, mmol/L	21.95±2.79	21.85±3.05	0.075
BNP, ng/L	(199.30, 741.70)	(114.70, 575.33)	0.018

Abbreviations: CVC, Central Venous Catheter; AVF, Arteriovenous Fistula; AVG, Arteriovenous Graft; URR, urea reduction rate; CRP, C-reactive protein; PTH, Parathyroid Hormone; BNP, B-type natriuretic peptide.

Table 2 Independent Risk Factors for New Fractures in MHD Patients

	β	Sx	Waldx2	P value	OR	95% CI
Age	1.128	0.544	4.302	0.038	3.809	1.064~8.966
Albumin	−0.059	0.049	1.450	0.228	0.943	0.857~1.038
Hemoglobin	−0.04	0.019	4.428	0.035	0.961	0.925~0.997
Phosphorus	1.202	0.563	4.559	0.033	3.325	1.104~10.019
CO2	0.100	0.105	0.916	0.339	1.106	0.900~1.358
PTH	0.000	0.001	0.002	0.960	1.000	0.999~1.001

Abbreviation: PTH, Parathyroid Hormone.

Table 3 Correlation Analysis Between Fracture and Poor Prognosis of Patients in MHD Patients

	Patients with Fracture (n=47)	Patients Without Fracture (n=135)	P value
Stroke (%)	8.5	6.7	0.280
AMI (%)	23.4	21.5	0.541
Malignancy (%)	8.5	2.2	<0.001
1-year mortality (%)	12.77	9.63	0.555
2-year mortality (%)	23.4	18.52	0.833
3-year mortality (%)	40.43	23.7	0.014
4-year mortality (%)	44.68	32.59	0.035
5-year mortality (%)	51.06	37.04	0.040

Abbreviations: MHD, Maintenance Hemodialysis; AMI, Acute Myocardial Infarction.

Figure 3 Analysis of 5-year death causes in MHD patients. During 5 years of follow-up, 74 of 182 patients died. The first leading cause of death was cardiovascular events (27.03%, 20/74), including heart failure, AMI and sudden cardiac death. The second cause was infection (18.92%, 14/74), followed by stroke (12.16%, 9/74) and respiratory failure (6.76%, 5/74).