Kidney Res Clin Pract.  2019 Jun;38(2):220-228. 10.23876/j.krcp.18.0099.

Fracture risk in chronic kidney disease: A Korean population-based cohort study

Affiliations
  • 1Department of Internal Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea.
  • 2The Korean Society of Nephrology, Seoul, Korea.
  • 3Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea.
  • 4Ewha Institute of Convergence Medicine and Research Institute for Human Health Information, Ewha Womans University, Seoul, Korea. ohjmd@naver.com

Abstract

BACKGROUND
Chronic kidney disease (CKD)-mineral and bone disorder (MBD) and fracture risk are both closely related to declining renal function. Controlling hyperphosphatemia with phosphate binders is a basic principle of CKD-MBD treatment. The aim of this study was to identify differences in fracture risk between pre-dialysis CKD patients and end-stage renal disease (ESRD) on dialysis, and to evaluate the effects of phosphate binders on fracture risk in ESRD patients.
METHODS
Data from a total of 89,533 CKD patients comprising CKD diagnosis, dialysis, fracture history, and phosphate binder prescription history from 2012 to 2016 were retrieved from the Health Insurance Review and Assessment Service Database. Multivariate Cox regression analyses were performed to identify whether dialysis or phosphate binders were associated with an increased fracture risk.
RESULTS
Overall, the rate of fractures in pre-dialysis CKD patients was 74 per 1,000 patient-years, while that in dialysis patients was 84 per 1,000 patient-years. The risk of fracture in ESRD patients was higher than pre-dialysis CKD patients (hazard ratio, 1.16; 95% confidence interval, 1.12-1.21; P < 0.001) after adjusting for confounding variables. In addition, the fracture risk in patients who were not taking phosphate binders was 20.0% higher compared to ESRD patients taking phosphate binders.
CONCLUSION
Fractures were more prevalent in ESRD patients on dialysis than pre-dialysis CKD patients. Use of phosphate binders was associated with a lower fracture risk in ESRD patients.

Keyword

Chronic renal insufficiency; Dialysis; Fracture; Phosphate binder

MeSH Terms

Cohort Studies*
Confounding Factors (Epidemiology)
Diagnosis
Dialysis
Humans
Hyperphosphatemia
Insurance, Health
Kidney Failure, Chronic
Prescriptions
Renal Insufficiency, Chronic*
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