Risk of hip and renal fracture among dialysis transplant recipients
Risk of hip and renal fracture among dialysis transplant recipients
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DOI：
10.1001/jama.288.23.3014
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发表时间：
2002-12-18
影响因子：
120.7
通讯作者：
Stehman-Breen, C
中科院分区：
文献类型：
--
作者：
Ball, AM;Gillen, DL;Stehman-Breen, C
背景肾功能衰竭使人们有特别高的髋部骨折风险。目的确定接受肾移植的患者是否比继续接受透析的患者发生髋部骨折的风险更大。设计、设置和参与者对1990年1月1日至1999年12月31日在美国肾移植等待名单上的101039名终末期肾病患者进行了队列研究。主要结果根据医疗保险索赔数据确定的髋部骨折。在接受透析的患者中，髋部骨折的发生率为每年2.9/1000名患者，而以前接受肾移植的患者中，髋部骨折的发生率为3.3/1000名/1000名患者。最初，与透析(调整后的RR，1.34；95%可信区间[CI]，1.12-1.61)相比，与透析相关的髋部骨折的相对风险(RR)高1.34倍，但随后每月下降1%(调整后的RR，0.99；95%CI，0.98-0.99)，直到移植后大约630天，透析和移植受者的估计风险变得相等(调整后的RR，1.00；95%CI，0.87-1-15)。在移植受者中，移植前透析时间较长的患者发生骨折的风险相对较高。结论肾移植患者移植后1~3年透析患者发生骨折的风险高于肾移植患者。
Context Renal failure places people at particularly high risk of hip fracture. However, the possible differential impact of dialysis and renal transplantation on this risk is not well understood.Objective To determine if patients who receive kidney transplants are at greater risk of hip fracture compared with those who continue to undergo dialysis.Design, Setting, and Participants Cohort study of 101039 patients with end-stage renal disease placed on the renal transplant waiting list in the United States between January 1, 1990, and December 31, 1999.Main Outcome Measures I Hip fractures, identified from Medicare claims data.Results Among the patients included in this analysis, 971 hip fractures were observed during the follow-up period of 314767 person-years. The incidence rate of hip fracture in patients receiving dialysis was 2.9 per 1000 patients per year compared with 3.3 hip fractures per 1000 patients per year in those who had previously received a renal transplant. Initially, the relative risk (RR) of hip fracture associated with transplantation was 1.34-fold greater when compared with dialysis (adjusted RR, 1.34; 95 % confidence interval [CI], 1.12-1.61) but then decreased by 1 % per month (adjusted RR, 0.99; 95% Cl, 0.98-0.99) until the estimated risk became equal for dialysis and transplant recipients approximately 630 days after transplantation (adjusted RR, 1.00; 95 % Cl, 0.87-1-15). Among transplant recipients, risk of fracture was relatively higher in persons with a prolonged period of dialysis before transplantation.Conclusion The high risk of hi p fracture among dialysis patients is exceeded by that among renal, transplant patients during the first 1 to 3 years after transplantation.