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Effect of Chronic Kidney Disease on All-Cause Mortality After Hip Fracture Surgery: A Retrospective Cohort Study

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Abstract

In this retrospective cohort study, we investigated: (1) The impact of comorbid chronic kidney disease (CKD) on postoperative mortality in patients with a hip fracture; (2) mortality variations by dialysis type, potentially indicating CKD stage; (3) the efficacy of different hip fracture surgical methods in reducing mortality for patients with CKD. This study included 25,760 patients from the Korean National Health Insurance Service-Senior cohort (2002–2019) who underwent hip fracture surgery. Participants were categorized as CKD and Non-CKD. Mortality rate was determined using a generalized linear model with a Poisson distribution. The effect size was presented as a hazard ratio (HR) through a Cox proportional-hazard model. During follow-up, we ascertained that 978 patients (3.8%) had CKD preoperatively. Compared to the Non-CKD group, the mortality risk (HR) in the CKD group was 2.17 times higher (95% confidence interval [CI], 1.99–2.37). In sensitivity analysis, the mortality risk of in patients who received peritoneal dialysis and hemodialysis was 6.21 (95% CI, 3.90–9.87) and 3.62 times (95% CI, 3.11–4.20) higher than that of patients who received conservative care. Mortality risk varied by surgical method: hip hemiarthroplasty (HR, 2.11; 95% CI, 1.86–2.40), open reduction and internal fixation (HR, 2.21; 95% CI, 1.94–2.51), total hip replacement (HR, 2.27; 95% CI, 1.60–3.24), and closed reduction and percutaneous fixation (HR, 3.08; 95% CI, 1.88–5.06). Older patients with CKD undergoing hip fracture surgery had elevated mortality risk, necessitating comprehensive pre- and postoperative assessments and management.

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Data Availability

The data can be viewed after requesting on the National Health Insurance Data Sharing Service website (http://nhiss.nhis.or.kr). The data application will be provided to the applicant for a fee once it is approved after being reviewed by the Research Support Investigation Committee.

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Acknowledgements

We extend our gratitude to our colleagues at the Yonsei University of Health Research Institute for their valuable guidance on literature review. We are also thankful to the NHIS for providing the representative cohort data for this study. Finally, we also thank the Editage (https://www.editage.co.kr/).

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea

    Yun Seo Jang, Soo Young Kim, Yu Shin Park & Il Yun

  2. Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea

    Yun Seo Jang, Hyunkyu Kim, Soo Young Kim, Yu Shin Park, Il Yun, Eun-Cheol Park & Suk-Yong Jang

  3. Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea

    Hyunkyu Kim

  4. Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea

    Hyunkyu Kim & Eun-Cheol Park

  5. Department of Healthcare Management, Graduate School of Public Health, Yonsei University, 50 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea

    Suk-Yong Jang

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Contributions

Jang YS designed the study, collected the data, performed the statistical analysis, and drafted the manuscript. Kim HK, Park YS, and Yun I designed the study and helped analysis. Also, Kim HK, Kim SY, and Park EC contributed to the discussion. All authors reviewed and edited drafts of the manuscript and approved the final version. Jang SY is the guarantor of this work and assumes responsibility for the data's integrity and the data analysis's accuracy. All authors have approved the final manuscript.

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Correspondence to Suk-Yong Jang.

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Yun Seo Jang, Hyunkyu Kim, Soo Young Kim, Yu Shin Park, Il Yun, Eun-Cheol Park and Suk-Yong Jang declare that they have no conflict of interest.

Human and Animal Rights and Informed consent

This study adhered to the principles of the Helsinki Declaration, and since the data does not contain personally identifiable information, it was exempted from approval by the Institutional Review Board at Yonsei University College of Medicine, Severance Hospital.

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Jang, Y.S., Kim, H., Kim, S.Y. et al. Effect of Chronic Kidney Disease on All-Cause Mortality After Hip Fracture Surgery: A Retrospective Cohort Study. Calcif Tissue Int (2024). https://doi.org/10.1007/s00223-024-01238-9

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