Fractures in CKD Patients—Risk Analysis in RRT Lombardy Patients
Abstract
:1. Introduction
2. Material and Methods
3. Ethical Consideration
4. Statistical Analysis
5. Results
6. Discussion
6.1. Epidemiology
6.2. CKD Treatment
6.3. Hospitalization
6.4. Mortality
6.5. Comorbidities
6.6. Drugs Prescription
6.7. Secondary Hyperparathyroidism
6.8. Costs Analysis
6.9. Weakness and Strength
6.10. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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ICD-9-CM Diagnosis | ICD-9-CM Procedures | ||
---|---|---|---|
Codes | Description | Codes | Description |
820 | Fracture of neck of femur | 78.55 | Internal fixation of bone without fracture reduction femur |
821 | Fracture of other parts of femur | 79.25 | Open reduction of fracture without internal fixation femur |
808 | Fracture of pelvis | 79.45 | Closed reduction of separated epiphysis femur |
805 | Fracture of vertebral column | 79.55 | Open reduction of separated epiphysis femur |
733.14 | Pathological fracture of neck of femur | 81.51 | Total hip replacement |
733.15 | Pathological fracture of other parts of femur | 81.52 | Partial hip replacement |
733.13 | Pathological fracture of vertebra | 81.53/81.40 | Revision of hip replacement/Repair of hip |
Drugs Groups (ATC Classification Codes) | n (%) Patients Using Drugs | % Fractures in Users | % Fractures in Non-Users | p Value (CMH) |
---|---|---|---|---|
Active on bone structure and mineralization (M05B) | 317 (3.9) | 7.9 | 2.9 | <0.001 |
Aspirin | 4793 (59.1) | 3.3 | 2.9 | 0.3517 |
Cardiac glycosides (C01AA05) | 305 (3.8) | 3.0 | 3.1 | 1.0000 |
Lipid-lowering drugs (C10A) | 4447 (54.8) | 2.7 | 3.5 | 0.0375 |
Steroid drugs (H02A, H02B) | 2229 (27.5) | 3.4 | 3.0 | 0.3502 |
Renin-angiotensin inhibitors (C09A, C09B, C09CA, C09D, C09X) | 5479 (67.6) | 2.7 | 3.9 | 0.0039 |
Vit D drugs (A11CB, A11CC) | 6305 (77.8) | 3.1 | 2.9 | 0.7183 |
Cinacalcet (H05BX01) | 1728 (21.3) | 2.5 | 3.2 | 0.1594 |
Proton pump inhibitors (A02BC) | 7168 (88.4) | 3.3 | 1.8 | 0.0199 |
Vit K antagonists (B01AA) | 1681 (20.7) | 3.8 | 2.9 | 0.0697 |
Comorbidities | n (%) Patients Affected | % Fractures in Affected | % Fractures in Non-Affected | p Value (CMH) |
---|---|---|---|---|
Secondary hyperparathyroidism | 2497 (30.8) | 2.8 | 3.2 | 0.4213 |
Diabetes | 2219 (27.4) | 3.3 | 3.0 | 0.5833 |
Peripheral vascular disease | 893 (11.0) | 3.6 | 3.0 | 0.4293 |
Myocardial infarction | 2024 (25.0) | 2.9 | 3.2 | 0.5387 |
Congestive heart failure | 1724 (21.3) | 3.5 | 3.0 | 0.3362 |
Cerebral vascular disease | 1195 (14.7) | 5.4 | 2.7 | <0.001 |
Dementia | 100 (1.2) | 7.0 | 3.0 | 0.03508 |
MCC*I (cat ≥1 vs. 0) | 4521 (55.8) | 3.8 | 2.2 | <0.001 |
SHPT n(%) | NO_SHPT n(%) | p Value | |
---|---|---|---|
Patients | 2497 (30.8) | 5612 (69.2) | --------- |
Gender (females) | 1028 (41.2) | 1952 (34.8) | <0.001 |
Age (mean ± SD) | 62.4 ± 15.0 | 69.3 ± 13.8 | <0.001 |
Renal replacement therapy HD | 2291 (91.8) | 5173 (92.2) | 0.5404 |
Kidney transplantation | 228 (9.1) | 310 (5.5) | <0.001 |
Fractures | 71 (2.8) | 180 (3.2) | 0.4213 |
Fractures | Number of Patients (n) | Total Costs for All Patients (€) | Mean Per-Patient Costs (€) | |
---|---|---|---|---|
All drugs | No | 7858 | 42,966,512.4 | 5467.9 |
Yes | 251 | 1,039,559.5 | 4141.7 | |
Territorial Drugs | No | 7858 | 32,261,086.1 | 4105.5 |
Yes | 251 | 773,330.6 | 3081.0 | |
Drugs distributed directly by RHS | No | 7858 | 10,705,426.3 | 1362.4 |
Yes | 251 | 266,228.9 | 1060.7 | |
Diagnostic and therapeutic procedures | No | 7858 | 400,579,033.0 | 50,977.2 |
Yes | 251 | 12,961,263.5 | 51,638.5 | |
Hospitalizations (all) | No | 7858 | 98,239,011.5 | 12,501.8 |
Yes | 251 | 5,283,639.7 | 21,050.4 | |
Total costs | No | 7858 | 541,784,556.9 | 68,946.9 |
Yes | 251 | 19,284,462.6 | 76,830.5 |
Variable | OR | 95% Wald CI | p Value |
---|---|---|---|
Age > 65 | 2.608 | 1.846–3.685 | p < 0.01 |
Gender (F, M) | 1.403 | 1.086–1.811 | p < 0.01 |
Kidney Transplant (Yes, No) | 0.287 | 0.090–0.916 | p < 0.05 |
PPI (Yes, No) | 1.904 | 1.154–3.140 | p < 0.05 |
CVD (/Yes, No) | 1.766 | 1.316–2.370 | p < 0.05 |
Myocardial Infarction (Yes, No) | 0.771 | 0.568–1.045 | p < 0.1 |
Observations: 8109; log–likelihood: −1074.519; Akaike inf. crit.: 2163.037 |
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Conte, F.; Roggeri, D.P.; Cozzolino, M.G.; Rossi, C.; Zocchetti, C.; Roggeri, A. Fractures in CKD Patients—Risk Analysis in RRT Lombardy Patients. Kidney Dial. 2023, 3, 95-110. https://doi.org/10.3390/kidneydial3010009
Conte F, Roggeri DP, Cozzolino MG, Rossi C, Zocchetti C, Roggeri A. Fractures in CKD Patients—Risk Analysis in RRT Lombardy Patients. Kidney and Dialysis. 2023; 3(1):95-110. https://doi.org/10.3390/kidneydial3010009
Chicago/Turabian StyleConte, Ferruccio, Daniela Paola Roggeri, Mario Gennaro Cozzolino, Carlotta Rossi, Carlo Zocchetti, and Alessandro Roggeri. 2023. "Fractures in CKD Patients—Risk Analysis in RRT Lombardy Patients" Kidney and Dialysis 3, no. 1: 95-110. https://doi.org/10.3390/kidneydial3010009