Abstract P169: Association of Kidney Function and Risk of Hospitalized Bone Fracture
Introduction: Persons with end-stage renal disease are at high risk of fracture. Less is known about fracture risk in milder chronic kidney disease (CKD), particularly in persons with albuminuria but preserved estimated glomerular filtration rate (eGFR), and whether CKD-associated fracture risk varies by sex.
Methods: Participants from the ARIC study were followed from 1996-2011. Kidney function was assessed at baseline by eGFR and urine albumin-to-creatinine ratio (ACR). Fracture-related diagnostic codes were identified through active surveillance of hospitalizations. Cox proportional hazards models were adjusted for demographic factors and other established risk factors for osteoporosis and fracture.
Results: Among 11,000 eligible participants (mean age 63.3 years, 55.9% female, 21.9% black), there were 722 fracture-related hospitalizations during a median follow-up of 13 years. Below eGFR 60 ml/min/1.73 m2, lower eGFR was associated with higher fracture risk (adjusted hazard ratio (aHR) per 10 ml/min/1.73 m2 lower eGFR: 1.49; 95% CI, 1.27, 1.75), independent of ACR (Figure). Above eGFR 60 ml/min/1.73 m2, there was no association between eGFR and fracture risk. There was a strong relationship between ACR and fracture, independent of eGFR (aHR per log-increase, 1.14; 95% CI, 1.08-1.20). More severe stages of both GFR and albuminuria conferred higher fracture risk. Even among those with eGFR ≥60 ml/min/1.73 m2, persons with ACR >300 mg/g or ACR 30-300 mg/g had higher fracture risk than those with ACR <30mg/g (adjusted incidence rate (aIR): 9.21; 95% CI, 5.00-17.12, aIR: 7.43; 95% CI, 5.59 -9.89, aIR: 5.17; 95% CI, 4.76-5.60, respectively). There was no difference in associations by sex (eGFR: p for interaction= 0.9; albuminuria: p for interaction= 0.6).
Conclusions: Low eGFR and albuminuria were independent risk factors for fracture-related hospitalization in both men and women in this community-based population. Persons with kidney disease might benefit from fracture prevention strategies.
Author Disclosures: N.R. Daya: None. A. Voskertchian: None. A.L.C. Schneider: None. S. Ballew: None. M. McAdams DeMarco: None. J. Coresh: None. L. Appel: None. E. Selvin: None. M.E. Grams: None.
- © 2015 by American Heart Association, Inc.