Chronic kidney disease patients with intertrochanteric fracture have a high mortality rate

Tae Woo Kim; Sang-Min Lee; Nam Hoon Moon; Won Chul Shin

doi:10.1016/j.injury.2021.05.045

Chronic kidney disease patients with intertrochanteric fracture have a high mortality rate

Injury. 2021 Aug;52(8):2350-2355. doi: 10.1016/j.injury.2021.05.045. Epub 2021 Jun 2.

Authors

Tae Woo Kim¹, Sang-Min Lee², Nam Hoon Moon³, Won Chul Shin⁴

Affiliations

¹ Department of Orthopedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea. Electronic address: namevalue01@gmail.com.
² Department of Orthopedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea. Electronic address: dh62121@gmail.com.
³ Department of Orthopedic Surgery, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea. Electronic address: namhoonmoon@gmail.com.
⁴ Department of Orthopedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea. Electronic address: dreami3e5t@pusan.ac.kr.

PMID: 34134855
DOI: 10.1016/j.injury.2021.05.045

Abstract

Aims: The prognosis of patients with chronic kidney disease (CKD) and intertrochanteric fractures is unclear. This study was aimed to analyze the mortality and complication rates among CKD patients with intertrochanteric femoral fractures and the risk factors of one-year mortality after surgery.

Patients and methods: This retrospective cohort study included 49 patients diagnosed with grades III, IV, or V CKD who were surgically treated for an intertrochanteric fracture between January 2011 and February 2019 at a tertiary university hospital. Preoperative parameters, including age, gender, bone mineral density, follow-up period (mean: 8.6 months range: 1~82 months), underlying disease, American Society of Anesthesiologists classification, fracture classification, and grade of CKD were identified, and complications and mortality rates after surgery were examined. The patients were divided into two groups according to whether one-year mortality after surgery had occurred or not, and a logistic regression analysis was performed to analyze the risk factors of mortality.

Results: Of the 49 total patients, 16 died <1 year postoperatively. Pneumonia (n = 11) was the most common postoperative complication. Twenty-one patients died during the follow-up period. Significant differences in gender (p = 0.006) and grade of CKD (p = 0.022) distributions were found between the two groups, divided according to whether one-year mortality had occurred or not. In a univariate analysis, CKD grade and postoperative septic shock were highly associated with one-year mortality. In a multivariate analysis, septic shock, acute kidney injury, and CKD grade were identified as the risk factors of one-year mortality.

Conclusion: The mortality and complication rates were high among the CKD patients with intertrochanteric fractures. Grades of CKD significantly correlated with one-year mortality after surgery; therefore, they and an important factor that must be considered when developing a strategy to improve the postoperative survival rate of patients with CKD.

Keywords: Acute kidney injury; Chronic kidney diseases; Intertrochanteric fracture; One-year mortality; Risk factors; Septic shock.

MeSH terms

Hip Fractures* / surgery
Humans
Infant
Postoperative Complications
Postoperative Period
Renal Insufficiency, Chronic* / complications
Retrospective Studies