Hospitalizations for Fractures after Renal Transplantation in the United States

Abbott, Kevin C.; Oglesby, Robert J.; Hypolite, Iman O.; Kirk, Allan D.; Ko, Chia W.; Welch, Paul G.; Agodoa, Lawrence Y.; Duncan, William E.

« Previous Next »Annals of Epidemiology
Volume 11, Issue 7 , Pages 450-457, October 2001

Hospitalizations for Fractures after Renal Transplantation in the United States☆

Kevin C. Abbott, MD
- Nephrology Service, Walter Reed Army Medical Center, Washington, DC USA
- Address reprint requests to: Dr. Kevin C. Abbott, LTC, MC, Director, Dialysis, Nephrology Service, Walter Reed Army Medical Center, Washington, DC 20307-5001. Tel.: (202) 782-6462/6463/6288, Fax: (202) 782-0185.
Robert J. Oglesby, MD
- Rheumatology Service, Walter Reed Army Medical Center, Washington, DC USA
- Uniformed Services University of the Health Sciences, Bethesda, MD USA
Iman O. Hypolite
- Office of Minority Research Health Coordination, National Institute for Diabetes, Digestive, and Kidney Disease (NIDDK), National Institutes of Health (NIH), Bethesda, MD USA
Allan D. Kirk, PhD
- Organ Transplantation Service, National Institutes of Health, Bethesda, MD USA
Chia W. Ko, PhD
- Epidemiology, Statistics, and Data System Branch, National Institute on Deafness and Other Communication Disorders(NIDCD), NIH, Bethesda, MD USA
Paul G. Welch, MD
- Nephrology Service, Walter Reed Army Medical Center, Washington, DC USA
Lawrence Y. Agodoa, MD
- Uniformed Services University of the Health Sciences, Bethesda, MD USA
- NIDDK, NIH, Bethesda, MD USA
William E. Duncan, MD, PhD
- Endocrinology Service, Walter Reed Army Medical Center, Washington, DC USA

Received 18 September 2000; received in revised form 8 January 2001; accepted 23 January 2001.

Abstract

PURPOSE: To investigate the incidence, risk factors, and associated mortality of fractures in renal transplant recipients.

METHODS: Retrospective registry study of 33,479 patients in the United States Renal Data System (USRDS) who received kidney transplants between 1 July 1994 and 30 June 1997. Associations with hospitalizations for a primary discharge diagnosis of fractures (all causes) were assessed.

RESULTS: Renal transplant recipients had an adjusted incidence ratio for fractures of 4.59 (95% confidence interval 3.29 to 6.31). In multivariate analysis, recipients with prevalent fractures, as well as recipients who were Caucasian, women, in the lower quartiles of recipient weight (<95.9 kg), had end stage renal disease caused by diabetes, and had prolonged pretransplant dialysis were at increased risk for hospitalization because of fractures after transplantation. Recipients hospitalized for hip fractures had decreased all-cause survival (hazard ratio for mortality 1.60, 95% CI 1.13 to 2.26) in Cox Regression analysis.

CONCLUSIONS: In the early post-transplant course (<3 years), renal transplant recipients had a greater incidence of fractures than the general population, which were associated with decreased patient survival. Preventive efforts should focus on recipients with the risk factors identified in this analysis, most of which can be easily obtained through history and physical examination.

Keywords: Fracture, Osteoporosis, Renal Transplant, Weight, Dialysis Duration, Complication, USRDS

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☆ The opinions expressed are solely those of the authors and do not represent an endorsement by the Department of Defense or the National Institutes of Health. This is a government work. There are no restrictions on its use. Portions of this article were presented at AST 2000 in Chicago, IL, 13-17 May, 2000.

PII: S1047-2797(01)00226-5

« Previous Next »Annals of Epidemiology
Volume 11, Issue 7 , Pages 450-457, October 2001

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