Table 2.
Incidence of hip fracture in CKD, measured with (a) admissions and (b) deaths
| Renal status | Total | Events n | PY follow to up (1000) | Rate per 1000 PY (95% CI) |
Unadjusted IRR (95% CI) |
Age/sex adjusted IRR (95% CI) |
Adjusted IRR (95% CI) final model* |
SIGN final model† |
| (a) Association of CKD and incidence of hip fracture admission | ||||||||
| CKD stages 3–5‡ | 19 537 | 915 | 91.4 | 10.0 (9.4 to 10.7) | 6.90 (5.83 to 8.15) | 1.58 (1.32 to 1.90) | 1.49 (1.24 to 1.79) | 1.53 (1.27 to 1.84) |
| CKD stage 5‡ | 182 | 2 | 0.6 | 3.3 (0.8 to 13.2) | 2.27 (0.56 to 9.16) | 0.78 (0.19 to 3.15) | 0.69 (0.17 to 2.78) | |
| CKD stage 4 | 1398 | 77 | 4.8 | 15.9 (12.7 to 19.9) | 10.96 (8.36 to 14.39) | 1.98 (1.49 to 2.63) | 1.74 (1.30 to 2.33) | |
| CKD stage 3b | 5261 | 320 | 22.6 | 14.1 (12.7 to 15.8) | 9.74 (8.06 to 11.77) | 1.83 (1.49 to 2.24) | 1.70 (1.38 to 2.09) | |
| CKD stage 3a | 12 696 | 516 | 63.3 | 8.2 (7.5 to 8.9) | 5.61 (4.70 to 6.70) | 1.47 (1.21 to 1.77) | 1.40 (1.16 to 1.70) | |
| Normal eGFR | 19 748 | 161 | 110.9 | 1.5 (1.2 to 1.7) | 1.00 (Reference) | 1.00 (Reference) | 1.00 (Reference) | 1.00 (Reference) |
| (b) Association of CKD and incidence of hip fracture-related death | ||||||||
| CKD stages 3–5‡ | 19 537 | 198 | 92.8 | 2.1 (1.9 to 2.5) | 7.91 (5.39 to 11.61) | 1.27 (0.85 to 1.88) | ||
| CKD stage 5‡ | 182 | 0 | 0.6 | – | – | – | ||
| CKD stage 4 | 1398 | 26 | 4.9 | 5.3 (3.6 to 7.8) | 19.59 (11.59 to 33.13) | 2.28 (1.32 to 3.92) | ||
| CKD stage 3b | 5261 | 78 | 23.1 | 3.4 (2.7 to 4.2) | 12.53 (8.22 to 19.08) | 1.57 (1.01 to 2.44) | ||
| CKD stage 3a | 12 696 | 94 | 64.1 | 1.5 (1.2 to 1.8) | 5.43 (3.60 to 8.19) | 1.03 (0.68 to 1.58) | ||
| Normal eGFR | 19 748 | 30 | 111.2 | 0.3 (0.2 to 0.4) | 1.00 (Reference) | 1.00 (Reference) | ||
*Final model adjusted for age, sex, Charlson Comorbidity Index score, deprivation, proteinuria and rurality (all variables remained in model).
†SIGN model developed using age, sex, diabetes, connective tissue disease, chronic pulmonary disease, dementia, chronic liver disease, non-haematological malignancy, haematological malignancy, metastatic solid tumour, peptic ulcer disease, HIV/AIDS, obesity (ICD-10 code E66) and smoking status (ICD-10 code Z72.0, F17.2, Z71.6). We did not have available: drug therapy, certain other coexisting diseases, low BMD (bone mineral density), alcohol use, previous fracture, parental history of osteoporosis and early menopause. The SIGN final (best) model was adjusted for age, sex, diabetes, chronic pulmonary disease, dementia and chronic liver disease.
‡CKD stage 5 does not include dialysis or transplants.
CKD, chronic kidney disease; ICD-10, 10th revision of International Classification of Diseases; IRR, incident rate ratio; PY, patient-years; SIGN, Scottish Intercollegiate Guidelines Network.