Sagar U Nigwekar1, Armando L Negri2, Divya Bajpai3, Andrew Allegretti4, Sahir Kalim4, Harish Seethapathy4, Ishir Bhan5, Kalyani Murthy6, Juan Carlos Ayus7. 1. Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States. Electronic address: snigwekar@mgh.harvard.edu. 2. Instituto de Investigaciones Metabólicas, Universidad del Salvador, Buenos Aires, Argentina. 3. Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States; King Edward Memorial Hospital and Seth G.S. Medical College, Mumbai, India. 4. Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States. 5. Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States; Biogen, Cambridge, MA, United States. 6. Division of General Internal Medicine, Lahey Hospital and Medical Center, Burlington, MA, United States. 7. Renal Consultants of Houston, Houston, TX, United States; University of California, Irving, CA, United States. Electronic address: carlosayus@yahoo.com.
Abstract
BACKGROUND: Chronic prolonged hyponatremia (CPH) is a risk factor for hip fracture in the general population. Whether CPH increases hip fracture risk in chronic kidney disease (CKD) patients is unknown. METHODS: Case-control study in patients over 60 years of age with stage 3 or greater CKD. Patients who had a hip fracture were referred to as cases (n = 1236) and controls had no hip fracture (n = 4515). Patients were classified as having CPH if serum sodium was <135 mEq/L on at least two occasions separated by a minimum of 90 days prior to the diagnosis of hip fracture (cases) or at any time during the study period (controls). Conditional logistic regression models were used to test the association between CPH and hip fracture. Analyses were conducted for patients with and without osteoporosis and falls and for patients with age >70 years versus ≤70 years. RESULTS: CPH was present in 21% of cases and 10% of controls (p < 0.001; sodium level: 131-134 mEq/L). In univariate logistic regression analysis, CPH was associated with higher odds of hip fracture (odds ratio [OR] 2.44, (95% [CI] 2.07-2.89). In a multivariate model adjusted for comorbidities, medications and laboratory parameters CPH association with higher odds of Hip fracture was attenuated but remained significant (OR 1.36, 95% CI 1.04-1.78). The association between CPH and risk of hip fracture was consistent in patients with or without osteoporosis and falls and across the age strata. CONCLUSION: Chronic prolonged hyponatremia is a risk factor for hip fracture in CKD patients older than 60 years of age.
BACKGROUND:Chronic prolonged hyponatremia (CPH) is a risk factor for hip fracture in the general population. Whether CPH increases hip fracture risk in chronic kidney disease (CKD) patients is unknown. METHODS: Case-control study in patients over 60 years of age with stage 3 or greater CKD. Patients who had a hip fracture were referred to as cases (n = 1236) and controls had no hip fracture (n = 4515). Patients were classified as having CPH if serum sodium was <135 mEq/L on at least two occasions separated by a minimum of 90 days prior to the diagnosis of hip fracture (cases) or at any time during the study period (controls). Conditional logistic regression models were used to test the association between CPH and hip fracture. Analyses were conducted for patients with and without osteoporosis and falls and for patients with age >70 years versus ≤70 years. RESULTS:CPH was present in 21% of cases and 10% of controls (p < 0.001; sodium level: 131-134 mEq/L). In univariate logistic regression analysis, CPH was associated with higher odds of hip fracture (odds ratio [OR] 2.44, (95% [CI] 2.07-2.89). In a multivariate model adjusted for comorbidities, medications and laboratory parameters CPH association with higher odds of Hip fracture was attenuated but remained significant (OR 1.36, 95% CI 1.04-1.78). The association between CPH and risk of hip fracture was consistent in patients with or without osteoporosis and falls and across the age strata. CONCLUSION:Chronic prolonged hyponatremia is a risk factor for hip fracture in CKDpatients older than 60 years of age.
Authors: Daniel Bernd Hoffmann; Christian Popescu; Marina Komrakova; Lena Welte; Dominik Saul; Wolfgang Lehmann; Thelonius Hawellek; Frank Timo Beil; Mohammed Dakna; Stephan Sehmisch Journal: Bone Rep Date: 2019-12-06