| ABSTRACTObjective:(ⅰ)analyze the characteristic of ROD patients when occur fragile fracture;(ⅱ)explore the independent risk factors of fragile fracture in ROD;(ⅲ)evaluate the prognosis of ESRD patients with fragile fracture;(ⅳ)explore the independent risk factors of mortality in ESRD.Methods:We conducted a retrospective case-control study on the ESRD patients who receive maintenance dialysis for at least 3 months in the first affiliated hospital of Chongqing Medical university from Jan.1st 2003 to Oct.31 2015. There were 512 patients in total, 42 cases confirmed fragile fracture according to the history and X-ray or CT examination set as fragile fracture group(FF group), then choose 174 cases from the left 470 patients, set as control group. There were no statistical differences of age and gender between two groups. Statistic analysis the differences of body mass index(BMI), the existence of primary hypertension or diabetes, hemoglobin, albumin, total cholesterol(TC), triglyceride(TG), low density lipoprotein(LDL), high-density lipoprotein(HDL), apolipoprotein- α, alkaline phosphatase(ALP),serum calcium, corrected calcium, serum phosphorus, Parathyroid hormone, calcium-phosphorus product and the existence of metastatic calcification between two groups. We also compared the difference of fragile fracture ratio between different serum corrected calcium, serum phosphorus and parathyroid hormone levels. Furthermore, we followed patients up for 4 months to 12.83 years,the average follow-up time is 1439.0(745.3, 2513.5) days, and note down the time of those who lose follow-up midway, utilized survival analysis to compare the incidence of all-cause and cardiovascular mortality.Results: Those with fragile fracture had a higher prevalence of primary hypertension, diabetes mellitus and metastatic calcification(P<0.05), and also had higher serum level of hemoglobin, alkaline phosphatase, calcium and corrected calcium(P<0.05), but lower serum level of i PTH, TC and LDL(P<0.05). Logistic regression demonstrate higher corrected calcium level was an independent risk factor of fragile fractures(P=0.019, OR=8.165,95% CI: 1.413 to 47.175),and so does the serum alkaline phosphatase(p=0.000,OR=1.008,95%CI:1.003-1.012),and presence of primary hypertension(p=0.009,OR=3.071,95%CI:1.325-7.117),while proper serum level of i PTH(p=0.002,OR=0.998,95%CI:0.996-0.999) and TC(p=0.002,OR=0.484,95%CI:0.304-0.771)may be the protective factors for fragile fracture. Additionally, fragile fracture was tend to happen in higher concentration of corrected calcium and lower concentration of i PTH(P<0.05). The follow-up period is 1439.0(745.3, 2513.5) days [range: 120-4685 days], the ratios of all-cause and CV mortality were both higher in the fragile fracture group. Adjusted hazard ratio of all-cause mortality for an increase of 1 unit in fragile fractures was 4.907(95% CI, 2.372-10.150), the other risk factors associated with all-cause mortality were female(p=0.021,RR=1.527,95%CI:1.067-2.185), higher serum LDL(p=0.021,RR=1.223,95%CI:1.032-1.473), and the prevalence of aortic calcification(p=0.027,RR=1.534,95%CI:1.050-2.241). The survival analysis for CV mortality was limited by the sample size.Conclusion:(ⅰ) The risk of fragile fracture was greatly increased in ESRD patients with dialysis treatment. In this study, the average annual incidence of fragile fracture in patients with ESRD was about 7.95 per thousand, with vertebral fractures to be the most frequent site, followed by the upper femur fractures.(ⅱ) Primary hypertension, diabetes, high levels of serum calcium, alkaline phosphatase, and excessive reduced i PTH levels may be the risk factors of fragile fracture in patients with ESRD, and primary hypertension, serum corrected calcium, alkaline phosphatase were independent risk factors, while good nutrition and appropriate level of i PTH may be protective.(ⅲ) The presence of fragile fracture is an independent predictor of all-cause mortality in patients with ESRD, ESRD patients with fragile fracture had a poor prognosis and significantly shortened survival time, and metastatic calcification is more evident, result in increased cardiovascular events, together with infection are the main causes of death in ESRD patients with fragile fracture. |
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