Incidence of fractures in middle-aged individuals with early chronic kidney disease: a population-based analysis of CARTaGENE
Abstract Background Previous studies evaluating fractures in chronic kidney disease (CKD) have mostly focused on hip or major fractures in aged populations with moderate to advanced CKD. We aimed at evaluating the association between early CKD and fracture incidence at all sites across age and sex i...
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| Veröffentlicht in: | Nephrology, dialysis, transplantation dialysis, transplantation, 2020-10, Vol.35 (10), p.1712-1721 |
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| creator | Desbiens, Louis-Charles Goupil, Rémi Madore, François Mac-Way, Fabrice |
| description | Abstract
Background
Previous studies evaluating fractures in chronic kidney disease (CKD) have mostly focused on hip or major fractures in aged populations with moderate to advanced CKD. We aimed at evaluating the association between early CKD and fracture incidence at all sites across age and sex in middle-aged individuals.
Methods
We analyzed CARTaGENE, a prospective population-based survey of 40- to 69-year-old individuals from Quebec (Canada). Estimated glomerular filtration rate (eGFR) at baseline was evaluated categorically or continuously using restricted cubic splines. Fractures at any site (except toes, hand and craniofacial) for up to 7 years of follow-up were identified through administrative databases using a validated algorithm. Adjusted Cox models were used to evaluate the association of CKD with fracture. Interaction terms for age and sex were also added.
Results
A total of 19 391 individuals (756 CKD Stage 3; 9114 Stage 2; 9521 non-CKD) were included and 829 fractures occurred during a median follow-up of 70 months. Compared with the median eGFR of 90 mL/min/1.73 m2, eGFRs of ≤60 mL/min/1.73 m2 were associated with increased fracture incidence in unadjusted and adjusted models [adjusted hazard ratio (HR) = 1.25 (95% confidence interval 1.05–1.49) for 60 mL/min/1.73 m2; 1.65 (1.14–2.37) for 45 mL/min/1.73 m2]. The eGFR was linearly associated with fracture incidence |
| doi_str_mv | 10.1093/ndt/gfz259 |
| format | Article |
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Background
Previous studies evaluating fractures in chronic kidney disease (CKD) have mostly focused on hip or major fractures in aged populations with moderate to advanced CKD. We aimed at evaluating the association between early CKD and fracture incidence at all sites across age and sex in middle-aged individuals.
Methods
We analyzed CARTaGENE, a prospective population-based survey of 40- to 69-year-old individuals from Quebec (Canada). Estimated glomerular filtration rate (eGFR) at baseline was evaluated categorically or continuously using restricted cubic splines. Fractures at any site (except toes, hand and craniofacial) for up to 7 years of follow-up were identified through administrative databases using a validated algorithm. Adjusted Cox models were used to evaluate the association of CKD with fracture. Interaction terms for age and sex were also added.
Results
A total of 19 391 individuals (756 CKD Stage 3; 9114 Stage 2; 9521 non-CKD) were included and 829 fractures occurred during a median follow-up of 70 months. Compared with the median eGFR of 90 mL/min/1.73 m2, eGFRs of ≤60 mL/min/1.73 m2 were associated with increased fracture incidence in unadjusted and adjusted models [adjusted hazard ratio (HR) = 1.25 (95% confidence interval 1.05–1.49) for 60 mL/min/1.73 m2; 1.65 (1.14–2.37) for 45 mL/min/1.73 m2]. The eGFR was linearly associated with fracture incidence <75 mL/min/1.73 m2 [HR = 1.18 (1.04–1.34) per 10 mL/min/1.73 m2 decrease] but not above [HR = 0.98 (0.91–1.06) per 10 mL/min/1.73 m2 decrease). The effect of decreased eGFR on fracture incidence was more pronounced in younger individuals [HR = 2.45 (1.28–4.67) at 45 years; 1.11 (0.73–1.67) at 65 years] and in men.
Conclusions
Even early CKD increases fracture incidence, especially in younger individuals and in men.</description><identifier>ISSN: 0931-0509</identifier><identifier>EISSN: 1460-2385</identifier><identifier>DOI: 10.1093/ndt/gfz259</identifier><identifier>PMID: 31951261</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Adult ; Aged ; Canada - epidemiology ; Female ; Fractures, Bone - epidemiology ; Fractures, Bone - etiology ; Fractures, Bone - pathology ; Glomerular Filtration Rate ; Humans ; Incidence ; Longitudinal Studies ; Male ; Middle Aged ; Prospective Studies ; Renal Insufficiency, Chronic - complications ; Risk Factors</subject><ispartof>Nephrology, dialysis, transplantation, 2020-10, Vol.35 (10), p.1712-1721</ispartof><rights>The Author(s) 2020. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. 2020</rights><rights>The Author(s) 2020. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c353t-4c2551a577362c950b1b58d6b429097d7f7f35b91bfa35007ae6cf6681c423583</citedby><cites>FETCH-LOGICAL-c353t-4c2551a577362c950b1b58d6b429097d7f7f35b91bfa35007ae6cf6681c423583</cites><orcidid>0000-0002-6879-9344</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31951261$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Desbiens, Louis-Charles</creatorcontrib><creatorcontrib>Goupil, Rémi</creatorcontrib><creatorcontrib>Madore, François</creatorcontrib><creatorcontrib>Mac-Way, Fabrice</creatorcontrib><title>Incidence of fractures in middle-aged individuals with early chronic kidney disease: a population-based analysis of CARTaGENE</title><title>Nephrology, dialysis, transplantation</title><addtitle>Nephrol Dial Transplant</addtitle><description>Abstract
Background
Previous studies evaluating fractures in chronic kidney disease (CKD) have mostly focused on hip or major fractures in aged populations with moderate to advanced CKD. We aimed at evaluating the association between early CKD and fracture incidence at all sites across age and sex in middle-aged individuals.
Methods
We analyzed CARTaGENE, a prospective population-based survey of 40- to 69-year-old individuals from Quebec (Canada). Estimated glomerular filtration rate (eGFR) at baseline was evaluated categorically or continuously using restricted cubic splines. Fractures at any site (except toes, hand and craniofacial) for up to 7 years of follow-up were identified through administrative databases using a validated algorithm. Adjusted Cox models were used to evaluate the association of CKD with fracture. Interaction terms for age and sex were also added.
Results
A total of 19 391 individuals (756 CKD Stage 3; 9114 Stage 2; 9521 non-CKD) were included and 829 fractures occurred during a median follow-up of 70 months. Compared with the median eGFR of 90 mL/min/1.73 m2, eGFRs of ≤60 mL/min/1.73 m2 were associated with increased fracture incidence in unadjusted and adjusted models [adjusted hazard ratio (HR) = 1.25 (95% confidence interval 1.05–1.49) for 60 mL/min/1.73 m2; 1.65 (1.14–2.37) for 45 mL/min/1.73 m2]. The eGFR was linearly associated with fracture incidence <75 mL/min/1.73 m2 [HR = 1.18 (1.04–1.34) per 10 mL/min/1.73 m2 decrease] but not above [HR = 0.98 (0.91–1.06) per 10 mL/min/1.73 m2 decrease). The effect of decreased eGFR on fracture incidence was more pronounced in younger individuals [HR = 2.45 (1.28–4.67) at 45 years; 1.11 (0.73–1.67) at 65 years] and in men.
Conclusions
Even early CKD increases fracture incidence, especially in younger individuals and in men.</description><subject>Adult</subject><subject>Aged</subject><subject>Canada - epidemiology</subject><subject>Female</subject><subject>Fractures, Bone - epidemiology</subject><subject>Fractures, Bone - etiology</subject><subject>Fractures, Bone - pathology</subject><subject>Glomerular Filtration Rate</subject><subject>Humans</subject><subject>Incidence</subject><subject>Longitudinal Studies</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Prospective Studies</subject><subject>Renal Insufficiency, Chronic - complications</subject><subject>Risk Factors</subject><issn>0931-0509</issn><issn>1460-2385</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kF1LwzAUQIMobk5f_AGSF0GEunw0bePbGHMOhoLM55LmY4t2aU1apYL_3Y6pjz6Fm3s4Fw4A5xjdYMTp2KlmvDafhPEDMMRxgiJCM3YIhv0SR4ghPgAnIbwghDhJ02MwoJgzTBI8BF8LJ63STmpYGWi8kE3rdYDWwa1VqtSRWGvVj8q-W9WKMsAP22ygFr7soNz4ylkJX61yuoPKBi2CvoUC1lXdlqKxlYuK_ktB4UTZBRt2Z6aTp5WYzx5mp-DI9Ep99vOOwPPdbDW9j5aP88V0sowkZbSJYkkYw4KlKU2I5AwVuGCZSoqYcMRTlZrUUFZwXBhBGUKp0Ik0SZJhGRPKMjoCV3tv7au3Vocm39ogdVkKp6s25ITGOEEZpqhHr_eo9FUIXpu89nYrfJdjlO9y533ufJ-7hy9-vG2x1eoP_e3bA5d7oGrr_0Tf5_yIyA</recordid><startdate>20201001</startdate><enddate>20201001</enddate><creator>Desbiens, Louis-Charles</creator><creator>Goupil, Rémi</creator><creator>Madore, François</creator><creator>Mac-Way, Fabrice</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-6879-9344</orcidid></search><sort><creationdate>20201001</creationdate><title>Incidence of fractures in middle-aged individuals with early chronic kidney disease: a population-based analysis of CARTaGENE</title><author>Desbiens, Louis-Charles ; Goupil, Rémi ; Madore, François ; Mac-Way, Fabrice</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c353t-4c2551a577362c950b1b58d6b429097d7f7f35b91bfa35007ae6cf6681c423583</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Canada - epidemiology</topic><topic>Female</topic><topic>Fractures, Bone - epidemiology</topic><topic>Fractures, Bone - etiology</topic><topic>Fractures, Bone - pathology</topic><topic>Glomerular Filtration Rate</topic><topic>Humans</topic><topic>Incidence</topic><topic>Longitudinal Studies</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Prospective Studies</topic><topic>Renal Insufficiency, Chronic - complications</topic><topic>Risk Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Desbiens, Louis-Charles</creatorcontrib><creatorcontrib>Goupil, Rémi</creatorcontrib><creatorcontrib>Madore, François</creatorcontrib><creatorcontrib>Mac-Way, Fabrice</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Nephrology, dialysis, transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Desbiens, Louis-Charles</au><au>Goupil, Rémi</au><au>Madore, François</au><au>Mac-Way, Fabrice</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Incidence of fractures in middle-aged individuals with early chronic kidney disease: a population-based analysis of CARTaGENE</atitle><jtitle>Nephrology, dialysis, transplantation</jtitle><addtitle>Nephrol Dial Transplant</addtitle><date>2020-10-01</date><risdate>2020</risdate><volume>35</volume><issue>10</issue><spage>1712</spage><epage>1721</epage><pages>1712-1721</pages><issn>0931-0509</issn><eissn>1460-2385</eissn><abstract>Abstract
Background
Previous studies evaluating fractures in chronic kidney disease (CKD) have mostly focused on hip or major fractures in aged populations with moderate to advanced CKD. We aimed at evaluating the association between early CKD and fracture incidence at all sites across age and sex in middle-aged individuals.
Methods
We analyzed CARTaGENE, a prospective population-based survey of 40- to 69-year-old individuals from Quebec (Canada). Estimated glomerular filtration rate (eGFR) at baseline was evaluated categorically or continuously using restricted cubic splines. Fractures at any site (except toes, hand and craniofacial) for up to 7 years of follow-up were identified through administrative databases using a validated algorithm. Adjusted Cox models were used to evaluate the association of CKD with fracture. Interaction terms for age and sex were also added.
Results
A total of 19 391 individuals (756 CKD Stage 3; 9114 Stage 2; 9521 non-CKD) were included and 829 fractures occurred during a median follow-up of 70 months. Compared with the median eGFR of 90 mL/min/1.73 m2, eGFRs of ≤60 mL/min/1.73 m2 were associated with increased fracture incidence in unadjusted and adjusted models [adjusted hazard ratio (HR) = 1.25 (95% confidence interval 1.05–1.49) for 60 mL/min/1.73 m2; 1.65 (1.14–2.37) for 45 mL/min/1.73 m2]. The eGFR was linearly associated with fracture incidence <75 mL/min/1.73 m2 [HR = 1.18 (1.04–1.34) per 10 mL/min/1.73 m2 decrease] but not above [HR = 0.98 (0.91–1.06) per 10 mL/min/1.73 m2 decrease). The effect of decreased eGFR on fracture incidence was more pronounced in younger individuals [HR = 2.45 (1.28–4.67) at 45 years; 1.11 (0.73–1.67) at 65 years] and in men.
Conclusions
Even early CKD increases fracture incidence, especially in younger individuals and in men.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>31951261</pmid><doi>10.1093/ndt/gfz259</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-6879-9344</orcidid><oa>free_for_read</oa></addata></record> |
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| source | Oxford University Press Journals All Titles (1996-Current); MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Adult Aged Canada - epidemiology Female Fractures, Bone - epidemiology Fractures, Bone - etiology Fractures, Bone - pathology Glomerular Filtration Rate Humans Incidence Longitudinal Studies Male Middle Aged Prospective Studies Renal Insufficiency, Chronic - complications Risk Factors |
| title | Incidence of fractures in middle-aged individuals with early chronic kidney disease: a population-based analysis of CARTaGENE |
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