Abstract: SA-PO655
AKI Followed by Complete Recovery Is Associated with Increased Bone Fracture Risk
Session Information
- Bone and Mineral Metabolism: Clinical - II
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Bone and Mineral Metabolism
- 402 Bone and Mineral Metabolism: Clinical
Authors
- Ambruso, Sophia L., University of Colorado, Denver, Colorado, United States
- You, Zhiying, UC Denver, Aurora, Colorado, United States
- Griffin, Benjamin, University of Colorado, Denver, Colorado, United States
- Holmen, John R., Intermountain Healthcare, Murray, Utah, United States
- Srinivas, Titte, Intermountain Medical Center, Murray, Utah, United States
- Chonchol, Michel, University of Colorado, Denver, Colorado, United States
- Faubel, Sarah, University of Colorado Denver , Denver, Colorado, United States
- Jovanovich, Anna Jeanette, Denver VA, Denver, Colorado, United States
Background
Acute kidney injury (AKI) affects multiple organ systems, including bone mineral metabolism. Fracture risk is increased among dialysis-requiring AKI patients. The relationship between fracture risk and AKI with complete recovery has not been characterized. We investigated fracture risk following an admission complicated by non-dialysis requiring AKI with complete recovery in a propensity score-matched cohort of cases and controls.
Methods
We identified 1139 AKI cases (AKI Network definition) with complete recovery at discharge, defined by creatinine <1.10 times the pre-admit baseline value, during a hospitalization between January 1, 1999 and December 31, 2009 from an integrated health care delivery system. We matched 1139 controls (no AKI during index admission) based on a propensity score including age, sex, race, prior inpatient visits, baseline creatinine, all comorbidities in the Charlson index, and season of admission. The primary outcome was incident bone fracture following discharge. Cox proportional hazards models were adjusted for prior fracture and body mass index (BMI) and censored for death.
Results
Baseline characteristics among cases and controls were similar: age 62 ± 17 years, 45% female, 92% white, creatinine 0.9 ± 0.2 mg/dL. During a median [IQR] follow-up of 63 [10-87] months, 294 (26%) AKI cases and 169 (15%) controls had a bone fracture. Those with AKI followed by complete recovery had a two-fold increased hazard of bone fracture (HR 2.13 [95% CI, 1.76-2.58]; p=<0.0001). After adjusting for prior fracture and BMI the association persisted but was somewhat attenuated (HR 1.49 [95% CI, 1.23-1.80]; p<0.0001).
Conclusion
Hospitalized patients whose course was complicated by non-dialysis requiring AKI with complete kidney function recovery had an increased risk of fracture following discharge compared to propensity score-matched controls. These data suggest alterations in bone mineral metabolism during AKI may be associated with long-term risk of fracture even if serum creatinine returns to baseline. Further studies investigating bone and mineral metabolism pathophysiology and AKI are warranted.
Funding
- Veterans Affairs Support