The Impact of Hemodialysis on Mortality and Personal Independence After Hip Fracture. A Prospective Matched Cohort Study.

Abstract

To determine the cumulative 30-day and 1-year mortality as well as personal independence after hip fracture in patients on hemodialysis. Prospective, observational cohort study with matched controls. One teaching hospital, one metropolitan trauma center, one peripheral hospital. Study group: a consecutive cohort of 64 patients with end-stage renal disease receiving chronic hemodialysis who had undergone surgery for a trochanteric or femoral neck fracture from June 2008 to November 2016. subjects without end-stage renal disease who underwent surgery for similar hip fractures. One-year mortality, activities of daily living, and ambulatory activity. The 30-day and 1-year mortality rate in patients with a hip fracture undergoing hemodialysis was 25.0% and 57.8%, respectively. Hemodialysis was independently associated with increased 30-day (Hazard ratio 2.933; 95% confidence interval 1.270-6.770; P = 0.018) and 1-year (hazard ratio 2.535; 95% confidence interval, 1.494-4.299; P < 0.001) mortality compared with the matched controls. At the 1-year follow-up, loss of personal independence in comparison with the prefracture status was detected. Hemodialysis was associated with increased mortality after hip fracture. A worse prefracture functional status predicted the loss of functional independence at follow-up. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.