Outcomes after surgical fixation of lower extremity fractures in patients with chronic kidney disease.

Abstract

Assess mortality and complications in patients with chronic kidney disease (CKD) after fixation of lower extremity fractures. Retrospective cohort. Single academic level 1 trauma center. Four hundred seventy-six patients with CKD and operative lower extremity fractures (pelvis to ankle). Patients were grouped according to preoperative glomerular filtration rate (GFR) per the National Kidney Foundation Guidelines. Patients with moderate-to-severe CKD and end stage renal disease (ESRD) were compared with those with predisease state CKD. Mortality and complication rates at time points up to 2 years or until death. Patients with predisease state CKD were significantly less likely to have a complication within 2 years than patients with ESRD but not patients with moderate-to-severe CKD. One-year and 2-year mortality rate were significantly higher in the moderate-to-severe CKD (36.1%) and ESRD (49.0%) groups than in the predisease state CKD group. Compared to the patients with predisease state CKD, patients with moderate-to-severe CKD and ESRD both had increased odds of 1-year mortality, 2-year mortality, and a complication at 2 years after operative fixation of a lower extremity fracture. Patients with ESRD also had increased odds of 30-day and 90-day mortality compared with patients with predisease state CKD. Compared to patients with predisease state CKD, patients with moderate-to-severe CKD and ESRD had increased odds of 1-year mortality and 2-year mortality, as well as a complication at 2 years. Patients with ESRD had increased odds of 30-day and 90-day mortality compared with patients with predisease state CKD. Two-year mortality rate was 49% in the ESRD group. Therapeutic level III.