Impact of Varied Severity of Chronic Kidney Disease Stage on Surgical Outcomes Following Distal Radius Fracture Operative Fixation.

Abstract

Chronic kidney disease (CKD) alters bone metabolism, immune function, and vascular health, potentially increasing postoperative risk following distal radius fracture (DRF) operative fixation (ie, open reduction and internal fixation, percutaneous pinning). However, data stratifying risk by CKD severity remain limited. This study evaluated the association between CKD stage and 90-day complications and 1-year orthopedic-related events following DRF operative fixation. Adults aged 18 to 65 undergoing isolated DRF operative fixation were identified in the PearlDiver M170 database. Patients were stratified by CKD status: none, stage 1 to 2, stage 3 to 4, and stage 5 or end-stage renal disease (ESRD). Ninety-day medical complications and 1-year orthopedic-related events were assessed using univariable and multivariable logistic regression controlling for age and sex, with and without adjustment for Elixhauser Comorbidity Index (ECI). Bonferroni correction was significant at <i>P</i> ≤ .001. Among 29,009 patients, 28,411 (97.9%) had no CKD history, 101 (0.3%) had stage 1 to 2 CKD, 336 (1.2%) had stage 3 to 4, and 161 (0.6%) had stage 5/ESRD. Complication risk increased stepwise with CKD severity. Adjusting for age and sex, odds ratios (OR) for any 90-day complication were 5.62, 15.07, and 30.63 for stages 1 to 2, 3 to 4, and 5/ESRD, respectively (all <i>P</i> < .001). After ECI adjustment, associations remained significant, although attenuated (OR = 2.23, 5.93, and 11.04, respectively). No differences were observed in 1-year orthopedic-related events, including hardware removal or malunion/nonunion. CKD independently and incrementally increased short-term complication risk following DRF operative fixation, even after accounting for comorbidity burden. These findings support stage-based perioperative counseling and multidisciplinary optimization in patients with CKD.