Association between pre-injury serum albumin levels and mortality after hip fracture in patients with end-stage renal disease undergoing hemodialysis.

Abstract

Risk stratification based on pre-injury laboratory data has not been adequately explored for patients with end-stage renal disease (ESRD) undergoing hemodialysis following hip fractures. In this study, we aimed to evaluate the predictive value of pre-injury laboratory parameters, particularly serum albumin with respect to mortality after hip fracture in hemodialysis patients. Sixty-six patients, aged 56-98 years, with ESRD and undergoing hemodialysis and who had suffered hip fractures were evaluated and stratified into two groups based on their 1-year survival status. Laboratory data that were obtained within 1 month before injury were evaluated, focusing on the pre-injury albumin level as a continuous variable. The primary outcomes were the 1-year survival rate and predisposing factors related to 1-year mortality. Cox proportional hazards regression analyses were conducted to examine the association between clinical variables and 1-year mortality. The overall 1-year survival rate was 83.3%. Among the assessed variables, pre-injury serum albumin level was significantly associated with 1-year mortality in both univariate (hazard ratio [HR] per 1 g/dL increase, 0.15; 95% confidence interval [CI]: 0.05, 0.45) and multivariate analyses (HR per 1 g/dL increase, 0.19; 95% CI: 0.06, 0.60). Pre-injury hypoalbuminemia may serve as a clinically useful and potentially modifiable marker for risk stratification in hemodialysis patients after hip fracture. Addressing hypoalbuminemia before injury may help improve prognosis in this population, underscoring the importance of nutritional management for patients with ESRD who are at an elevated risk of hip fractures.