Acute and chronic kidney disease in elderly patients with hip fracture: prevalence, risk factors and outcome with development and validation of a risk prediction model for acute kidney injury
Background Hip fracture is a common injury in older people with a high rate of postoperative morbidity and mortality. This patient group is also at high risk of acute kidney injury (AKI) and chronic kidney disease (CKD), but little is known of the impact of kidney disease on outcome following hip f...
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| Format: | Article |
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BioMed Central
2017
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| Online Access: | https://eprints.nottingham.ac.uk/40437/ |
| _version_ | 1848796056336203776 |
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| author | Porter, Christine J. Moppett, Iain K. Juurlink, Irene Nightingale, Jessica Moran, Christopher G. Devonald, Mark A.J. |
| author_facet | Porter, Christine J. Moppett, Iain K. Juurlink, Irene Nightingale, Jessica Moran, Christopher G. Devonald, Mark A.J. |
| author_sort | Porter, Christine J. |
| building | Nottingham Research Data Repository |
| collection | Online Access |
| description | Background
Hip fracture is a common injury in older people with a high rate of postoperative morbidity and mortality. This patient group is also at high risk of acute kidney injury (AKI) and chronic kidney disease (CKD), but little is known of the impact of kidney disease on outcome following hip fracture.
Methods
An observational cohort of consecutive patients with hip fracture in a large UK secondary care hospital. Predictive modelling of outcomes using development and validation datasets. Inclusion: all patients admitted with hip fracture with sufficient serum creatinine measurements to define acute kidney injury. Main outcome measures – development of acute kidney injury during admission; mortality (in hospital, 30-365 day and to follow-up); length of hospital stay.
Results
Data were available for 2848 / 2959 consecutive admissions from 2007-2011; 776 (27.2%) male. Acute kidney injury occurs in 24%; development of acute kidney injury is independently associated with male sex (OR 1.48 (1.21 to 1.80), premorbid chronic kidney disease stage 3B or worse (OR 1.52 (1.19 to 1.93)), age (OR 3.4 (2.29 to 5.2) for >85 years) and greater than one major co-morbidities (OR 1.61 (1.34 to 1.93)). Acute kidney injury of any stage is associated with an increased hazard of death, and increased length of stay (Acute kidney injury: 19.1 (IQR 13 to 31) days; no acute kidney injury 15 (11 to 23) days). A simplified predictive model containing Age, CKD stage (3B-5), two or more comorbidities, and male sex had an area under the ROC curve of 0.63 (0.60 to 0.67).
Conclusions
Acute kidney injury following hip fracture is common and associated with worse outcome and greater hospital length of stay. With the number of people experiencing hip fracture predicted to rise, recognition of risk factors and optimal perioperative management of acute kidney injury will become even more important. |
| first_indexed | 2025-11-14T19:41:55Z |
| format | Article |
| id | nottingham-40437 |
| institution | University of Nottingham Malaysia Campus |
| institution_category | Local University |
| last_indexed | 2025-11-14T19:41:55Z |
| publishDate | 2017 |
| publisher | BioMed Central |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | nottingham-404372020-05-04T18:30:42Z https://eprints.nottingham.ac.uk/40437/ Acute and chronic kidney disease in elderly patients with hip fracture: prevalence, risk factors and outcome with development and validation of a risk prediction model for acute kidney injury Porter, Christine J. Moppett, Iain K. Juurlink, Irene Nightingale, Jessica Moran, Christopher G. Devonald, Mark A.J. Background Hip fracture is a common injury in older people with a high rate of postoperative morbidity and mortality. This patient group is also at high risk of acute kidney injury (AKI) and chronic kidney disease (CKD), but little is known of the impact of kidney disease on outcome following hip fracture. Methods An observational cohort of consecutive patients with hip fracture in a large UK secondary care hospital. Predictive modelling of outcomes using development and validation datasets. Inclusion: all patients admitted with hip fracture with sufficient serum creatinine measurements to define acute kidney injury. Main outcome measures – development of acute kidney injury during admission; mortality (in hospital, 30-365 day and to follow-up); length of hospital stay. Results Data were available for 2848 / 2959 consecutive admissions from 2007-2011; 776 (27.2%) male. Acute kidney injury occurs in 24%; development of acute kidney injury is independently associated with male sex (OR 1.48 (1.21 to 1.80), premorbid chronic kidney disease stage 3B or worse (OR 1.52 (1.19 to 1.93)), age (OR 3.4 (2.29 to 5.2) for >85 years) and greater than one major co-morbidities (OR 1.61 (1.34 to 1.93)). Acute kidney injury of any stage is associated with an increased hazard of death, and increased length of stay (Acute kidney injury: 19.1 (IQR 13 to 31) days; no acute kidney injury 15 (11 to 23) days). A simplified predictive model containing Age, CKD stage (3B-5), two or more comorbidities, and male sex had an area under the ROC curve of 0.63 (0.60 to 0.67). Conclusions Acute kidney injury following hip fracture is common and associated with worse outcome and greater hospital length of stay. With the number of people experiencing hip fracture predicted to rise, recognition of risk factors and optimal perioperative management of acute kidney injury will become even more important. BioMed Central 2017-01-14 Article PeerReviewed Porter, Christine J., Moppett, Iain K., Juurlink, Irene, Nightingale, Jessica, Moran, Christopher G. and Devonald, Mark A.J. (2017) Acute and chronic kidney disease in elderly patients with hip fracture: prevalence, risk factors and outcome with development and validation of a risk prediction model for acute kidney injury. BMC Nephrology, 18 (20). pp. 1-11. ISSN 1471-2369 Hip fracture Acute kidney injury (AKI ) KDIGO creatinine criteria Hospital length of stay Kidney function Mortality Postoperative AKI Surgery Surgical complication http://bmcnephrol.biomedcentral.com/articles/10.1186/s12882-017-0437-5 doi: 10.1186/s12882-017-0437-5 doi: 10.1186/s12882-017-0437-5 |
| spellingShingle | Hip fracture Acute kidney injury (AKI ) KDIGO creatinine criteria Hospital length of stay Kidney function Mortality Postoperative AKI Surgery Surgical complication Porter, Christine J. Moppett, Iain K. Juurlink, Irene Nightingale, Jessica Moran, Christopher G. Devonald, Mark A.J. Acute and chronic kidney disease in elderly patients with hip fracture: prevalence, risk factors and outcome with development and validation of a risk prediction model for acute kidney injury |
| title | Acute and chronic kidney disease in elderly patients with hip fracture: prevalence, risk factors and outcome with development and validation of a risk prediction model for acute kidney injury |
| title_full | Acute and chronic kidney disease in elderly patients with hip fracture: prevalence, risk factors and outcome with development and validation of a risk prediction model for acute kidney injury |
| title_fullStr | Acute and chronic kidney disease in elderly patients with hip fracture: prevalence, risk factors and outcome with development and validation of a risk prediction model for acute kidney injury |
| title_full_unstemmed | Acute and chronic kidney disease in elderly patients with hip fracture: prevalence, risk factors and outcome with development and validation of a risk prediction model for acute kidney injury |
| title_short | Acute and chronic kidney disease in elderly patients with hip fracture: prevalence, risk factors and outcome with development and validation of a risk prediction model for acute kidney injury |
| title_sort | acute and chronic kidney disease in elderly patients with hip fracture: prevalence, risk factors and outcome with development and validation of a risk prediction model for acute kidney injury |
| topic | Hip fracture Acute kidney injury (AKI ) KDIGO creatinine criteria Hospital length of stay Kidney function Mortality Postoperative AKI Surgery Surgical complication |
| url | https://eprints.nottingham.ac.uk/40437/ https://eprints.nottingham.ac.uk/40437/ https://eprints.nottingham.ac.uk/40437/ |