TY - JOUR
T1 - Fractures and Subsequent Graft Loss and Mortality among Older Kidney Transplant Recipients
AU - Salter, Megan L.
AU - Liu, Xinran
AU - Bae, Sunjae
AU - Chu, Nadia M.
AU - Miller Dunham, Alexandra
AU - Humbyrd, Casey
AU - Segev, Dorry L.
AU - McAdams-DeMarco, Mara A.
N1 - Funding Information:
Sponsor’s Role: This study was supported by National Institutes of Health grant R01DK120518 (Principal Investigator: Mara A. McAdams-DeMarco), R01AG042504 (Principal Investigator: Dorry L. Segev), and K24DK101828 (Principal Investigator: Dorry L. Segev). Mara A. McAdams-DeMarco was supported by the National Institute on Aging (P30AG021334, K01AG043501, R01AG055781) and by the National Institute of Diabetes and Digestive and Kidney Diseases (R01DK114074). The data reported here were supplied by the Minneapolis Medical Research Foundation as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the author(s) and should in no way be seen as an official policy of or interpretation by the SRTR or the US government.
Funding Information:
Conflict of Interest: Dorry L. Segev holds speaking honoraria from Sanofi, Novartis, and CSL Behring. The remaining authors of this article have no conflicts of interest to disclose. Author Contributions: Design and concept of the study: Salter, Liu, and McAdams-DeMarco. Data analysis and interpretation: Salter, Liu, Bae, and McAdams-DeMarco. Writing and critical revisions for intellectual content and final approval of the article: All authors. Sponsor's Role: This study was supported by National Institutes of Health grant R01DK120518 (Principal Investigator: Mara A. McAdams-DeMarco), R01AG042504 (Principal Investigator: Dorry L. Segev), and K24DK101828 (Principal Investigator: Dorry L. Segev). Mara A. McAdams-DeMarco was supported by the National Institute on Aging (P30AG021334, K01AG043501, R01AG055781) and by the National Institute of Diabetes and Digestive and Kidney Diseases (R01DK114074).The data reported here were supplied by the Minneapolis Medical Research Foundation as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the author(s) and should in no way be seen as an official policy of or interpretation by the SRTR or the US government.
Publisher Copyright:
© 2019 The American Geriatrics Society
PY - 2019
Y1 - 2019
N2 - OBJECTIVES: Older adults who undergo kidney transplantation (KT) are living longer with a functioning graft and are at risk for age-related adverse events including fractures. Understanding recipient, transplant, and donor factors and the outcomes associated with fractures may help identify older KT recipients at increased risk. We determined incidence of hip, vertebral, and extremity fractures; assessed factors associated with incident fractures; and estimated associations between fractures and subsequent death-censored graft loss (DCGL) and mortality. DESIGN: This was a prospective cohort study of patients who underwent their first KT between January 1, 1999, and December 31, 2014. SETTING: We linked data from the Scientific Registry of Transplant Recipients to Medicare claims through the US Renal Data System. PARTICIPANTS: The analytic population included 47 815 KT recipients aged 55 years or older. MEASUREMENTS: We assessed the cumulative incidence of and factors associated with post-KT fractures (hip, vertebral, or extremity) using competing risks models. We estimated risk of DCGL and mortality after fracture using adjusted Cox proportional hazards models. RESULTS: The 5-year incidence of post-KT hip, vertebral, and extremity fracture for those aged 65 to 69 years was 2.2%, 1.0%, and 1.7%, respectively. Increasing age was associated with higher hip (adjusted hazard ratio [aHR] = 1.37 per 5-y increase; 95% confidence interval [CI] = 1.30-1.45) and vertebral (aHR = 1.31; 95% CI = 1.20-1.42) but not extremity (aHR =.97; 95% CI =.91-1.04) fracture risk. DCGL risk was higher after hip (aHR = 1.34; 95% CI = 1.12-1.60) and extremity (aHR = 1.30; 95% CI = 1.08-1.57) fracture. Mortality risk was higher after hip (aHR = 2.31; 95% CI = 2.11-2.52), vertebral (aHR = 2.80; 95% CI = 2.44-3.21), and extremity (aHR = 1.85; 95% CI = 1.64-2.10) fracture. CONCLUSION: Our findings suggest that older KT recipients are at higher risk for hip and vertebral fracture but not extremity fracture; and those with hip, vertebral, or extremity fracture are more likely to experience subsequent graft loss or mortality. These findings underscore that different fracture types may have different underlying etiologies and risks, and they should be approached accordingly. J Am Geriatr Soc 67:1680–1688, 2019.
AB - OBJECTIVES: Older adults who undergo kidney transplantation (KT) are living longer with a functioning graft and are at risk for age-related adverse events including fractures. Understanding recipient, transplant, and donor factors and the outcomes associated with fractures may help identify older KT recipients at increased risk. We determined incidence of hip, vertebral, and extremity fractures; assessed factors associated with incident fractures; and estimated associations between fractures and subsequent death-censored graft loss (DCGL) and mortality. DESIGN: This was a prospective cohort study of patients who underwent their first KT between January 1, 1999, and December 31, 2014. SETTING: We linked data from the Scientific Registry of Transplant Recipients to Medicare claims through the US Renal Data System. PARTICIPANTS: The analytic population included 47 815 KT recipients aged 55 years or older. MEASUREMENTS: We assessed the cumulative incidence of and factors associated with post-KT fractures (hip, vertebral, or extremity) using competing risks models. We estimated risk of DCGL and mortality after fracture using adjusted Cox proportional hazards models. RESULTS: The 5-year incidence of post-KT hip, vertebral, and extremity fracture for those aged 65 to 69 years was 2.2%, 1.0%, and 1.7%, respectively. Increasing age was associated with higher hip (adjusted hazard ratio [aHR] = 1.37 per 5-y increase; 95% confidence interval [CI] = 1.30-1.45) and vertebral (aHR = 1.31; 95% CI = 1.20-1.42) but not extremity (aHR =.97; 95% CI =.91-1.04) fracture risk. DCGL risk was higher after hip (aHR = 1.34; 95% CI = 1.12-1.60) and extremity (aHR = 1.30; 95% CI = 1.08-1.57) fracture. Mortality risk was higher after hip (aHR = 2.31; 95% CI = 2.11-2.52), vertebral (aHR = 2.80; 95% CI = 2.44-3.21), and extremity (aHR = 1.85; 95% CI = 1.64-2.10) fracture. CONCLUSION: Our findings suggest that older KT recipients are at higher risk for hip and vertebral fracture but not extremity fracture; and those with hip, vertebral, or extremity fracture are more likely to experience subsequent graft loss or mortality. These findings underscore that different fracture types may have different underlying etiologies and risks, and they should be approached accordingly. J Am Geriatr Soc 67:1680–1688, 2019.
KW - fractures
KW - graft loss
KW - kidney transplant
KW - mortality
KW - older adults
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U2 - 10.1111/jgs.15962
DO - 10.1111/jgs.15962
M3 - Article
C2 - 31059126
AN - SCOPUS:85065391995
SN - 0002-8614
VL - 67
SP - 1680
EP - 1688
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
IS - 8
ER -