BACKGROUND Major fractures (MF) are common in dialysis patients. We investigated incidence, predictors and clinical outcomes associated with first MF occurring after initiation of dialysis (MFfirst). METHODS In Swedish Renal Registry of 9714 incident (2005-2016) dialysis patients (age 68 years, 67% men), we identified all MFfirst in hip, spine, humerus and forearm. Using flexible parametric hazard models and Fine-Gray analysis, we estimated incidence, mortality rates and predictors of MFfirst, and, in time-dependent analysis, risk of all-cause and cardiovascular disease (CVD) mortality following MFfirst. RESULTS During median follow-up of 2.2 years, the crude incidence rate of MFfirst (n = 835) was 23.7/1000 patient-years and that of hip fractures (n = 470) 13.3/1000 patient-years. The multivariate-adjusted fracture incidence rates increased gradually after dialysis initiation and were 47% higher among women. Female sex, higher age, comorbidity, and previous history of MF (MFprevious) were associated with increased risk for MFfirst, whereas peritoneal dialysis as compared to hemodialysis was associated with decreased risk. The adjusted fracture incidence rate of MFfirst during the first 90 days following dialysis initiation was higher in patients with MFprevious than in those without MFprevious. MFfirst independently predicted increased all-cause (sub-distribution hazard ratio, SHR, 1.67(95%CI 1.47-1.91)) and CVD (SHR 1.49 (95%CI 1.22-1.84)) mortality. Adjusted mortality rate following hip fractures was higher than for other types of MF. Spline curves showed that mortality following MFfirst was highest during the first 6 months of follow-up. CONCLUSIONS MF are common and associated with increased mortality in incident dialysis patients.

中文翻译：

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透析开始后的严重骨折：发生率、预测因素和与死亡率的关联

背景重大骨折（MF）在透析患者中​​很常见。我们调查了与透析开始后 (MFfirst) 发生的首次 MF 相关的发生率、预测因素和临床结果。方法 在瑞典肾脏登记处的 9714 例（2005-2016）透析患者（年龄 68 岁，67% 男性）中，我们在髋部、脊柱、肱骨和前臂中确定了所有 MFfirst。使用灵活的参数风险模型和 Fine-Gray 分析，我们估计了 MFfirst 的发生率、死亡率和预测因子，并在时间相关分析中估计了 MFfirst 后全因和心血管疾病 (CVD) 死亡率的风险。结果 在中位随访 2.2 年期间，MFfirst（n = 835）的粗发病率为 23.7/1000 患者年，髋部骨折（n = 470）的粗发病率为 13.3/1000 患者年。透析开始后多变量调整的骨折发生率逐渐增加，女性高出 47%。女性、较高年龄、合并症和既往 MF 病史（MFprevious）与 MFfirst 风险增加相关，而与血液透析相比，腹膜透析与风险降低相关。在透析开始后的前 90 天内，MFfirst 调整后的骨折发生率在有 MF 以前的患者中高于没有 MF 以前的患者。MFfirst 独立预测增加的全因（亚分布风险比，SHR，1.67（95%CI 1.47-1.91））和 CVD（SHR 1.49（95%CI 1.22-1.84））死亡率。髋部骨折后的调整死亡率高于其他类型的 MF。样条曲线显示，MFfirst 后的死亡率在随访的前 6 个月内最高。结论 MF 很常见，并且与透析患者死亡率增加有关。