Diabetes increases the risk of fracture among patients on kidney replacement therapy

Patients undergoing kidney replacement therapy (KRT) appear to be at increased risk of developing a fracture in the presence of diabetes, a study has found.

The study used data from the Nationwide Danish registries and included prevalent adult patients on haemodialysis (HD) or peritoneal dialysis (PD) as well as incident patients starting KRT (HD, PD, kidney transplanted [KTX]). A comparison group that involved adults not on KRT was also established.

All participants were further divided into two according to their diabetes status. They were followed until the incidence of first fracture, emigration, death, or end-of-study.

The total study population comprised 4,074,085 individuals not on KRT with or without diabetes, and 9,053 patients on KRT with or without diabetes. Diabetes was present in 18–30 percent of patients with end-stage kidney disease.

In Cox proportional hazards regression models, diabetes contributed to an increased risk of fractures in end-stage kidney disease, with the risk increase greatest among dialysis patients relative to adults who were not on KRT and without diabetes.

The corresponding unadjusted hazard ratios for any first fracture associated with diabetes were 1.2 (95 percent confidence interval [CI], 1.0–1.3) in the HD subgroup, 1.4 (95 percent CI, 1.1–1.7) in the PD subgroup, and 1.7 (95 percent CI, 1.4–2.2) in the KTX subgroup.

Results were consistent even after adjusting for age, sex, prior fractures, comorbidity, and medication.