PMID- 32646504
OWN - NLM
STAT- MEDLINE
DCOM- 20211013
LR  - 20211013
IS  - 1471-2369 (Electronic)
IS  - 1471-2369 (Linking)
VI  - 21
IP  - 1
DP  - 2020 Jul 9
TI  - Osteoporotic fracture rates in chronic hemodialysis and effect of heparin 
      exposure: a retrospective cohort study.
PG  - 261
LID - 10.1186/s12882-020-01916-4 [doi]
LID - 261
AB  - BACKGROUND: Patients receiving chronic hemodialysis treatments are at a higher 
      risk of fracture compared to the general population. While the use of heparin 
      during dialysis is crucial to avoid thrombosis of the extracorporeal circuit, the 
      association of unfractionated heparin (UFH) and the risk of osteoporotic fracture 
      has been shown for many years. However, this association was not as clear for 
      low-molecular-weight heparin (LMWH) and the few collected data originated from 
      studies among pregnant women. Our aim was to measure osteoporotic fracture rate 
      among hemodialysis patients and to evaluate the association of LMWH compared to 
      UFH in hemodialysis. METHODS: A retrospective cohort study was conducted on data 
      extracted from the RAMQ and Med-Echo databases from January 2007 to March 2013 
      with patients chronically hemodialyzed in 21 participating centers. Incidence 
      rates for each fracture sites were measured per 1000 patient-year (p-y) and their 
      95% confidence intervals (CI). Osteoporotic fracture risk for a first event with 
      LMWH compared to UFH was estimated using a cox proportional hazard model using 
      demographics, comorbidities and drug use as covariates. RESULTS: 4796 patients 
      undergoing chronic hemodialysis were identified. The incidence rate for all 
      fracture sites was 22.7 /1000 p-y (95% CI: 19.6-26.1) and 12.8 /1000 p-y (95% CI: 
      10.5-15.4) for hip and femur fractures. We found a similar risk of osteoporotic 
      fracture for LMWH compared to UFH (adjusted HR = 1.01; 95%CI: 0.72-1.42). Age and 
      malignancy increased the risk of fracture while cerebrovascular disease decreased 
      the risk of fracture. CONCLUSIONS: Compared to UFH, LMWH did not change the risk 
      of osteoporotic fracture when used for the extracorporeal circuit anticoagulation 
      in chronic hemodialysis.
FAU - Harrak, Hind
AU  - Harrak H
AD  - Centre de recherche Hopital Maisonneuve-Rosemont, Montreal, Canada.
FAU - Rene, Emilie
AU  - Rene E
AD  - Centre de recherche Hopital Maisonneuve-Rosemont, Montreal, Canada.
FAU - Alsalemi, Noor
AU  - Alsalemi N
AD  - Centre de recherche Hopital Maisonneuve-Rosemont, Montreal, Canada.
FAU - Elftouh, Naoual
AU  - Elftouh N
AD  - Centre de recherche Hopital Maisonneuve-Rosemont, Montreal, Canada.
FAU - Lafrance, Jean-Philippe
AU  - Lafrance JP
AUID- ORCID: 0000-0001-7876-0446
AD  - Centre de recherche Hopital Maisonneuve-Rosemont, Montreal, Canada. 
      jean-philippe.lafrance@umontreal.ca.
AD  - Service de nephrologie, Hopital Maisonneuve-Rosemont, 5415, boul. de 
      l'Assomption, Montreal, Quebec, H1T 2M4, Canada. 
      jean-philippe.lafrance@umontreal.ca.
AD  - Departement de pharmacologie et physiologie, Universite de Montreal, Montreal, 
      Canada. jean-philippe.lafrance@umontreal.ca.
LA  - eng
PT  - Journal Article
DEP - 20200709
PL  - England
TA  - BMC Nephrol
JT  - BMC nephrology
JID - 100967793
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Age Factors
MH  - Aged
MH  - Aged, 80 and over
MH  - Anticoagulants/*therapeutic use
MH  - Cerebrovascular Disorders/epidemiology
MH  - Cohort Studies
MH  - Female
MH  - Femoral Fractures/epidemiology
MH  - Heparin/therapeutic use
MH  - Heparin, Low-Molecular-Weight/*therapeutic use
MH  - Hip Fractures/epidemiology
MH  - Humans
MH  - Kidney Failure, Chronic/*therapy
MH  - Male
MH  - Middle Aged
MH  - Neoplasms/epidemiology
MH  - Osteoporotic Fractures/*epidemiology
MH  - Proportional Hazards Models
MH  - Renal Dialysis/*methods
MH  - Retrospective Studies
MH  - Risk Factors
PMC - PMC7350680
OTO - NOTNLM
OT  - Heparin, low molecular weight
OT  - Kidney failure, chronic
OT  - Osteoporotic fracture
OT  - Pharmacoepidemiology
OT  - Unfractionated heparin
COIS- The authors declare that they have no competing interests.
EDAT- 2020/07/11 06:00
MHDA- 2021/10/14 06:00
PMCR- 2020/07/09
CRDT- 2020/07/11 06:00
PHST- 2019/09/30 00:00 [received]
PHST- 2020/06/28 00:00 [accepted]
PHST- 2020/07/11 06:00 [entrez]
PHST- 2020/07/11 06:00 [pubmed]
PHST- 2021/10/14 06:00 [medline]
PHST- 2020/07/09 00:00 [pmc-release]
AID - 10.1186/s12882-020-01916-4 [pii]
AID - 1916 [pii]
AID - 10.1186/s12882-020-01916-4 [doi]
PST - epublish
SO  - BMC Nephrol. 2020 Jul 9;21(1):261. doi: 10.1186/s12882-020-01916-4.