Statin use and hip fractures in U.S. kidney transplant recipients

BMC Nephrology

Research Article

Wolfgang C. Winkelmayer¹  Chandan Vangala²  Venkat Ramanathan³  Sankar D. Navaneethan⁴  Maria E. Montez-Rath⁵  Colin R. Lenihan⁶  Sumi Sukumaran Nair⁷ 

[1] Baylor College of Medicine, Section of Nephrology, One Baylor Plaza, BCM 395, 77030, Houston, TX, USA;Baylor College of Medicine, Section of Nephrology, One Baylor Plaza, BCM 620 – 11D32.5, 77030, Houston, TX, USA;Baylor College of Medicine, Section of Nephrology, One Baylor Plaza, BCM 620 – 11D32.5, 77030, Houston, TX, USA;Section of Nephrology, Michael E. DeBakey VA Medical Center, 2002 Holcombe Boulevard, #111-J, 77030, Houston, TX, USA;Baylor College of Medicine, Section of Nephrology, One Baylor Plaza, Ste 100-37D, 77030, Houston, TX, USA;Division of Nephrology, Department of Medicine, Stanford University School of Medicine, 1070 Arastradero Road # 3C11C, 94304, Palo Alto, CA, USA;Division of Nephrology, Stanford University School of Medicine, 777 Welch Road Suite DE, 94304, Palo Alto, CA, USA;Mayo Clinic Arizona, 5777E Mayo Blvd, 85012, Phoenix, AZ, USA;

关键词: End-stage renal disease;    Hip fracture;    Outcomes;    Drug safety;    Case-control;    USRDS;   

DOI  :  10.1186/s12882-017-0559-9

 received in 2016-11-08, accepted in 2017-04-19,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundBasic and translational research supports beneficial effects of statins on bone metabolism. Clinical studies suggest that statin use may reduce the risk of hip fractures in the general population. Whether statin use is associated with hip fracture risk in kidney transplant recipients, a particularly high-risk group for this outcome, is unknown.MethodsFrom the U.S. Renal Data System (2007–2011), we identified all hip fracture events recorded in Medicare billing claims of first-time kidney transplant recipients. We then matched all cases to an unlimited number of controls on age (±3 years), sex, race (black vs. non-black), and time since transplant. Cases and controls were required to have >1 year of Medicare Parts A + B + D coverage and be without a recorded history of hip fracture. We ascertained any statin use in the previous year and defined adherent statin use as those who had filled prescriptions for statins to cover >80% of days in that year (proportion of days covered, PDC). We ascertained several potential confounders (demographics, comorbidities, BMI, transplant-related factors) and applied conditional logistic regression with multiple imputation for missing data to estimate odds ratios (OR) and 95% confidence intervals (CI).ResultsWe identified 231 hip fracture cases (mean age 51.8 years; 53% female; 11.3% black; 6.9 years from transplant, and 9.9 years from ESRD) and 15,575 matched controls. Any prior statin use was present in 64.1% of cases and 60.3% of controls with 37.2% of cases and 33.9% of controls being found adherent. Unadjusted conditional logistic regression showed an OR of 1.17 (0.89-1.54) for any statin use, and a fully-adjusted OR of 0.89 (0.67-1.19). Compared with statin non-users, the adjusted OR for patients with lesser adherence (PDC ≤80%) and those with greater adherence (PDC >80%) were 0.93 (0.66-1.31) and 0.87 (0.63-1.20), respectively.ConclusionStatin use was not associated with hip fracture risk in first-time kidney transplant recipients.

【 授权许可】

CC BY   
© The Author(s). 2017