The impact of hemodialysis on mortality and personal independence following hip fracture. A prospective matched cohort study.

Objective: To determine the cumulative 30-day and 1-year mortality as well as personal independence after hip fracture in patients on hemodialysis. Design: Prospective, observational cohort study with matched controls. Setting: One teaching hospital, one metropolitan trauma center, one peripheral hospital. Patients and Intervention: Study group: a consecutive cohort of 64 patients with end-stage renal disease receiving chronic hemodialysis who had undergone surgery for a trochanteric or femoral neck fracture from June 2008 to November 2016. Control group: subjects without end-stage renal disease who underwent surgery for similar hip fractures. Main Outcome Measure: One-year mortality, activities of daily living, and ambulatory activity. Results: The 30-day and 1-year mortality rate in patients with a hip fracture undergoing hemodialysis was 25.0% and 57.8%, respectively. Hemodialysis was independently associated with increased 30-day (Hazard ratio 2.933; 95% confidence interval 1.270-6.770; P = 0.018) and 1-year (hazard ratio 2.535; 95% confidence interval, 1.494-4.299; P < 0.001) mortality compared with the matched controls. At the 1-year follow-up, loss of personal independence in comparison with the prefracture status was detected. Conclusions: Hemodialysis was associated with increased mortality after hip fracture. A worse prefracture functional status predicted the loss of functional independence at follow-up.