Risk factors for fracture in patients with end-stage renal disease: a Meta-analysis

Objective  To systematically explore the factors related to fractures in patients with end-stage renal disease（ESRD）.

Methods  The authors conducted a computerized search of CNKI, VIP, Wanfang, China Biomedical Database, PubMed and Embase for the relevant literature published since their inceptions. Two researchers independently selected and evaluated the quality of the studies, extracted data and utilized Review Manager 5.3 software for statistical analysis.

Results  A total of 19 articles were retrieved. Among 8 related factors, 6 of them were risk factors as follows: age（OR=1.28, 95%CI:1.20-1.37, P＜0.01）, female（OR=1.93, 95%CI:1.51-2.46, P＜0.01）, alkaline phosphatase（OR=1.03, 95%CI:1.01-1.05, P=0.008）, parathyroid hormone（OR=1.07, 95%CI:1.04-1.10, P＜0.01）, diabetes mellitus（OR=1.70, 95%CI:1.44-2.02, P＜0.01）, duration of dialysis（OR=1.83, 95%CI:1.20-2.80, P=0.005） and two protective factors of serum albumin（OR=0.81, 95%CI:0.69-0.96, P=0.02） and activated vitamin D3（OR = 0.33, 95%CI:0.16-0.67, P=0.002）.

Conclusion  Risk factors for fracture in ESRD patients include age ≥65 years, female, elevated alkaline phosphatase, abnormal level of parathyroid hormone, dialysis duration＞6 years and concurrent diabetes mellitus. Normal levels of serum albumin and activated vitamin D3 are protective factors for fracture.