TY - JOUR
T1 - Statin use and hip fractures in U.S. kidney transplant recipients
AU - Vangala, Chandan
AU - Lenihan, Colin R.
AU - Montez-Rath, Maria E.
AU - Nair, Sumi Sukumaran
AU - Navaneethan, Sankar D.
AU - Ramanathan, Venkat
AU - Winkelmayer, Wolfgang C.
N1 - Funding Information:
CV was supported by a gift from Dr. and Mrs. Harold Selzman. CRL receives grant support through a Mentored Clinical and Population Research Award from the American Heart Association (Western State Affiliate) and a Norman S. Coplon Extramural Grant for Clinical Applied Research from Satellite Healthcare. SSN was funded by a fellowship grant from Sanofi-Aventis. The Stanford nephrology fellowship program was supported by grant T32DK007357 from the National Institutes of Health. WCW receives support through the endowed Gordon A. Cain Chair in Nephrology at Baylor College of Medicine.
Publisher Copyright:
© 2017 The Author(s).
PY - 2017/5/1
Y1 - 2017/5/1
N2 - Background: Basic 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. Methods: From 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). Results: We 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. Conclusion: Statin use was not associated with hip fracture risk in first-time kidney transplant recipients.
AB - Background: Basic 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. Methods: From 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). Results: We 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. Conclusion: Statin use was not associated with hip fracture risk in first-time kidney transplant recipients.
KW - Case-control
KW - Drug safety
KW - End-stage renal disease
KW - Hip fracture
KW - Outcomes
KW - USRDS
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U2 - 10.1186/s12882-017-0559-9
DO - 10.1186/s12882-017-0559-9
M3 - Article
C2 - 28460645
AN - SCOPUS:85018956291
SN - 1471-2369
VL - 18
JO - BMC Nephrology
JF - BMC Nephrology
IS - 1
M1 - 145
ER -