Introduction
Methods
Search strategy and selection criteria
Data extraction
Quality assessment
Data synthesis and analysis
Results
Characteristics of included studies
Study | Study design | Patient selection | Number of participants | Number of patients with eGFR < 60/dialysis** | Age (me(di)an (± range) | % male | Me(di)an follow-up time in years (range) | Overall score quality assessment (…/9) | Outcome | |||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Accidental falls | Hip/femur +pelvis fractures | Vertebral fracture | Any type of fracture | |||||||||
Alem, 2000 [14] | RCS | US Renal Data System (USRDS) | ? | 326,464** | NR | 56% | ? (?–7) | 4 | X | |||
Arneson, 2013 [13] | RCS | Medicare, USA | 1,267,416* | 101,995** | ≥ 66 | 46%* | ? (?–1) | 7 | X | |||
Atteritano, 2017 [15] | CS | Population-based cohort, USA | 192 | 92** | 65.9* | 78%* | NA | 8 | X | |||
Bowling, 2016 [21] | PCS | Population-based cohort, USA (REGARDS) | 8744 | 1604 | ≥ 65 | 51% | 5.9 (?–9.9) | 7 | X | |||
Chen, 2018 [22] | PCS | Population-based cohort, The Netherlands (LASA) | 1477 | 560* | 75.8 ± 6.6 | 48% | ? (?–6) | 7/8 | X | X | X | |
Coco, 2000 [18] | RCS | Outpatient dialysis unit (monocenter) | NR | 1272 | 58 ± 0.4 | 49% | 3.2 (?–10) | 7 | X | |||
Daya, 2016 [42] | PCS | Population-based (ARIC), USA | 10,955 | 693 | 63.3* | 44%* | 13 (?–15) | 7 | X | |||
Dooley, 2008 [30] | RS | Multicenter Veteran clinic, USA | 33,091 | 13,632 | 67.5 (?) | 100% | 3 (?–7) | 8 | X | |||
Dukas, 2005 [23] | PCS | Multicenter study, Germany | 186 | NR | 75.0 ± 4.1 | 48%* | ? (?–0.7) | 6 | X | |||
Dukas, 2005 [24] | CS | Post hoc subanalysis of RCT | 5313 | NR | 74.0 (?) | 20% | NA | 6/5 | X | X | X | |
Elliott, 2013 [12] | PCS | Population-based cohort, Canada | 1,815,943 | 128,957 | ≥ 65 | 44% | 4.4 (?–6) | 5 | X | X | X | |
Ensrud, 2007 [31] | CC | Population-based cohort, USA (SOF) | 396 | 186 | ≥ 65 | 0% | 5.9 (?) | 6 | X | X | ||
Ensrud, 2012 [43] | CC | Multicenter cohort study, USA (WHI-OS) | 2190 | NR | 64.3* | 0% | 8.6 (?–12) | 8 | X | |||
Ensrud, 2014 [32] | CC | Population-based cohort, USA (MrOS) | 1602 | 388 | 73.8* | 100% | 7.9 (?–8) | 8 | X | |||
Fried, 2007 [33] | PCS | Population-based cohort, USA | 5888 | 1190* | 74.8* | 42%* | 7.1 (?) | 7 | X | |||
Hall, 2015 [25] | RCS | Multiple nursing homes, USA (RCT CONNECT for quality) | 510 | 179* | 77.2 ± 11.5 | 73% | 0.2 (?–0.5) | 7 | X | |||
Hall, 2018 [44] | PCS | Multicenter Veteran clinic, USA | 712,918 | 356,459 | 73.0* | 100% | 5.2 (?–10) | 6 | X | |||
Hansen, 2016 [16] | RCS | Danish population + all patients receiving dialysis in Denmark | 4,099,342 | 7566** | 46* | 49% | ? (?–2) | 6 | X | |||
Iwagami, 2018 [34] | RCS | Population-based cohort, England | 484,698 | 242,349 | 75.4 ± 9.7 | 39% | 4.2 (?–10) | 7 | X | |||
Kaji, 2010 [40] | CS | Outpatient clinic for metabolic bone disorders, Japan | 659 | 85 | 64.5 ± 8.2 | 0% | NA | 5 | X | |||
Kim, 2016 [35] | RCS | Multicenter cohort, USA (NIS) | 278,018 | 38,932 | NR | 31%* | ? (?–1) | 5 | X | |||
Kinsella, 2010 [45] | CS | Monocenter study, Ireland | 1702 | 347 | 61.7 ± 10.8 | 0% | 4 | X | ||||
Kistler, 2018 [26] | CS | Behavioral risk factor surveillance system (BRFSS), USA | 157,753 | 9116 | ≥ 65 | 44% | NA | 6 | X | |||
Kurajoh, 2018 [46] | CS | Multicenter study, Japan | 555 | 181 | 76.8* | 0% | NA | 6 | X | |||
LaCroix, 2008 [39] | CC | Multicenter cohort study, USA (WHI-OS) | 794 | 144 | 71 (?) | 0% | 7 (0.7–9.3) | 9 | X | |||
Liao, 2016 [47] | RCS | Population-based cohort, Taiwan (LHID2005) | 11,312 | 1427 | ≥ 40 | 68% | 2.6 (?–10) | 6 | X | |||
Maravic, 2014 [17] | RCS | French national database | 68,953 | 29,487** | 82.1* | 24%* | ? (?–1) | 5 | X | |||
McCarthy, 2008 [50] | PCS | Multicenter cohort + population-based cohort, USA | 427 | 85 | 68 ± 13.5 | 0% | 14 (?–25) | 7 | X | |||
Mishima, 2015 [41] | CS | Tertiary center, Japan | 173 | 68 | 62.3 ± 12.2 | 57% | NA | 4 | X | |||
Naylor, 2014 [29] | PCS | Population-based cohort, Canada | 679,114 | 107,841 | > 65 | 45%* | ? (?–3) | 7 | X | X | ||
Naylor, 2015 [49] | PCS | Population-based cohort, Canada (CaMos) | 2107 | 320 | 67.2* | 29% | 4.8 (?–5) | 4 | X | |||
Nickolas, 2006 [36] | CS | Population-based cohort, USA (NHANES III) | 6270 | 875 | 64.9* | 48%* | NA | 6 | X | |||
Pérez-Sáez, 2015 [37] | RCS | Population-based cohort, Spain (SIDIAPQ) | 873,073 | 32,934 | 67.6 | 47% | 3 (?–3) | 6 | X | |||
Račić, 2015 [19] | CS | Multiple HD centers, Bosnia and Herzegovina and Serbia + primary care center | 406 | 106** | 77.6* | 61% | NA | 4 | X | |||
Rafiq, 2014 [27] | RS | Multiple GP databases, UK (QICKD) | 135,433 | NR | 75.4 ± 7.6 | 44% | 2,5 (?–5) | 6 | X | |||
Robertson, 2018 [38] | RCS | Single health region Scotland | 39,630 | 19,882 | 63.3* | 41%* | ? (5.5–?) | 7 | X | |||
Rothenbacher, 2014 [28] | PCS | Population-based cohort, Ulm + Germany (ActiFE) | 1385 | 196 | 75.6 ± 6.5 | 57% | 1 (?–1) | 8 | X | |||
Wakasugi, 2013 [20] | RCS | All dialysis facilities in Japan | NR | 128,141 | NR | 62% | ? (?–1) | 4 | X | |||
Yenchek, 2012 [48] | PCS | Population-based cohort, USA (Health, aging, and body composition study) | 2754 | 587 | 73.6 ± 2.9 | 49%* | 11.3 (?) | 7 | X |
Quality assessment
Accidental falling
Accidental falls | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|
Study | Degree of kidney impairment | Adjusted (+/−) | Reference group | |||||||
eGFR method | < 15 | 15–29 | 30–44 | < 45 | 45–59 | < 60 | Other | |||
Bowling, 2016 [21] | CKD-EPI (creatinine) | HR 1.09 (0.86–1.37)‡ | HR 0.91 (0.76–1.09) | +a,b,c,d,e,f | ≥ 60 | |||||
Chen, 2018 [22] | MDRD (creatinine) | eGFR 9–57 HR 0.999 (0.995–1.002) | +a,b,c,d | ≥ 74 | ||||||
Dukas, 2005 [23] | CG (creatinine) | eGFR < 65 OR 4.01 (1.48–10.89)‡ | +a,c,d,e | ≥ 65 | ||||||
Dukas, 2005 [24] | CG (creatinine) | eGFR < 65 OR 1.69 (1.50-1.91)‡ | +a,c,e | ≥ 65 | ||||||
Hall, 2015 [25] | MDRD (creatinine) | Rate ratio 1.06 (0.85–1.32) | Rate ratio 0.97 (0.76–1.23) | +a,f | ≥ 60 | |||||
Kistler, 2018 [26] | Self-report | CKD OR 1.26 (1.13-1.47) | +a,d,f | Non-CKD | ||||||
Naylor, 2014 [29] | CKD-EPI (creatinine) | ♀ Risk ratio 3.45* | ♀Risk ratio 2.39* | ♀Risk ratio 2.00* | ♀Risk ratio 1.55* | − | ≥ 60 | |||
Račić, 2015 [19] | Hemodialysis | Risk ratio 4.7* | − | Non-CKD | ||||||
Rafiq, 2014 [27] | NHS codes | OR 0.9 (0.9–0.9) | eGFR 60–89 OR 1.1 (1.1–1.2) | +a,b,d,e | ≥ 90 | |||||
Rothenbacher, 2014 [28] | CKD-EPI (cystatin C) | Risk ratio 1.03 (0.83-1.28)* | − | ≥ 60 |
Hip fractures
Hip/femur fractures | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Study | Degree of kidney impairment | Adjusted (+/−) | Reference group | ||||||||
eGFR method | < 15 | 15–29 | < 30 | 30–44 | < 45 | 45–59 | < 60 | Other | |||
Alem, 2000 [14] | Dialysis | ♂Rate ratio 4.44 (4.16–4.75) ♀Rate ratio 4.40 (4.16–4.64) | +a | General population | |||||||
Arneson, 2013 [13] | Hemodialysis | Rate ratio 4.0* | +a,d | Non-ESKD | |||||||
Coco, 2000 [18] | Dialysis | Rate ratio 17.4 (12.4–34.0) | − | General population | |||||||
Dooley, 2008 [30] | MDRD (creatinine) | ♂HR 3.65 (1.87–7.13)‡ | +a,b,c,f | General population | |||||||
Dukas, 2005 [24] | CG (creatinine) | OR 1.57 (1.18–2.09)‡ | +a,b,c,e,f | ≥ 65 | |||||||
Elliott, 2013 [12] | CKD-EPI (creatinine) | Rate ratio 3.46 (3.13–3.83)* | Rate ratio 2.53 (2.38–2.69)* | Rate ratio 1.62 (1.54–1.71)* | − | ≥ 60 | |||||
Ensrud, 2007 [31] | MDRD (creatinine) | ♀HR 1.58 (0.59–4.23) | ♀HR 1.49 (0.93–2.38) | +a,c,h | ≥ 60 | ||||||
Ensrud, 2014 [32] | CKD-EPI (creatinine) | ♂HR 0.92 (0.58–1.47) | +a,c,d,g,h | ≥ 60 | |||||||
Fried, 2007 [33] | MDRD (creatinine) | ♂ HR 0.97 (0.58–1.62) ♀ HR 1.38 (0.99-1.94) | +a,b,c,d | ≥ 60 | |||||||
Iwagami, 2018 [34] | CKD-EPI (creatinine) | HR 1.72 (1.59–1.85)‡ | HR 1.29 (1.24–1.36) | HR 1.04 (1.00–1.08) | HR 1.11 (1.07–1.15)‡ | +a,d,e | ≥ 60 | ||||
Kim, 2016 [35] | ICD | Rate ratio 3.30* | Rate ratio 1.53*‡ | +a,b,e,f,h | Normal kidney function | ||||||
LaCroix, 2008 [39] | Cystatin C^-1*76.7 | ♀OR 2.64 (1.41–4.97) | GFR 60-89: ♀OR 1.10 (0.71–1.73) | +a,b,c, | ≥ 90 | ||||||
Maravic, 2014 [17] | Dialysis | Rate ratio 4.1* | − | Non-dialysis | |||||||
Nickolas, 2006 [36] | MDRD (creatinine) | OR 2.32 (1.13–4.74)‡ | +a,b,c,d,g,h | ≥ 60 | |||||||
Pérez-Sáez, 2015 [37] | ICD | HR 1.16 (1.06–1.27) | +a,b,c,d,f | ≥ 60 | |||||||
Robertson, 2018 [38] | MDRD (creatinine) | Rate ratio 1.74 (1.30–2.33) | Rate ratio 1.70 (1.38–2.09) | Rate ratio 1.40 (1.16–1.70) | Rate ratio 1.49 (1.24–1.79) | +a,d | ≥ 60 | ||||
Wakasugi, 2013 [20] | Dialysis | ♂Rate ratio 6.2 (5.7–6.8) ♀Rate ratio 4.9 (4.6–5.3) | +a | General population |
Vertebral fractures
Vertebral fractures | |||||||||
---|---|---|---|---|---|---|---|---|---|
Study | Degree of kidney impairment | Adjusted (+/−) | Reference group | ||||||
eGFR method | < 15 | 15–29 | 30–44 | < 45 | 45–59 | < 60 | |||
Atteritano, 2017 [15] | Hemodialysis | OR 6.33 (2.92–13.73)* | +a | Normal kidney function | |||||
Chen, 2018 [22] | MDRD (creatinine) | OR 0.63 (0.53–1.24) | OR 0.86 (0.56–1.32) | +a,b,c,d | ≥ 60 | ||||
Dukas, 2005 [24] | CG (creatinine) | OR 1.31 (1.10–1.55)‡ | +a,b,c,e,f | ≥ 65 | |||||
Elliott, 2013 [12] | CKD-EPI (creatinine) | Rate ratio 1.61 (1.37–1.89)* | Rate ratio 1.67 (1.54–1.81)* | Rate ratio 1.35 (1.27–1.44)* | − | ≥ 60 | |||
Ensrud, 2007 [31] | MDRD (creatinine) | ♀ OR 0.73 (0.24–2.24) | ♀ OR 0.75 (0.45–1.23) | +a,c,h | ≥ 60 | ||||
Kaji, 2010 [40] | MDRD (creatinine) | ♀ OR 2.32 (1.45–3.71)* | −e,f | ≥ 60 | |||||
Mishima, 2015 [41] | Formula proposed by the Japanese Society of Nephrology | OR 2.48 (1.20–5.12)*‡ | −e,f | ≥ 60 |
Any type of fracture
Any type of fracture | |||||||||
---|---|---|---|---|---|---|---|---|---|
Study | Degree of kidney impairment | Adjusted (+/−) | Reference group | ||||||
eGFR method | < 15 | 15–29 | 30–44 | 45–59 | < 60 | Other | |||
Chen, 2018 [22] | MDRD (creatinine) | HR 1.46 (1.12–1.91) | HR 1.28 (1.12–1.46) | +a,b,c,d | ≥ 60 | ||||
Daya, 2016 [42] | CKD-EPI (creatinine) | HR 0.89 (0.56–1.41) | +a,b,c,d,e,f | ≥ 90 | |||||
Elliott, 2013 [12] | CKD-EPI (creatinine) | Rate ratio 2.16 (2.00–2.34)* | Rate ratio 1.80 (1.72–1.88)* | Rate ratio 1.38 (1.33–1.42)* | − | ≥ 60 | |||
Ensrud, 2012 [43] | CKD-EPI (cystatin C) | ♀HR 2.46 (1.16–5.21) | GFR 60–89 ♀HR 1.16 (0.85–1.58) | +a,e | ≥ 90 | ||||
Hall, 2018 [44] | MDRD | ♂HR 1.91 (1.45–2.50) | ♂HR 1.32 (1.16–1.49) | +a,b,c,d,e | ≥ 60 | ||||
Hansen, 2016 [16] | Dialysis | HR 1.85 (1.75–1.95) | +a,d,e | General population | |||||
Kinsella, 2010 [45] | MDRD (creatinine) | ♀OR 1.37 (1.0–1.89) | GFR < 75 ♀OR 1.20 (0.93–1.55) | +a,e,f | 75–89 | ||||
Kurajoh, 2018 [46] | Japanese formula for eGFRcr | Per 10 ml/min/1.73 m2decrease: OR 0.96 (0.85–1.01) | +a,b,c,d | NA | |||||
Liao, 2016 [47] | ? | CKD HR 1.10 (0.95–1.27) | +a,d,f | No CKD | |||||
McCarthy, 2008 [50] | MDRD | Per 10 ml/min/1.73 m2decrease: HR 0.92 (0.84–1.01) | +a,c | NA | |||||
Naylor, 2014 [29] | CKD-EPI | ♂ Rate ratio 4.3 (3.70–5.00) ♀Rate ratio 3.1 (2.80–3.50) | ♂Rate ratio 2.7 (2.20–3.30) ♀Rate ratio 2.1 (1.90–2.30) | ♂Rate ratio 1.8 (1.60–2.00) ♀Rate ratio 1.6 (1.50–1.70) | ♂Rate ratio 1.3 (1.20–1.40) ♀Rate ratio 1.40 (1.30–1.50) | − | ≥ 60 | ||
Naylor, 2015 [49] | CKD-EPI (creatinine) | Risk ratio 1.86 (1.07–3.24)* | − | ≥ 60 | |||||
Yenchek, 2012 [48] | MDRD (creatinine) | Risk Ratio 1.26 (1.02–1.56)* | − | ≥ 60 |