Bone Abstracts

Introduction: Kidney dysfunction is common in the elderly and has been proven to have an association with increased hip fracture incidence. Acute dysfunction may also delay surgery. Serum creatinine, a product of metabolised muscle tissue is a marker used to determine changes in renal function.

Objective: To assess the renal function of hip fracture patients throughout their hospital stay using serum creatinine as the marker of renal function.

Method: Data on serum creatinine levels was collected from records for 100 consecutive patients admitted to an acute hip fracture ward in a UK district Hospital (Carmarthen, Wales). Patients’ serum creatinine levels (in μmol/l) were recorded; pre-admission (from previous blood tests), on admission and before discharge. Laboratory specific creatinine reference ranges were used; 44–80 μmol/l (females), 62–106 μmol/l (males). Comparisons were made between levels pre-admission to discharge (PA-DC) and admission to discharge (OA-DC).

Results: 100 hip fracture patients, 65% females. Average age: 80 years. The table shows creatinine levels in hip fracture patients.

The average creatinine reduction PA-DC was 10.2 μmol/l, OA-DC it was 19.7 μmol/l. A creatinine reduction of over 20 μmol/l was noted in 26 patients OA-DC but in only 11 patients PA-DC.

Conclusions: This study suggests significant percentages of patients presenting to hospital with a hip fractures have some degree of renal impairment as defined by a high creatinine level. Many of these patients’ creatinine levels normalise during their hospital stay. The greatest reductions in creatinine were observed between admission and discharge; this suggests a substantial number of hip fracture patients have acute kidney injury on admission. As such, reversible causes of renal impairment should be actively sought and treated in hip fracture patients. The contribution of renal impairment towards post operative outcomes and bone fragility needs further investigation.