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. 2025 Dec 5;9(1):e457.
doi: 10.1097/OI9.0000000000000457. eCollection 2026 Mar.

Outcomes after surgical fixation of lower extremity fractures in patients with chronic kidney disease

Alexander D Jeffs  1 , Kristin A Toy  1 , Beau R White  1 , Feng-Chang Lin  1 , Di Hu  1 , Margaret D Fisher  2 , Jason McCartney  2 , Judith A Siegel  1 , Andrew T Chen  1
Affiliations

Outcomes after surgical fixation of lower extremity fractures in patients with chronic kidney disease

Alexander D Jeffs et al. OTA Int. .

Abstract

Objectives: Assess mortality and complications in patients with chronic kidney disease (CKD) after fixation of lower extremity fractures.

Design: Retrospective cohort.

Setting: Single academic level 1 trauma center.

Patients: Four hundred seventy-six patients with CKD and operative lower extremity fractures (pelvis to ankle).

Intervention: Patients were grouped according to preoperative glomerular filtration rate (GFR) per the National Kidney Foundation Guidelines. Patients with moderate-to-severe CKD and end stage renal disease (ESRD) were compared with those with predisease state CKD.

Outcome measurements: Mortality and complication rates at time points up to 2 years or until death.

Results: Patients with predisease state CKD were significantly less likely to have a complication within 2 years than patients with ESRD but not patients with moderate-to-severe CKD. One-year and 2-year mortality rate were significantly higher in the moderate-to-severe CKD (36.1%) and ESRD (49.0%) groups than in the predisease state CKD group. Compared to the patients with predisease state CKD, patients with moderate-to-severe CKD and ESRD both had increased odds of 1-year mortality, 2-year mortality, and a complication at 2 years after operative fixation of a lower extremity fracture. Patients with ESRD also had increased odds of 30-day and 90-day mortality compared with patients with predisease state CKD.

Conclusions: Compared to patients with predisease state CKD, patients with moderate-to-severe CKD and ESRD had increased odds of 1-year mortality and 2-year mortality, as well as a complication at 2 years. Patients with ESRD had increased odds of 30-day and 90-day mortality compared with patients with predisease state CKD. Two-year mortality rate was 49% in the ESRD group.

Level of evidence: Therapeutic level III.

Keywords: chronic kidney disease; lower extremity fractures; outcomes.

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Conflict of interest statement

The authors report no conflict of interest.

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