Incidence, Risk Factors, and Treatment of Achilles Tendon Rupture in Patients with End-Stage Renal Disease

Abstract

Category: Trauma Introduction/Purpose: Patients who are dialysis-dependent and those who have received kidney transplants may be at increased risk for Achilles tendon rupture (ATR) as a result of compromised kidney function. Our goal was to examine the incidence, risk factors, and type of ATR treatment in patients with end-stage renal disease (ESRD). Methods: We studied all Medicare patients with ESRD from 1999 through 2013, as captured by the Centers for Medicare & Medicaid Services and the United States Renal Data System. Patients were categorized as not waitlisted for a transplant, waitlisted but not yet transplanted, or received a transplant. Patients were migrated to the corresponding groups at the time when they were waitlisted or received a transplant. We performed multivariate negative binomial regression using age, race, sex, body mass index, cause of ESRD, comorbidities, and year of study entry as covariables to estimate the adjusted incidence rate ratios (aIRR) for all groups and to identify risk factors for ATR. We performed a subgroup analysis using the above methods for participants with Medicare Part D to characterize the association of fluoroquinolones and steroids with ATR. Results: We identified 1091 ATRs (incidence, 3.80 per 10,000 person-years; 95% confidence interval [CI], 3.58–4.03). Patients who sustained an ATR were significantly younger, had higher mean body mass index, and had fewer comorbidities than patients without ATR. Compared with the incidence of ATR among transplant recipients, the incidence of ATR was lower in the non-waitlisted group (aIRR, 0.44; 95% CI, 0.37–0.53) and similar in the waitlisted group (aIRR, 0.94; 95% CI, 0.78–1.12). Patients who used fluoroquinolones and steroids had a higher incidence of ATR (aIRR 1.65; 95% CI, 1.32 -1.84 and aIRR 1.72, 95% CI, 1.44-2.05 respectively). A small proportion of patients (n = 184; 17%) received surgical treatment within 14 days of diagnosis of ATR, and the 30-day cumulative incidence of surgical site infections was 6.5%. Conclusion: The incidence of ATR was higher in the transplanted and waitlisted groups compared with the non-waitlisted group. Younger age, higher body mass index, better health, fluoroquinolone use and steroid use were significant risk factors for ATR. Patients were more likely to receive nonoperative than surgical treatment for ATR. Those who underwent surgical treatment for ATR had a low incidence of surgical site infection.