E-Cigarette Use and Risks of Mortality and Fragility Fractures in Stage 3 CKD

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E-Cigarette Use and Risks of Mortality and Fragility Fractures in Stage 3 CKD

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Co-author 1

Yu-Hsien Wu ux12091666@gmail.com Taichung Veterans General Hospital Department of Medical Education Taichung Taiwan *

Co-author 2

Tung-Min Yu yu5523@gmail.com Taichung Veterans General Hospital Division of Nephrology Taichung Taiwan -

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Introduction

The systemic effects of e-cigarettes in CKD remain unclear. We investigated their association with mortality and skeletal outcomes in stage 3 CKD.

Methods

Using the TriNetX Global Network (2018–2024), we identified adults (≥18 years) with CKD stage 3 (eGFR 30–59). Patients with prior hip, vertebral, or lower leg fractures or osteoporosis were excluded. E-cigarette users (ICD-10-CM U07.0/F17.290) were 1:1 propensity score–matched with non-users, yielding 29,106 per group. Outcomes were 5-year mortality, hip, vertebral, lower leg fractures, and osteoporosis diagnosis.

Results

Median follow-up was 668 days for e-cigarette users and 1,778 days for non-users. During follow-up, e-cigarette users experienced higher risks of mortality (5,458 vs 6,542 cases; HR 1.24, 95% CI 1.20–1.29), hip fracture (352 vs 418; HR 1.33, 95% CI 1.15–1.54), vertebral fracture (1,785 vs 1,695; HR 1.61, 95% CI 1.50–1.72), and lower leg fracture (588 vs 694; HR 1.30, 95% CI 1.17–1.46). Osteoporosis diagnoses were paradoxically less frequent in e-cigarette users (926 vs 1,621; HR 0.88, 95% CI 0.81–0.96).

Conclusion

Among stage 3 CKD patients, e-cigarette use was associated with increased mortality and fracture risks but fewer osteoporosis diagnoses, suggesting diagnostic under-recognition and highlighting potential harm in this vulnerable population.

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