Renal osteodystrophy (ROD) is an early complication in chronic kidney disease (CKD). Irreversible skeletal complications and deformities in children are already present before CKD progresses to end stage renal disease; therefore, the early detection of coexisting ROD is important in children with CKD. In the present work, we present a case of ROD in a 14-year-old female patient with chronic renal failure. The patient had already suffered bilateral femoral neck fractures before starting extracorporeal dialysis. On the 21st day after dialysis, external fixations of the femoral neck were performed.
Adolescent ; Child ; Congenital Abnormalities ; Dialysis ; Female ; Femoral Neck Fractures ; Femur Neck ; Humans ; Kidney Failure, Chronic ; Renal Dialysis ; Renal Insufficiency, Chronic ; Renal Osteodystrophy ; Renal Replacement Therapy

Objectives: The distribution of hospitals in Korea is unbalanced in terms of accessibility. Many local public health centers (PHCs) exempt out-of-pocket payments (OOPs) based on local government laws to increase coverage. However, this varies across administrative regions, as many make this exemption for the elderly, while others do not. This study aimed to evaluate the effects of the OOP exemption at local PHCs among elderly individuals. Methods: This study used online data on Korean national law to gather information on individual local governments’ regulations regarding OOP exemptions. Individual-level data were gathered from the 2018 Community Health Survey and regional-level data from public online sources. Results: The study analyzed 132 regions and 44 918 elderly people. A statistical analysis of rate differences and 2-level multiple logistic regression were carried out. The rate difference according to whether elderly individuals resided in areas with the OOP exemption was 1.97%p (95% confidence interval [CI], 1.07 to 2.88) for PHC utilization, 1.37%p (95% CI, 0.67 to 2.08) for hypertension treatment, and 2.19%p (95% CI, 0.63 to 3.74) for diabetes treatment. The regression analysis showed that OOP exemption had an effect on hypertension treatment, with a fixed-effect odds ratio of 1.25 (95% CI, 1.05 to 1.48). Conclusions The OOP exemption at PHCs can affect medical utilization in Korea, especially for hypertension treatment. The OOP exemption should be expanded to improve healthcare utilization in Korea.