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Increased Risk of Chronic Kidney Disease in Rheumatoid Arthritis Associated with Cardiovascular Complications - A National Population-Based Cohort Study.
PLoS One 2015; 10(9):e0136508Plos

Abstract

BACKGROUND AND OBJECTIVES

There have been few large population-based studies of the association between rheumatoid arthritis (RA) and chronic kidney disease (CKD) and glomerulonephritis. This nationwide cohort study investigated the risks of developing CKD and glomerulonephritis in patients with RA, and the associated risks for cardiovascular complications.

METHODS

From the Taiwan National Health Insurance Research Database, we identified a study cohort of 12,579 patients with RA and randomly selected 37,737 subjects without RA as a control cohort. Each subject was individually followed for up for 5 years, and the risk of CKD was analyzed using Cox proportional hazards regression models.

RESULTS

During the follow-up period, after adjusting for traditional cardiovascular risk factors RA was independently associated with a significantly increased risk of CKD (adjusted hazard ratio [aHR] 1.31; 95% confidence interval [CI] 1.23-1.40) and glomerulonephritis (aHR 1.55; 95% CI 1.37-1.76). Increased risk of CKD was also associated with the use of non-steroidal anti-inflammatory drugs, cyclosporine, glucocorticoids, mycophenolate mofetil, and cyclophosphamide. Patients with comorbidities had even greater increased risk of CKD. Moreover, RA patients with concurrent CKD had significantly higher likelihood of developing ischemic heart disease and stroke.

CONCLUSIONS

RA patients had higher risk of developing CKD and glomerulonephritis, independent of traditional cardiovascular risk factors. Their increased risk of CKD may be attributed to glomerulonephritis, chronic inflammation, comorbidities, and renal toxicity of antirheumatic drugs. Careful monitoring of renal function in RA patients and tight control of their comorbid diseases and cardiovascular risk factors are warranted.

Authors+Show Affiliations

Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan; Department of Dermatology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan; Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.Institute of Bioinformatics and Systems Biology, National Chiao Tung University, Hsinchu, Taiwan; Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan.Institute of Bioinformatics and Systems Biology, National Chiao Tung University, Hsinchu, Taiwan; Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan.Institute of Bioinformatics and Systems Biology, National Chiao Tung University, Hsinchu, Taiwan.Institute of Bioinformatics and Systems Biology, National Chiao Tung University, Hsinchu, Taiwan.Institute of Bioinformatics and Systems Biology, National Chiao Tung University, Hsinchu, Taiwan.Institute of Bioinformatics and Systems Biology, National Chiao Tung University, Hsinchu, Taiwan.Department of Dermatology, Cathay General Hospital, Taipei, Taiwan.Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.Institute of Bioinformatics and Systems Biology, National Chiao Tung University, Hsinchu, Taiwan; Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26406879

Citation

Chiu, Hsien-Yi, et al. "Increased Risk of Chronic Kidney Disease in Rheumatoid Arthritis Associated With Cardiovascular Complications - a National Population-Based Cohort Study." PloS One, vol. 10, no. 9, 2015, pp. e0136508.
Chiu HY, Huang HL, Li CH, et al. Increased Risk of Chronic Kidney Disease in Rheumatoid Arthritis Associated with Cardiovascular Complications - A National Population-Based Cohort Study. PLoS ONE. 2015;10(9):e0136508.
Chiu, H. Y., Huang, H. L., Li, C. H., Chen, H. A., Yeh, C. L., Chiu, S. H., ... Ho, S. Y. (2015). Increased Risk of Chronic Kidney Disease in Rheumatoid Arthritis Associated with Cardiovascular Complications - A National Population-Based Cohort Study. PloS One, 10(9), pp. e0136508. doi:10.1371/journal.pone.0136508.
Chiu HY, et al. Increased Risk of Chronic Kidney Disease in Rheumatoid Arthritis Associated With Cardiovascular Complications - a National Population-Based Cohort Study. PLoS ONE. 2015;10(9):e0136508. PubMed PMID: 26406879.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Increased Risk of Chronic Kidney Disease in Rheumatoid Arthritis Associated with Cardiovascular Complications - A National Population-Based Cohort Study. AU - Chiu,Hsien-Yi, AU - Huang,Hui-Ling, AU - Li,Chien-Hsun, AU - Chen,Hung-An, AU - Yeh,Chia-Lun, AU - Chiu,Shih-Hsiang, AU - Lin,Wei-Chun, AU - Cheng,Yu-Pin, AU - Tsai,Tsen-Fang, AU - Ho,Shinn-Ying, Y1 - 2015/09/25/ PY - 2015/06/01/received PY - 2015/08/04/accepted PY - 2015/9/26/entrez PY - 2015/9/26/pubmed PY - 2016/6/2/medline SP - e0136508 EP - e0136508 JF - PloS one JO - PLoS ONE VL - 10 IS - 9 N2 - BACKGROUND AND OBJECTIVES: There have been few large population-based studies of the association between rheumatoid arthritis (RA) and chronic kidney disease (CKD) and glomerulonephritis. This nationwide cohort study investigated the risks of developing CKD and glomerulonephritis in patients with RA, and the associated risks for cardiovascular complications. METHODS: From the Taiwan National Health Insurance Research Database, we identified a study cohort of 12,579 patients with RA and randomly selected 37,737 subjects without RA as a control cohort. Each subject was individually followed for up for 5 years, and the risk of CKD was analyzed using Cox proportional hazards regression models. RESULTS: During the follow-up period, after adjusting for traditional cardiovascular risk factors RA was independently associated with a significantly increased risk of CKD (adjusted hazard ratio [aHR] 1.31; 95% confidence interval [CI] 1.23-1.40) and glomerulonephritis (aHR 1.55; 95% CI 1.37-1.76). Increased risk of CKD was also associated with the use of non-steroidal anti-inflammatory drugs, cyclosporine, glucocorticoids, mycophenolate mofetil, and cyclophosphamide. Patients with comorbidities had even greater increased risk of CKD. Moreover, RA patients with concurrent CKD had significantly higher likelihood of developing ischemic heart disease and stroke. CONCLUSIONS: RA patients had higher risk of developing CKD and glomerulonephritis, independent of traditional cardiovascular risk factors. Their increased risk of CKD may be attributed to glomerulonephritis, chronic inflammation, comorbidities, and renal toxicity of antirheumatic drugs. Careful monitoring of renal function in RA patients and tight control of their comorbid diseases and cardiovascular risk factors are warranted. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/26406879/Increased_Risk_of_Chronic_Kidney_Disease_in_Rheumatoid_Arthritis_Associated_with_Cardiovascular_Complications___A_National_Population_Based_Cohort_Study_ L2 - http://dx.plos.org/10.1371/journal.pone.0136508 DB - PRIME DP - Unbound Medicine ER -