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The risk of chronic kidney disease in tuberculosis: a population-based cohort study
T-C Shen1, K-Y Huang2, C-H Chao2
1From the Graduate Institute of Clinical Medicine Science, College of Medicine, China Medical University, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung 404, Division of Pulmonary Medicine, Department of Internal Medicine, Chang Bing Show Chwan Memorial Hospital, Changhua 505, Management Office for Health Data, China Medical University Hospital, China Medical University, Division of Nephrology, Department of Pediatrics, China Medical University Hospital, China Medical University and Department of Nuclear Medicine and PET Center, China Medical University Hospital, China Medical University, Taichung 404, Taiwan From the Graduate Institute of Clinical Medicine Science, College of Medicine, China Medical University, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung 404, Division of Pulmonary Medicine, Department of Internal Medicine, Chang Bing Show Chwan Memorial Hospital, Changhua 505, Management Office for Health Data, China Medical University Hospital, China Medical University, Division of Nephrology, Department of Pediatrics, China Medical University Hospital, China Medical University and Department of Nuclear Medicine and PET Center, China Medical University Hospital, China Medical University, Taichung 404, Taiwan.
Background:
The relationship between tuberculosis (TB) and subsequent chronic kidney disease (CKD) remains unclear. Therefore, we examined the risk of CKD among patients with TB in a nationwide study.
Methods:
We conducted a retrospective cohort study using data from the National Health Insurance system of Taiwan. The cohort included 8735 patients who were newly diagnosed with TB. Patients were recruited between 1998 and 2002, and the date of diagnosis was defined as the index date. Each patient was randomly matched with four people from the general population without TB, according to age, gender and the index year. The occurrence of CKD was followed up until the end of 2011. The relative risks of CKD were estimated using the Cox proportional hazard model after adjusting for age, gender, index year and comorbidities.
Results:
The overall incidence of CKD was 1.27-fold greater in the TB cohort than in the non-TB cohort. The adjusted hazard ratio (HR) of CKD associated with TB was higher in women (1.72; 95% confidence interval [CI]: 1.33-2.22), those aged <50 years (1.67; 95% CI: 1.15-2.41) and those without comorbidities (1.39; 95% CI: 1.06-1.83). In addition, patients with more comorbidities among hypertension, diabetes and hyperlipidemia have a greater risk of developing CKD in both cohorts, and the adjusted HRs were higher in the TB cohort than in the non-TB cohort.
Conclusion:
TB patients had a significantly higher risk of developing CKD than the general population. The detailed mechanisms need further investigation.
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