Increased Risk of Chronic Kidney Disease in Rheumatoid Arthritis Associated with Cardiovascular Complications – A National Population-Based Cohort Study

• Published in: PloS one Vol. 10; no. 9; p. e0136508
• Main Authors: Chiu, Hsien-Yi, Huang, Hui-Ling, Li, Chien-Hsun, Chen, Hung-An, Yeh, Chia-Lun, Chiu, Shih-Hsiang, Lin, Wei-Chun, Cheng, Yu-Pin, Tsai, Tsen-Fang, Ho, Shinn-Ying
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 25.09.2015; Public Library of Science (PLoS)
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Ambulatory care; Anti-inflammatory agents; Antirheumatic Agents - adverse effects; Antirheumatic Agents - therapeutic use; Arthritis; Arthritis, Rheumatoid - complications; Arthritis, Rheumatoid - drug therapy; Arthritis, Rheumatoid - epidemiology; Autoimmune diseases; Bioinformatics; Biology; Cardiovascular diseases; Cardiovascular Diseases - complications; Cardiovascular Diseases - epidemiology; Cohort analysis; Cohort Studies; Comorbidity; Complications; Confidence intervals; Coronary artery disease; Cyclophosphamide; Cyclosporins; Databases, Factual; Dermatology; Diabetes; Drugs; Female; Follow-Up Studies; Glomerulonephritis; Glucocorticoids; Hazards; Health risk assessment; Health risks; Heart; Heart diseases; Hospitals; Humans; Identification methods; Incidence; Inflammation; Ischemia; Kaplan-Meier Estimate; Kidney diseases; Kidneys; Male; Medicine; Middle Aged; Mortality; Mycophenolate mofetil; Mycophenolic acid; Nonsteroidal anti-inflammatory drugs; Patients; Population; Population studies; Population Surveillance; Population-based studies; Proportional Hazards Models; Regression analysis; Regression models; Renal function; Renal Insufficiency, Chronic - epidemiology; Renal Insufficiency, Chronic - etiology; Renal Insufficiency, Chronic - mortality; Rheumatoid arthritis; Risk; Risk analysis; Risk factors; Statistical analysis; Stroke; Studies; Taiwan - epidemiology; Toxicity; Urbanization; Young Adult; Taiwan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0136508

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. 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. 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. 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.