Clinical Research Papers:
Risk of aortic aneurysm and dissection in patients with autosomal-dominant polycystic kidney disease: a nationwide population-based cohort study
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Abstract
Pei-Hsun Sung1, Yao-Hsu Yang2,3,7, Hsin-Ju Chiang4, John Y. Chiang5,6, Chi-Jen Chen7, Chien-Ting Liu8, Cheuk-Man Yu9 and Hon-Kan Yip1,10,11,12
1 Department of Internal Medicine, Division of Cardiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung, Taiwan
2 Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
3 Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan
4 Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung, Taiwan
5 Department of Computer Science and Engineering, National Sun Yat-Sen University, Kaohsiung, Taiwan
6 Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan
7 Center of Excellence for Chang Gung Research Datalink, Chang Gung Memorial Hospital, Chiayi, Taiwan
8 Department of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung, Taiwan
9 Director of Heart Centre, Hong Kong Baptist Hospital and Honorary Clinical Professor, The Chinese University of Hong Kong, Hong Kong, China
10 Institute for Translational Research in Biomedicine, Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung, Taiwan
11 Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
12 Department of Nursing, Asia University, Taichung, Taiwan
Correspondence to:
Hon-Kan Yip, email:
Keywords: autosomal-dominant polycystic kidney disease, aortic aneurysm, aortic dissection, population-based cohort study
Received: December 05, 2016 Accepted: February 07, 2017 Published: March 17, 2017
Abstract
Although cardiovascular complications are the most common cause of death in patients with autosomal-dominant polycystic kidney disease (ADPKD), the incidence and risk of aortic aneurysm and dissection (AAD) in ADPKD remains unclear due to limited data and insufficient cases. We utilized the data from Taiwan National Health Insurance Research Database (NHIRD) to do a population-based cohort study (1997-2008). After excluding those patients with age <18 years old and initially concomitant diagnoses of end-stage renal disease and AAD, a total of 2076 ADPKD patients were selected from 1,000,000 of general population. Additionally, the non-ADPKD group was set up as comparison group in 1:10 ratio after matching with age, gender, income and urbanization (n=20760). The result showed that ADPKD group had higher frequency of comorbidities than non-ADPKD group. The frequency of AAD in ADPKD was significantly higher than in general population (0.92% v.s. 0.11%, p<0.0001). Of them, 58% of AAD were acute aortic dissection. In addition, Kaplan-Meier analysis demonstrated that cumulative incidence of AAD was remarkably higher in the ADPKD than non-ADPKD group (p<0.001). The mean time period from ADPKD diagnosis to AAD occurrence was 4.02±3.16 years. After adjusting for age, gender and comorbidities, the ADPKD patients had up to 5.49-fold greater risk for AAD occurrence as compared to non-ADPKD counterparts (95% CI 2.86-10.52, p<0.0001). Particularly, those patients with co-existing ADPKD and hypertension had very high risk for future development of AAD. In conclusion, the risk of AAD significantly increases in patients with ADPKD as compared with those of general population.
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