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Shurrab M, Ko DT, Jackevicius CA, Tu K, Middleton A, Michael F, Austin PC. A review of the use of propensity score methods with multiple treatment groups in the general internal medicine literature. Pharmacoepidemiol Drug Saf 2023; 32:817-831. [PMID: 37144449 DOI: 10.1002/pds.5635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 03/31/2023] [Accepted: 04/30/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Propensity score (PS) methods with two treatment groups (e.g., treated vs. control) is a well-established technique for reducing the effects of confounding in nonrandomized studies. However, researchers are often interested in comparing multiple interventions. PS methods have been modified to incorporate multiple exposures. We described available techniques for PS methods in multicategory exposures (≥3 groups) and examined their use in the medical literature. METHODS A comprehensive search was conducted for studies published in PubMed, Embase, Google Scholar, and Web of Science until February 27, 2023. We included studies using PS methods for multiple groups in general internal medicine research. RESULTS The literature search yielded 4088 studies (2616 from PubMed, 86 from Embase, 85 from Google Scholar, 1671 from Web of Science, five from other sources). In total, 264 studies using PS method for multiple groups were identified; 61 studies were on general internal medicine topics and included. The most commonly used method was that of McCaffrey et al., which was used in 26 studies (43%), where the Toolkit for Weighting and Analysis of Nonequivalent Groups (TWANG) method and corresponding inverse probabilities of treatment weights were estimated via generalized boosted models. The next most commonly used method was pairwise propensity-matched comparisons, which was used in 20 studies (33%). The method by Imbens et al. using a generalized propensity score was implemented in six studies (10%). Four studies (7%) used a conditional probability of being in a particular group given a set of observed baseline covariates where a multiple propensity score was estimated using a non-parsimonious multinomial logistic regression model. Four studies (7%) used a technique that estimates generalized propensity scores and then creates 1:1:1 matched sets, and one study (2%) used the matching weight method. CONCLUSIONS Many propensity score methods for multiple groups have been adopted in the literature. The TWANG method is the most commonly used method in the general medical literature.
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Affiliation(s)
- Mohammed Shurrab
- Cardiology Department, Health Sciences North, Northern Ontario School of Medicine University, Sudbury, Ontario, Canada
- Health Sciences North Research Institute, Sudbury, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto and North, Ontario, Canada
| | - Dennis T Ko
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto and North, Ontario, Canada
- Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Cynthia A Jackevicius
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto and North, Ontario, Canada
- Department of Pharmacy Practice and Administration, College of Pharmacy, Western University of Health Sciences, Pomona, California, USA
- Pharmacy Department, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Karen Tu
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- North York General Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto Western Hospital Family Health Team, University Health Network, Toronto, Ontario, Canada
| | - Allan Middleton
- Cardiology Department, Health Sciences North, Northern Ontario School of Medicine University, Sudbury, Ontario, Canada
| | - Faith Michael
- Cardiology Department, Health Sciences North, Northern Ontario School of Medicine University, Sudbury, Ontario, Canada
| | - Peter C Austin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto and North, Ontario, Canada
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Shao L, Luo C, Yuan C, Ye X, Zeng Y, Ren Y, Ye B, Li Y, Jin J, He Q, Shen X. LASSO-derived nomogram predicting new-onset diabetes mellitus in patients with kidney disease receiving immunosuppressive drugs. J Clin Pharm Ther 2022; 47:1627-1635. [PMID: 35791031 PMCID: PMC9796007 DOI: 10.1111/jcpt.13713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/15/2022] [Accepted: 05/29/2022] [Indexed: 11/07/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Patients with kidney disease receiving immunosuppressive drugs (ISDs) (tacrolimus, cyclosporine and glucocorticoids) have a high risk of developing new-onset diabetes mellitus (NODM). We aimed to establish a precise and convenient model for predicting NODM in patients receiving immunosuppressive drugs. METHODS This retrospective study recruited 1883 patients receiving ISDs between January 2010 and October 2018. The occurrence of NODM was the primary endpoint. The patients were randomly divided into training (n = 1318) and validation cohorts (n = 565) at a 7:3 ratio. A nomogram was established based on a least absolute shrinkage and selection operator (LASSO)-derived logistic regression model. The nomogram's discrimination and calibration abilities were evaluated in both cohorts using the Hosmer-Lemeshow test and calibration curves. Decision curve analysis (DCA) was used to evaluate the net benefit of the predictive efficacy. RESULTS AND DISCUSSION Amongst the 1883 patients with kidney disease receiving immunosuppressive drugs, 375 (28.5%) and 169 (29.9%) developed NODM in the training (n = 1318) and validation cohorts (n = 565), respectively. Nine clinic predictors were included in this LASSO-derived nomogram, which is easy to be operated clinically. The discriminative ability, determined by the area under the receiver operating characteristic curve (AUC), was 0.816 (95% confidence interval [CI] 0.790-0.841) and 0.831 (95%CI 0.796-0.867) in the training and validation cohorts, respectively. Calibration was confirmed with the Hosmer-Lemeshow test in the training and validation cohorts (p = 0.238, p = 0.751, respectively). WHAT IS NEW AND CONCLUSION Nearly one-third of patients with kidney disease receiving immunosuppressive drugs developed NODM. The nomogram established in this study may aid in predicting the occurrence of NODM in patients with kidney disease receiving immunosuppressive drugs.
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Affiliation(s)
- Lina Shao
- Urology & Nephrology Center, Department of NephrologyZhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College)HangzhouChina
| | - Chuxuan Luo
- Urology & Nephrology Center, Department of NephrologyZhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College)HangzhouChina,Division of Health SciencesHangzhou Normal UniversityHangzhouChina
| | - Chaoyun Yuan
- Department of Medical Information TechnologyZhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College)HangzhouChina
| | - Xiaolan Ye
- Center for Clinical Pharmacy, Cancer Center, Department of PharmacyZhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College)HangzhouChina
| | - Yuqun Zeng
- Urology & Nephrology Center, Department of NephrologyZhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College)HangzhouChina
| | - Yan Ren
- Urology & Nephrology Center, Department of NephrologyZhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College)HangzhouChina
| | - Binxian Ye
- Urology & Nephrology Center, Department of NephrologyZhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College)HangzhouChina
| | - Yiwen Li
- Urology & Nephrology Center, Department of NephrologyZhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College)HangzhouChina
| | - Juan Jin
- Urology & Nephrology Center, Department of NephrologyZhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College)HangzhouChina
| | - Qiang He
- Department of NephrologyThe First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine)HangzhouChina
| | - Xiaogang Shen
- Urology & Nephrology Center, Department of NephrologyZhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College)HangzhouChina
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Yen FS, Wei JCC, Shih YH, Hsu CC, Hwu CM. The Risk of Nephropathy, Retinopathy, and Leg Amputation in Patients With Diabetes and Hypertension: A Nationwide, Population-Based Retrospective Cohort Study. Front Endocrinol (Lausanne) 2021; 12:756189. [PMID: 34867799 PMCID: PMC8637105 DOI: 10.3389/fendo.2021.756189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/03/2021] [Indexed: 12/24/2022] Open
Abstract
Purpose To compare the risks of chronic kidney disease (CKD), end-stage renal disease (ESRD), sight-threatening retinopathy, and leg amputation between patients with diabetes or hypertension. Methods From January 1, 2000, to December 31, 2015, we identified 28943 matched pairs of patients with diabetes with and without subsequent hypertension, 89102 pairs of patients with hypertension with and without subsequent diabetes, and 145294 pairs of patients with coexisting diabetes and hypertension with a previous history of diabetes or hypertension from Taiwan's National Health Insurance Research Database. Cox proportional-hazard models were used for calculating the risks of CKD, sight-threatening retinopathy, and leg amputation. Results The mean follow-up time of this study in different cohorts was between 3.59 and 4.28 years. In diabetes patients with vs. without subsequent hypertension, hypertension patients with vs. without subsequent diabetes, and comorbid diabetes and hypertension patients with previous diabetes vs. with previous hypertension, the adjusted HRs (95% CIs) for CKD were 2.77 (2.61-2.94), 1.73 (1.68-1.77), and 1.04 (1.02-1.07); for ESRD were 42.38 (22.62-79.4), 2.76 (2.43-3.13), and 0.72 (0.66-0.79); for sight-threatening retinopathy were 2.07 (1.85-2.3), 3.41 (3.14-3.71), and for leg amputation were 1.51 (1.43-1.58); and 4.74 (3.02-7.43), 6.27(4.72-8.31), and 1.19(1.03-1.38). Conclusions This study demonstrated that both diabetes and hypertension are risk factors for the development of CKD, retinopathy, and amputation. Tracing subsequent diabetes for patients with hypertension, and hypertension for patients with diabetes are important in clinical settings.
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Affiliation(s)
| | - James Cheng-Chung Wei
- Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung City, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung City, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung City, Taiwan
| | - Ying-Hsiu Shih
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung City, Taiwan
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
- Department of Family Medicine, Min-Sheng General Hospital, Taoyuan, Taiwan
| | - Chii-Min Hwu
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Section of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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Ding Y, Chen D, Ding X, Wang G, Wan Y, Shen Q. A bibliometric analysis of income and cardiovascular disease: Status, Hotspots, Trends and Outlook. Medicine (Baltimore) 2020; 99:e21828. [PMID: 32846827 PMCID: PMC7447358 DOI: 10.1097/md.0000000000021828] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 07/14/2020] [Accepted: 07/18/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Income is 1 of the socio-economic indicators and could directly influence the health outcomes of cardiovascular disease (CVD). The relationship between income and CVD has attracted more and more scholars' attention in the past 20 years. METHODS To study the current research dynamics of this field, a bibliometric analysis was conducted to evaluate the publications from 1990 to 2018 based on the Science Citation Index Expanded database. By using the Derwent Date Analyzer software, the following aspects were explored: RESULTS:: The USA ranked first in this field, followed by UK and Canada in terms of number of publications. As for institutions, Harvard University took the leading place in the number of publications, as well as the h-index. Plos One had the most publications and "health" was the most frequent used keyword. The leading research area was "public environmental occupational health". CONCLUSIONS In conclusion, the elderly, the children and the puerpera were the main study population in this field and "disease prevention" was the main study direction. The most concerned health issues in this field were "obesity" and "diet". There might be a lack of articles that explore the associations between income and CVD with a global perspective. Articles on this content are urgently warranted.
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Affiliation(s)
- Ye Ding
- School of Public Health, Hangzhou Medical College
| | - Dingwan Chen
- School of Public Health, Hangzhou Medical College
| | - Xufen Ding
- Institute of Information Resources, Zhejiang University of Technology
- Library, Zhejiang University of Technology, Hangzhou, China
| | - Guan Wang
- School of Public Health, Hangzhou Medical College
| | - Yuehua Wan
- Institute of Information Resources, Zhejiang University of Technology
- Library, Zhejiang University of Technology, Hangzhou, China
| | - Qing Shen
- School of Public Health, Hangzhou Medical College
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Wang CJ, Hsieh YP, Kor CT, Chiu PF. The CHA 2DS 2-VASc score predicts chronic kidney disease among patients with atrial fibrillation. Int Urol Nephrol 2020; 52:1523-1531. [PMID: 32488758 DOI: 10.1007/s11255-020-02514-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 05/16/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND It is unclear how the CHA2DS2-VASc score can predict subsequent chronic kidney disease (CKD) and end-stage renal disease (ESRD) among atrial fibrillation (AF) patients. METHODS We identified incident AF patients without CKD between 2000 and 2013 from the National Health Insurance Research Database (NHIRD) of Taiwan and calculated the CHA2DS2-VASc score for each patient. Adjusted hazard ratio (HR) with 95% confidence interval (CI) was estimated from multivariate cause-specific Cox models to assess the risk of CKD and ESRD associated with the CHA2DS2-VASc score. RESULTS A total of 8764 participants with AF who did not have CKD were included in the analysis. The mean age was 69.63 ± 13.48 years and 4800 (54.8%) were males. The adjusted HR of CKD displayed a stepwise increase with the increase in the CHA2DS2-VASc score. When compared with those with a CHA2DS2-VASc score of 0, the adjusted HRs of CKD were 1.57 (95% CI 1.09-2.26), 2.04 (95% CI 1.42-2.94), 2.48 (95% CI 1.70-3.62), 2.88 (95% CI 1.95-4.26), 3.29 (95% CI 2.18-4.95) and 4.00 (95% CI 2.61-6.13) for the AF patients with a CHA2DS2-VASc score of 1, 2, 3, 4, 5 and ≥ 6, respectively. Similarly, as the CHA2DS2-VASc score increased, the adjusted HR of ESRD showed a gradual increase. CONCLUSIONS Patients with a higher CHA2DS2-VASc score were linked to a higher risk of CKD and ESRD in a dose-dependent effect, i.e. the incidence of CKD/ESRD increased with the increasing CHA2DS2-VASc score.
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Affiliation(s)
- Chih-Jen Wang
- Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Yao-Peng Hsieh
- Division of Nephrology, Department of Internal Medicine, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan, R.O.C.. .,School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. .,School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
| | - Chew-Teng Kor
- Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Ping-Fang Chiu
- Division of Nephrology, Department of Internal Medicine, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan, R.O.C.. .,School of Medicine, Chung Shan Medical University, Taichung, Taiwan. .,Department of Recreation and Holistic Wellness, MingDao University, Changhua, Taiwan.
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Vidal-Petiot E, Greenlaw N, Kalra PR, Garcia-Moll X, Tardif JC, Ford I, Zamorano J, Ferrari R, Tendera M, Fox KM, Steg PG. Chronic Kidney Disease Has a Graded Association with Death and Cardiovascular Outcomes in Stable Coronary Artery Disease: An Analysis of 21,911 Patients from the CLARIFY Registry. J Clin Med 2019; 9:E4. [PMID: 31861379 PMCID: PMC7019870 DOI: 10.3390/jcm9010004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 12/11/2019] [Accepted: 12/13/2019] [Indexed: 12/01/2022] Open
Abstract
: Chronic kidney disease (CKD) is associated with an increased cardiovascular risk in a broad spectrum of populations. However, the risk associated with a reduced estimated glomerular filtration rate (eGFR) in patients with stable coronary artery disease receiving standard care in the modern era, independently of baseline cardiovascular disease, risk factors, and comorbidities, remains unclear. We analyzed data from 21,911 patients with stable coronary artery disease, enrolled in 45 countries between November 2009 and July 2010 in the CLARIFY registry. Patients with abnormal renal function were older, with more comorbidities, and received slightly lower-although overall high-rates of evidence-based secondary prevention therapies than patients with normal renal function. The event rate of patients with CKD stage 3b or more (eGFR <45 mL/min/1.73 m2) was much higher than that associated with any comorbid condition. In a multivariable adjusted Cox proportional hazards model, lower eGFR was independently associated with a graded increased risk of cardiovascular mortality, with adjusted HRs (95% CI) of 0.98 (0.81-1.18), 1.31 (1.05-1.63), 1.77 (1.38-2.27), and 3.12 (2.25-4.33) for eGFR 60-89, 45-59, 30-44, and <30 mL/min/1.73 m2, compared with eGFR ≥90 mL/min/1.73 m2. A strong graded independent relationship exists between the degree of CKD and cardiovascular mortality in this large cohort of patients with chronic coronary artery disease, despite high rates of secondary prevention therapies. Among clinical risk factors and comorbid conditions, CKD stage 3b or more is associated with the highest cardiovascular mortality.
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Affiliation(s)
- Emmanuelle Vidal-Petiot
- Université de Paris, Paris, France;
- Physiology Department, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, 75018 Paris, France
- Institut nationale de la santé et de la recherché médicale (INSERM) U1149, Centre de Recherche sur l’Inflammation, 75018 Paris, France
| | - Nicola Greenlaw
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow G12 8QQ, UK; (N.G.); (I.F.)
| | - Paul R. Kalra
- Portsmouth Hospitals NHS Trust, Portsmouth PO6 3LY, UK;
| | | | - Jean-Claude Tardif
- Montreal Heart Institute, Université de Montreal, Montreal, QC H1T1C8, Canada;
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow G12 8QQ, UK; (N.G.); (I.F.)
| | - Jose Zamorano
- University Hospital Ramon y Cajal, 28040 Madrid, Spain;
| | - Roberto Ferrari
- Centro Cardiologico Universitario di Ferrara, University of Ferrara, 44124 Cona, FE, Italy;
- Maria Cecilia Hospital, GVM Care & Research, 48033 Cotignola, RA, Italy
| | - Michal Tendera
- Department of Cardiology and Structural Heart Disease, School of Medicine in Katowice, Medical University of Silesia, 40-055 Katowice, Poland;
| | - Kim M. Fox
- National Heart and Lung Institute, Imperial College, Royal Brompton Hospital, London SW3 6NP, UK;
| | - Philippe Gabriel Steg
- Université de Paris, Paris, France;
- National Heart and Lung Institute, Imperial College, Royal Brompton Hospital, London SW3 6NP, UK;
- Cardiology Department, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, French Alliance for Cardiovascular Trials, INSERM U1148, 75018 Paris, France
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Chronic Kidney Disease: The Silent Epidemy. J Clin Med 2019; 8:jcm8111795. [PMID: 31717778 PMCID: PMC6912263 DOI: 10.3390/jcm8111795] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 10/22/2019] [Indexed: 12/19/2022] Open
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Effects of Prevalent and Incident Atrial Fibrillation on Renal Outcome, Cardiovascular Events, and Mortality in Patients with Chronic Kidney Disease. J Clin Med 2019; 8:jcm8091378. [PMID: 31484322 PMCID: PMC6780958 DOI: 10.3390/jcm8091378] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 08/18/2019] [Accepted: 09/01/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Little is known about how incident atrial fibrillation (AF) affects the clinical outcomes in chronic kidney disease (CKD) patients and whether there is a different influence between pre-existing and incident AF. METHODS Incident CKD patients from 2000 to 2013 were retrieved from the National Health Insurance Research Database (NHIRD) of Taiwan and they were classified as non-AF (n = 15,251), prevalent AF (n = 612), and incident AF (n = 588). The outcomes of interest were end-stage renal disease (ESRD) requiring dialysis, all-cause mortality, cardiovascular (CV) mortality, acute myocardial infarction (AMI), stroke or systemic thromboembolism. RESULTS Compared with CKD patients without AF, those with prevalent or incident AF were associated with higher adjusted rates of ESRD (hazard ratio (HR), 1.40; 95% confidence interval (CI), 1.32-1.48; HR, 2.91; 95% CI, 2.74-3.09, respectively), stroke or systemic thromboembolism (HR, 1.89; 95% CI, 1.77-2.03; HR, 1.67; 95% CI, 1.54-1.81, respectively), AMI (HR, 1.24; 95% CI, 1.09-1.41; HR, 1.99; 95% CI, 1.75-2.27, respectively), all-cause mortality (HR, 1.64; 95% CI, 1.56-1.72; HR, 2.17; 95% CI, 2.06-2.29, respectively), and CV mortality (HR, 2.95; 95% CI, 2.62-3.32; HR, 4.61; 95% CI, 4.09-5.20, respectively). Intriguingly, CKD patients with prevalent AF were associated with lower adjusted rates of ESRD, AMI, all-cause mortality, and CV mortality compared with those with incident AF. CONCLUSION Both incident and prevalent AF were independently associated with greater risks of AMI, all-cause mortality, CV mortality, ESRD, and stroke or systemic thromboembolism. Our findings are novel in that, compared with prevalent AF, incident AF possessed an even higher risk of some clinical consequences, including ESRD, all-cause mortality, CV mortality, and AMI.
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Effects of Prevalent and Incident Chronic Kidney Disease on Cardiovascular Events in Patients with Atrial Fibrillation. J Clin Med 2019; 8:jcm8081184. [PMID: 31394871 PMCID: PMC6723547 DOI: 10.3390/jcm8081184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 08/04/2019] [Indexed: 12/11/2022] Open
Abstract
Background: Chronic kidney disease (CKD) is a well-known complication of atrial fibrillation (AF) but how the incident CKD affects the clinical outcomes amongst AF patients is not clear. Methods: Our study data were retrieved from National Health Insurance Research Data for the period from 1996 to 2013. Incident AF patients were classified as non-CKD group (n = 7272), prevalent CKD group (n = 2104), and incident CKD group (n = 1507) based on administrative codes. Patients with prevalent CKD were those participants who already had CKD ahead of the index date of AF, whereas patients with incident CKD were those who developed CKD after the index date and the remaining patients were designated as non-CKD. Multivariate-adjusted time-dependent Cox models were conducted to estimate the associations of CKD status with the outcomes of interest, including heart failure (HF), acute myocardial infarction (AMI), stroke or systemic thromboembolism, all-cause mortality, and cardiovascular (CV) mortality, expressed as hazard ratio (HR) and 95% confidence interval (CI). Results: The mean age was 70.8 ± 13.3 years, and 55.4% of the studied population were men. In Cox models, the adjusted rate of HF, AMI, all-cause mortality, and CV mortality was greater in the prevalent and incident CKD groups, ranging from 1.31-fold to 4.28-fold, compared with non-CKD group. Notably, incident CKD was associated with higher rates of HF (HR, 1.8; 95% CI, 1.67–1.93), stroke or systemic thromboembolism (HR, 1.33; 95% CI, 1.22–1.45), AMI (HR, 1.46; 95% CI, 1.25–1.71), all-cause mortality (HR, 1.76; 95% CI, 1.68–1.85), and CV mortality (HR, 2.13; 95% CI, 1.92–2.36) compared with prevalent CKD. Conclusion: The presence of CKD was associated with higher risks of subsequent adverse clinical outcomes in patients with AF. Our study was even highlighted by the finding that incident CKD was linked to higher risks of outcome events compared with prevalent CKD.
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