Hepatointestinal complications in polycystic kidney disease
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Shih-Ting Huang1,2, Ya-Wen Chuang1, Tung-Min Yu1,3, Cheng-Li Lin4,5 and Long-Bin Jeng3,6
1Division of Nephrology, Taichung Veterans General Hospital, Taichung, Taiwan
2Graduate Institute of Public Health, China Medical University, Taichung, Taiwan
3Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
4Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
5College of Medicine, China Medical University, Taichung, Taiwan
6Department of Surgery, Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
Long-Bin Jeng, email: otc.Jeng@gmail.com
Keywords: bleeding, cholangitis, cirrhosis, pancreatitis, polycystic kidney disease
Received: May 19, 2017 Accepted: August 07, 2017 Published: September 15, 2017
Background: The objective of this study was to determine the incidence of major hepatointestinal complications in patients with polycystic kidney disease (PKD).
Methods: We analyzed the Taiwan National Health Insurance claims data (2000–2010) of 6031 patients with PKD and 23,976 non-PKD hospitalized controls. The control cohort was propensity score matched with the PKD cohort at a 1:4 ratio. All patients were followed up from the index date to the first inpatient diagnosis of hepatointestinal complications, death, or 31 December, 2011. Cox proportional hazard regression models were used to identify the risk of outcome after adjustment for potential confounders.
Results: The incidence rates of acute pancreatitis, cholangitis, peptic ulcer bleeding, and cirrhosis were 5.72, 4.01, 19.9, and 5.46 per 1000 person-years, respectively, in the PKD cohort. Compared with the non-PKD controls, patients with PKD exhibited an increased risk of hospitalization for acute pancreatitis, cholangitis, peptic ulcer bleeding, and cirrhosis (adjusted subhazard ratio [aSHR]: 2.36, 95% confidence interval [95% CI], 1.95–2.84]; 2.36, [95% CI, 1.95–2.84]; 2.41, [95% CI, 1.93–3.01]; 2.41, [95% CI, 2.17–2.67]; and 1.39, [95% CI, 1.16–1.66], respectively; all p < 0.001). PKD, chronic kidney disease, and alcoholism were independent predictors of all these hepatointestinal complications. Kaplan–Meier analysis revealed an increased overall mortality in patients with PKD who developed acute pancreatitis and peptic ulcer bleeding (log-rank p < 0.05).
Conclusion: PKD is associated with clinically significant extrarenal complications including acute pancreatitis, cholangitis, peptic ulcer bleeding, and cirrhosis.
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