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      Relative risk of end-stage renal disease requiring dialysis in treated ankylosing spondylitis patients compared with individuals without ankylosing spondylitis: A nationwide, population-based, matched-cohort study

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          Abstract

          Objective

          To examine the relative risk of end-stage renal disease (ESRD) requiring dialysis among treated ankylosing spondylitis (AS) patients compared with non-AS individuals.

          Methods

          We used claims data from Taiwan’s National Health Insurance Research Database obtained between 2003 and 2012, and enrolled 37,070 newly treated AS patients and randomly selected 370,700 non-AS individuals matched (1:10) for age, sex and year of index date. Those with a history of chronic renal failure or dialysis were excluded. After adjusting for age, sex, diabetes mellitus, hypertension, IgA nephropathy, frequency of serum creatinine examinations, use of methotrexate, sulfasalazine, ciclosporis, corticosteroid, aminoglycoside, amphotericin B, cisplatin, contrast agents and annual cumulative defined daily dose (cDDD) of traditional NSAIDs, selective cyclooxygenase-2 inhibitors (COX-2i) and preferential COX-2i, we calculated the adjusted hazard ratios (aHRs) with 95% confidence intervals using the Cox proportional hazard model to quantify the risk of ESRD in AS patients. We re-selected 6621 AS patients and 6621 non-AS subjects by further matching (1:1) for cDDDs of three groups of NSAIDs to re-estimate the aHRs for ESRD.

          Results

          Fifty-one (0.14%) of the 37,070 AS patients and 1417 (0.38%) of the non-AS individuals developed ESRD after a follow-up of 158,846 and 1,707,757 person-years, respectively. The aHR for ESRD was 0.59 (0.42–0.81) in AS patients compared with non-AS individuals. However, after further matching for cDDD of NSAIDs, the aHR of ESRD was 1.02 (0.41–2.53). Significant risk factors included hypertension, IgA nephropathy and use of COX-2i.

          Conclusions

          The risk of ESRD was not significantly different between treated AS patients and non-AS individuals matched for age, sex, year of index date and dose of NSAID.

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          Most cited references25

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          Taiwan's new national health insurance program: genesis and experience so far.

          In 1995, after a planning effort of about half a decade, the Republic of China (Taiwan) replaced a previous patchwork of separate social health insurance funds with one single-payer, national health insurance scheme that is administered by an agency of the central government's Department of Health. Within a year this bold legislative act brought the health care utilization rates of the 41 percent of Taiwan's hitherto uninsured population up to par with those of the previously insured population. This paper describes the achievements of this policy initiative so far, along with the growing pains it has encountered, and seeks to extract lessons from the experience for health policymakers in other countries.
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            Incidence, prevalence and mortality trends of dialysis end-stage renal disease in Taiwan from 1990 to 2001: the impact of national health insurance.

            Incident and prevalent (I&P) rates in dialysis end-stage renal disease (ESRD) patients in Taiwan increased rapidly following the launch of National Health Insurance (NHI) in 1995. Our aim was to explore the impact of NHI on the status and trends of ESRD epidemiology in Taiwan. This study was conducted using retrospective cohort analysis of data collected from the Taiwan national dialysis registry. From 1990 to 2001, I&P rates of ESRD patients increased 2.6 times from 126 to 331 per million populations (pmp) and 3.46 times from 382 to 1322 pmp, respectively. Increasing ESRD was seen in patients who were middle-aged, elderly and who had diabetic nephropathy as their primary renal disease. The mean age of I&P patients increased by 7.2 years and 7.1 years, respectively. All of these parameters increased markedly in 1995, the year of NHI implementation. First-year mortality decreased to 7.8 per 1000 patient-months in 1994, and then increased to 18.0 in 2001. The cumulative survival rate of the elderly subgroup (age >65) in the incident 1990-1994 cohort was greater than in the 1995-1999 cohort. These data indicated that NHI implementation significantly influenced the inflow and the mortality of ESRD patients. In addition to presenting ESRD epidemiology in Taiwan, this study demonstrated that NHI implementation stimulated the growth of treated ESRD populations. Preventive plans mounted against chronic kidney diseases will be essential to reduce the growth of ESRD patient numbers and consequent economic burdens.
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              Prevalence and factors associated with CKD: a population study from Beijing.

              Chronic kidney disease (CKD) is considered a serious worldwide public health problem, but data from developing countries are extremely limited. Cross-sectional study. A representative sample of 13,925 adults in Beijing, China. Age (18 to 39, 40 to 59, 60 to 69, and >70 years), sex, urban or rural area, history of chronic respiratory infection and cardiovascular disease, hepatitis B virus infection, smoking, family history (diabetes, hypertension, and CKD), nephrotoxic medications, central obesity, diabetic and hypertension status, and dyslipidemia. CKD was defined as estimated glomerular filtration rate less than 60 mL/min/1.73 m(2) or markers of kidney damage. Glomerular filtration rate was estimated by using calibrated serum creatinine level and a formula specific for China. Persistent albuminuria and hematuria were considered markers of kidney damage. The prevalence of CKD in adults in Beijing was 13.0% (95% confidence interval [CI], 11.9 to 14.2). It therefore was estimated that the number of adults in Beijing with CKD was 1.43 million. In subjects aged 18 to 39, 40 to 59, 60 to 69, and older than 70 years, prevalences of CKD were 10.0% (95% CI, 8.9 to 11.3), 14.2% (95% CI, 13.0 to 15.4), 20.8% (95% CI, 18.1 to 23.9), and 30.5% (95% CI, 26.6 to 34.7), respectively. Factors independently associated with decreased kidney function included older age (odds ratio [OR], 1.83; 95% CI, 1.51 to 2.22 per 10-year increase), nephrotoxic medications (OR, 2.19; 95% CI, 1.21 to 3.97), rural area (versus urban area; OR, 0.47; 95% CI, 0.28 to 0.78), history of cardiovascular disease (OR, 2.04; 95% CI, 1.24 to 3.38), high-density lipoprotein cholesterol level less than 40 mg/dL (OR, 3.00; 95% CI, 1.39 to 6.51), and hypertension status (with duration > 10 years; OR, 1.85; 95% CI, 1.19 to 2.88). Kidney function and indicators of kidney damage were based on single measurements. CKD is a public health burden in Beijing.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: ValidationRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: ResourcesRole: Software
                Role: ConceptualizationRole: ResourcesRole: ValidationRole: Visualization
                Role: ConceptualizationRole: ValidationRole: Visualization
                Role: ConceptualizationRole: ResourcesRole: Validation
                Role: InvestigationRole: ValidationRole: Visualization
                Role: ResourcesRole: Validation
                Role: Data curationRole: Formal analysis
                Role: Data curationRole: Formal analysis
                Role: Formal analysisRole: Validation
                Role: MethodologyRole: ResourcesRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                20 April 2020
                2020
                : 15
                : 4
                : e0231458
                Affiliations
                [1 ] Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
                [2 ] Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
                [3 ] School of Medicine, National Yang-Ming University, Taipei, Taiwan
                [4 ] Institute of Biomedical Science and Rong-Hsing Research Center for Translational Medicine, Chung-Hsing University, Taichung, Taiwan
                [5 ] School of Medicine, Chung Shan Medical University, Taichung, Taiwan
                [6 ] Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan
                [7 ] Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan
                [8 ] Department of Healthcare Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
                [9 ] College of Business, Feng Chia University, Taichung, Taiwan
                [10 ] Department of Medical Education, Taichung Veterans General Hospital, Taichung, Taiwan
                [11 ] Department of International Business, Tunghai University, Taichung, Taiwan
                [12 ] Department of Statistics, Tunghai University, Taichung, Taiwan
                University of Nottingham School of Medicine, UNITED KINGDOM
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0002-7304-4587
                Article
                PONE-D-19-23326
                10.1371/journal.pone.0231458
                7170243
                32310965
                ccb7473c-5e7f-46ae-a78b-984802d49121
                © 2020 Chen et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 19 August 2019
                : 24 March 2020
                Page count
                Figures: 2, Tables: 5, Pages: 14
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/501100010101, Taichung Veterans General Hospital;
                Award ID: TCVGH-1067313C
                Award Recipient :
                This study was supported in part by grant TCVGH-1067313C from Taichung Veterans General Hospital, Taiwan. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. There was no additional external funding received for this study.
                Categories
                Research Article
                Medicine and Health Sciences
                Clinical Medicine
                Clinical Immunology
                Autoimmune Diseases
                Ankylosing Spondylitis
                Biology and Life Sciences
                Immunology
                Clinical Immunology
                Autoimmune Diseases
                Ankylosing Spondylitis
                Medicine and Health Sciences
                Immunology
                Clinical Immunology
                Autoimmune Diseases
                Ankylosing Spondylitis
                Medicine and Health Sciences
                Nephrology
                Chronic Kidney Disease
                Medicine and health sciences
                Pharmacology
                Drugs
                Analgesics
                NSAIDs
                Medicine and health sciences
                Pain management
                Analgesics
                NSAIDs
                Medicine and Health Sciences
                Nephrology
                Medical Dialysis
                Medicine and Health Sciences
                Vascular Medicine
                Blood Pressure
                Hypertension
                Medicine and Health Sciences
                Endocrinology
                Endocrine Disorders
                Diabetes Mellitus
                Medicine and Health Sciences
                Metabolic Disorders
                Diabetes Mellitus
                Biology and Life Sciences
                Biochemistry
                Biomarkers
                Creatinine
                Biology and Life Sciences
                Anatomy
                Renal System
                Medicine and Health Sciences
                Anatomy
                Renal System
                Custom metadata
                All relevant data are within the paper and its Supporting Information files.

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