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      Migraine and subsequent chronic kidney disease risk: a nationwide population-based cohort study

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          Abstract

          Objective

          We compared the incidence and risk of chronic kidney disease (CKD) between subjects with new-onset migraine and matched controls without migraine in this large-scale retrospective cohort study.

          Design

          Population-based cohort study.

          Setting

          8880 subjects with migraine and 503 070 subjects without migraine were enrolled between January 1, 2000 and December 31, 2013, all diagnosed to be without kidney disease. All the participants were registered in the National Health Insurance Research Database.

          Participants

          Finally, data from 7156 subjects with migraine and 7156 propensity-score-matched control subjects were analysed.

          Primary outcome measure

          We used Cox proportional hazards regression to estimate adjusted HRs for incident CKD; subgroup analyses were performed to assess the interactive effects of migraine with demographics, comorbidities and long-term medications.

          Results

          The incidence of CKD was higher in the migraine group than in the control group. The risk of developing CKD was significantly higher in subjects with migraine than without migraine (P=0.031). Subjects with migraine aged <65 years (age 40–64 (adjusted HR (aHR) 1.35; 95% CI 1.05 to 1.73); age <40 (aHR 1.55; 95% CI 1.02 to 2.36)), with ≥1 comorbid diseases (1–2 diseases (aHR 1.30; 95% CI 1.01 to 1.68); ≥3 diseases (aHR 1.45; 95% CI 1.01 to 2.07)), and not receiving anti-migraine agents (aHR 1.26; 95% CI 1.04 to 1.54) were at a higher risk of developing CKD compared with the control subjects. The interaction between migraine and comorbidities was not significant; age, male gender and long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) were independent risk factors for CKD in subjects with migraine.

          Conclusion

          Migraine may be an independent risk factor for CKD. Young subjects with migraine, and those with comorbid conditions or without medical control, are likely to be at higher risk for CKD. Ageing, male sex and NSAIDs tend to have an association with CKD in subjects with migraine.

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          Most cited references38

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          A critical appraisal of propensity-score matching in the medical literature between 1996 and 2003.

          Peter C Austin (2008)
          Propensity-score methods are increasingly being used to reduce the impact of treatment-selection bias in the estimation of treatment effects using observational data. Commonly used propensity-score methods include covariate adjustment using the propensity score, stratification on the propensity score, and propensity-score matching. Empirical and theoretical research has demonstrated that matching on the propensity score eliminates a greater proportion of baseline differences between treated and untreated subjects than does stratification on the propensity score. However, the analysis of propensity-score-matched samples requires statistical methods appropriate for matched-pairs data. We critically evaluated 47 articles that were published between 1996 and 2003 in the medical literature and that employed propensity-score matching. We found that only two of the articles reported the balance of baseline characteristics between treated and untreated subjects in the matched sample and used correct statistical methods to assess the degree of imbalance. Thirteen (28 per cent) of the articles explicitly used statistical methods appropriate for the analysis of matched data when estimating the treatment effect and its statistical significance. Common errors included using the log-rank test to compare Kaplan-Meier survival curves in the matched sample, using Cox regression, logistic regression, chi-squared tests, t-tests, and Wilcoxon rank sum tests in the matched sample, thereby failing to account for the matched nature of the data. We provide guidelines for the analysis and reporting of studies that employ propensity-score matching. Copyright (c) 2007 John Wiley & Sons, Ltd.
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            Validation of Acute Myocardial Infarction Cases in the National Health Insurance Research Database in Taiwan

            Ching-Lan Cheng, Cheng-Han Lee, Po-Sheng Chen … (2014)
            Background The aim of this study was to determine the validity of acute myocardial infarction (AMI) diagnosis coding in the National Health Insurance Research Database (NHIRD) by cross-comparisons of discharge diagnoses listed in the NHIRD with those in the medical records obtained from a medical center in Taiwan. Methods This was a cross-sectional study comparing records in the NHIRD and discharge notes in one medical center (DNMC) in the year 2008. Positive predictive values (PPVs) for AMI diagnoses were evaluated by reviewing the relevant clinical and laboratory data recorded in the discharge notes of the medical center. Agreement in comorbidities, cardiac procedures, and antiplatelet agent (aspirin or clopidogrel) prescriptions between the two databases was evaluated. Results We matched 341 cases of AMI hospitalizations from the two databases, and 338 cases underwent complete chart review. Of these 338 AMI cases, 297 were confirmed with clinical and lab data, which yielded a PPV of 0.88. The consistency rate for coronary intervention, stenting, and antiplatelet prescription at admission was high, yielding a PPV over 0.90. The percentage of consistency in comorbidity diagnoses was 95.9% (324/338) among matched AMI cases. Conclusions The NHIRD appears to be a valid resource for population research in cardiovascular diseases.
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              Stroke and cerebrovascular diseases in patients with chronic kidney disease.

              Kazunori Toyoda, Toshiharu Ninomiya (2014)
              Chronic kidney disease, defined as a reduced glomerular filtration rate or increased urinary albumin excretion, is recognised as a rapidly growing global health burden, and increasing evidence suggests that it contributes to the risk and severity of cerebrovascular diseases. In particular, chronic kidney disease is an established risk factor for stroke and is also strongly associated with subclinical cerebrovascular abnormalities and cognitive impairment, partly because it shares several traditional and non-traditional risk factors, and sometimes uraemia-related and dialysis-related factors, with cerebrovascular diseases. The effect of chronic kidney disease on incident stroke differs among regions and races and is greater in Asian than in non-Asian people. Chronic kidney disease seems to be predictive of severe neurological deficits and poor vital and functional outcomes after both ischaemic and haemorrhagic strokes, which is partly due to the limitations of pharmacotherapies, including limited use and effects of novel oral anticoagulants, other antithrombotic treatments, and reperfusion treatment for hyperacute ischaemic stroke. In view of the strong two-way association between stroke and kidney disease, the pathophysiological interactions between the brain and kidney should be the subject of intensive study.
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                Author and article information

                Journal
                Journal ID (nlm-ta): BMJ Open
                Journal ID (iso-abbrev): BMJ Open
                Journal ID (hwp): bmjopen
                Journal ID (publisher-id): bmjopen
                Title: BMJ Open
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Electronic): 2044-6055
                Publication date Collection: 2017
                Publication date (Electronic): 27 December 2017
                Volume: 7
                Issue: 12
                Electronic Location Identifier: e018483
                Affiliations
                [1 ] departmentInstitute of Clinical Medicine , National Yang-Ming University , Taipei, Taiwan
                [2 ] departmentDepartment of Internal Medicine, Center for Geriatrics and Gerontology, Division of Nephrology , Taichung Veterans General Hospital , Taichung, Taiwan
                [3 ] departmentDepartment of Internal Medicine, Division of Nephrology , Changhua Christian Hospital , Changhua, Taiwan
                [4 ] departmentSchool of Medicine , Chung-Shan Medical University , Taichung, Taiwan
                [5 ] departmentInternal Medicine Research Center , Changhua Christian Hospital , Changhua, Taiwan
                [6 ] departmentDepartment and Institute of Physiology , National Yang-Ming University , Taipei, Taiwan
                [7 ] departmentDepartment of Medicine, Division of Nephrology , Taipei Veterans General Hospital , Taipei, Taiwan
                Author notes
                [Correspondence to ] Dr Chia-Chu Chang; 27509@ 123456cch.org.tw
                Author information
                http://orcid.org/0000-0003-3172-8507
                Article
                Publisher ID: bmjopen-2017-018483
                DOI: 10.1136/bmjopen-2017-018483
                PMC ID: 5770945
                PubMed ID: 29284721
                SO-VID: 18a288ad-d371-44dc-b4fe-4d03470983af
                Copyright © © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
                License:

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                Date received : 04 July 2017
                Date revision received : 27 October 2017
                Date accepted : 28 November 2017
                Categories
                Subject: Epidemiology
                Subject: Research
                Subject: 1506
                Subject: 1692
                Custom metadata
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                ScienceOpen disciplines: Medicine
                Keywords: chronic kidney disease,national health insurance research database,anti-migraine agents,propensity score,migraine
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: chronic kidney disease, national health insurance research database, anti-migraine agents, propensity score, migraine

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