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      Risks of all-cause mortality and major kidney events in patients with new-onset primary open-angle glaucoma: a nationwide long-term cohort study in Taiwan

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          Abstract

          Objective

          Cardiovascular risk factors are associated with primary open-angle glaucoma (POAG) in the general population. However, long-term mortality and major kidney events in patients with new-onset POAG remain unclear.

          Methods

          Using the Taiwan National Health Insurance Research Database between 1997 and 2011, 15 185 patients with a new diagnosis of POAG were enrolled and propensity score matched (1:1) with 15 185 patients without ocular disorders (WODs). All-cause mortality and major kidney events were analysed by a multivariate Cox proportional hazards regression model and a competing risk regression model.

          Results

          The risk of all-cause mortality was significantly higher in patients with new-onset POAG than in those WODs (adjusted HR (aHR) 2.11, 95% CI 1.76 to 2.54; p<0.001). Patients with POAG had higher risks of acute renal failure (ARF) (competing risk aHR 2.58, 95% CI 1.88 to 3.55; p<0.001) and end-stage renal disease (ESRD) (competing risk aHR 4.84, 95% CI 3.02 to 7.77; p<0.001) than those WODs.

          Conclusions

          Our data demonstrate that POAG is a risk of all-cause mortality, ARF and ESRD, thus needing to notice mortality and major kidney events in patients with new-onset POAG.

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          Most cited references 25

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          The impact of ocular blood flow in glaucoma.

          Two principal theories for the pathogenesis of glaucomatous optic neuropathy (GON) have been described--a mechanical and a vascular theory. Both have been defended by various research groups over the past 150 years. According to the mechanical theory, increased intraocular pressure (IOP) causes stretching of the laminar beams and damage to retinal ganglion cell axons. The vascular theory of glaucoma considers GON as a consequence of insufficient blood supply due to either increased IOP or other risk factors reducing ocular blood flow (OBF). A number of conditions such as congenital glaucoma, angle-closure glaucoma or secondary glaucomas clearly show that increased IOP is sufficient to lead to GON. However, a number of observations such as the existence of normal-tension glaucoma cannot be satisfactorily explained by a pressure theory alone. Indeed, the vast majority of published studies dealing with blood flow report a reduced ocular perfusion in glaucoma patients compared with normal subjects. The fact that the reduction of OBF often precedes the damage and blood flow can also be reduced in other parts of the body of glaucoma patients, indicate that the hemodynamic alterations may at least partially be primary. The major cause of this reduction is not atherosclerosis, but rather a vascular dysregulation, leading to both low perfusion pressure and insufficient autoregulation. This in turn may lead to unstable ocular perfusion and thereby to ischemia and reperfusion damage. This review discusses the potential role of OBF in glaucoma and how a disturbance of OBF could increase the optic nerve's sensitivity to IOP.
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            Taiwan's New National Health Insurance Program: Genesis And Experience So Far

             T.-M. Cheng (2003)
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              Effects of diabetes and level of glycemia on all-cause and cardiovascular mortality. The San Antonio Heart Study.

              Although the level of hyperglycemia is clearly a risk factor for microvascular complications in diabetic patients, its role in macrovascular complications remains controversial. We followed 4,875 subjects (65% Mexican-American) for 7-8 years to investigate the effects of diabetes and hyperglycemia on all-cause and cardiovascular disease (CVD) mortality. These end points were also analyzed according to quartiles of baseline fasting plasma glucose among diabetic participants. The Cox proportional hazards model was used to estimate the relative risks (RRs) for all-cause and CVD mortality. Diabetes was significantly associated with increased all-cause mortality (RR [95% CI] = 2.1 [1.3-3.5] in men; 3.2 [1.9-5.4] in women) and increased CVD mortality (3.2 [1.4-7.1] in men; 8.5 [2.8-25.2] in women). Among diabetic subjects, those in quartile 4 had a 4.2-fold greater risk of all-cause mortality (P 6.2 mmol/l were significant predictors of CVD mortality using Cox models. We conclude that diabetes is a predictor of both all-cause and CVD mortality in the general population and that both hyperglycemia and common CVD risk factors are important predictors of all-cause and CVD mortality in diabetic subjects.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2018
                22 March 2018
                : 8
                : 3
                Affiliations
                [1 ] departmentDivision of Nephrology, Department of Internal Medicine , Taipei Medical University Hospital, Taipei Medical University , Taipei, Taiwan
                [2 ] departmentDivision of Nephrology, Department of Internal Medicine , Tri-Service General Hospital, National Defense Medical Center , Taipei, Taiwan
                [3 ] Institute of Medical Sciences, Tzu Chi University , Hualien, Taiwan
                [4 ] departmentDepartment of Internal Medicine , School of Medicine, College of Medicine, Taipei Medical University , Taipei, Taiwan
                Author notes
                [Correspondence to ] Professor Te-Chao Fang; fangtechao@ 123456gmail.com
                Article
                bmjopen-2017-021270
                10.1136/bmjopen-2017-021270
                5875628
                29572399
                © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

                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/

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                Ophthalmology
                Research
                1506
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                Medicine

                end-stage renal disease, acute renal failure, mortality, primary open-angle glaucoma

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