Research Reports - Long-term renal outcomes in patients with traumatic brain injury

PLoS One. 2017 Feb 14;12(2):e0171999. doi: 10.1371/journal.pone.0171999.
eCollection 2017.

Wu CL(1,)(2,)(3,)(4,)(5), Kor CT(4), Chiu PF(1,)(2,)(4), Tsai CC(1,)(2), Lian
IB(6), Yang TH(4,)(5), Tarng DC(3,)(7,)(8), Chang CC(1,)(2,)(4,)(5).

BACKGROUND: Traumatic brain injury (TBI) is an important cause of death and
disability worldwide. The relationship between TBI and kidney diseases is largely
unknown.
METHODS: We aimed to determine whether TBI is associated with long-term adverse
renal outcomes. We performed a nationwide, population-based, propensity
score-matched cohort study of 32,152 TBI patients and 128,608 propensity
score-matched controls. Data were collected by the National Health Insurance
Research Database of Taiwan from 2000 to 2012. Our clinical outcomes were chronic
kidney disease (CKD), end-stage renal disease (ESRD) and the composite endpoint
of ESRD or all-cause mortality.
RESULTS: The incidence rate of CKD was higher in the TBI than in the control
cohort (8.99 vs. 7.4 per 1000 person-years). The TBI patients also showed higher
risks of CKD (adjusted hazard ratio [aHR] 1.14, 95% confidence interval [CI]
1.08-1.20; P < 0.001) and composite endpoints (aHR 1.08, 95% CI 1.01-1.15; P =
0.022) than the control groups, but the ESRD was not significantly different
between the groups. In subgroup analyses, the risks of incident CKD and composite
endpoints were significantly raised in TBI patients aged < 65 years and/or
without comorbidities. However, the risks of both CKD and composite outcome were
little affected by the severity of TBI.
CONCLUSIONS: TBI has a modest but significant effect on incident CKD and
composite endpoint, but not on ESRD alone. TBI patients under 65 are at greater
risk of CKD and composite outcome than their older counterparts. 

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