Long-Term Outcomes in Patients with Incident Chronic Obstructive Pulmonary Disease after Acute Kidney Injury: A Competing-Risk Analysis of a Nationwide Cohort
Journal
Journal of clinical medicine
Journal Volume
7
Journal Issue
9
Date Issued
2018-08-24
Author(s)
Wu, Che-Hsiung
Chang, Huang-Ming
Wang, Cheng-Yi
Chen, Likwang
Chen, Liang-Wen
Lai, Chien-Heng
Chu, Tzong-Shinn
Chang, Yu-Hsing
Tseng, Li-Jung
Shiao, Chih-Chung
Wu, Chih-Jen
Wang, Jian-Jhong
Wang, Wei-Jie
Lin, Jui-Hsiang
Chen, Cheng-Yi
National Taiwan University Study Group on Acute Renal Failure
Abstract
Both acute kidney injury (AKI) and chronic obstructive pulmonary disease (COPD) are associated with increased morbidity and mortality. However, the incidence of de novo COPD in patients with AKI, and the impact of concurrent COPD on the outcome during post-AKI care is unclear. Patients who recovered from dialysis-requiring AKI (AKI-D) during index hospitalizations between 1998 and 2010 were identified from nationwide administrative registries. A competing risk analysis was conducted to predict the incidence of adverse cardiovascular events and mortality. Among the 14,871 patients who recovered from temporary dialysis, 1535 (10.7%) were identified as having COPD (COPD group) one year after index discharge and matched with 1473 patients without COPD (non-COPD group) using propensity scores. Patients with acute kidney disease superimposed withs COPD were associated with a higher risk of incident ischemic stroke (subdistribution hazard ratio (sHR), 1.52; 95% confidence interval (95% CI), 1.17 to 1.97; p = 0.002) and congestive heart failure (CHF; sHR, 1.61; (95% CI), 1.39 to 1.86; p < 0.001). The risks of incident hemorrhagic stroke, myocardial infarction, end-stage renal disease, and mortality were not statistically different between the COPD and non-COPD groups. This observation adds another dimension to accumulating evidence regarding pulmo-renal consequences after AKI.
Subjects
acute kidney injury; chronic obstructive pulmonary disease; congestive heart failure; stroke
Publisher
MDPI
Type
journal article