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Increased Risk of Active Tuberculosis following Acute Kidney Injury: A Nationwide, Population-Based Study
BACKGROUND: Profound alterations in immune responses associated with uremia and exacerbated by dialysis increase the risk of active tuberculosis (TB). Evidence of the long-term risk and outcome of active TB after acute kidney injury (AKI) is limited. METHODS: This population-based-cohort study used...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2013
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3723893/ https://www.ncbi.nlm.nih.gov/pubmed/23936044 http://dx.doi.org/10.1371/journal.pone.0069556 |
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author | Wu, Vin-Cent Wang, Chen-Yi Shiao, Chih-Chung Chang, Chia-Hsui Huang, Hui-Yu Huang, Tao-Min Lai, Chun-Fu Lin, Meng-Chun Ko, Wen-Je Wu, Kwan-Dun Yu, Chong-Jen Shu, Chin-Chung Lee, Chih-Hsin Wang, Jann-Yuan |
author_facet | Wu, Vin-Cent Wang, Chen-Yi Shiao, Chih-Chung Chang, Chia-Hsui Huang, Hui-Yu Huang, Tao-Min Lai, Chun-Fu Lin, Meng-Chun Ko, Wen-Je Wu, Kwan-Dun Yu, Chong-Jen Shu, Chin-Chung Lee, Chih-Hsin Wang, Jann-Yuan |
author_sort | Wu, Vin-Cent |
collection | PubMed |
description | BACKGROUND: Profound alterations in immune responses associated with uremia and exacerbated by dialysis increase the risk of active tuberculosis (TB). Evidence of the long-term risk and outcome of active TB after acute kidney injury (AKI) is limited. METHODS: This population-based-cohort study used claim records retrieved from the Taiwan National Health Insurance database. We retrieved records of all hospitalized patients, more than 18 years, who underwent dialysis for acute kidney injury (AKI) during 1999–2008 and validated using the NSARF data. Time-dependent Cox proportional hazards model to adjust for the ongoing effect of end-stage renal disease (ESRD) was conducted to predict long-term de novo active TB after discharge from index hospitalization. RESULTS: Out of 2,909 AKI dialysis patients surviving 90 days after index discharge, 686 did not require dialysis after hospital discharge. The control group included 11,636 hospital patients without AKI, dialysis, or history of TB. The relative risk of active TB in AKI dialysis patients, relative to the general population, after a mean follow-up period of 3.6 years was 7.71. Patients who did (hazard ratio [HR], 3.84; p<0.001) and did not (HR, 6.39; p<0.001) recover from AKI requiring dialysis had significantly higher incidence of TB than patients without AKI. The external validated data also showed nonrecovery subgroup (HR = 4.37; p = 0.049) had high risk of developing active TB compared with non-AKI. Additionally, active TB was associated with long-term all-cause mortality after AKI requiring dialysis (HR, 1.34; p = 0.032). CONCLUSIONS: AKI requiring dialysis seems to independently increase the long-term risk of active TB, even among those who weaned from dialysis at discharge. These results raise concerns that the increasing global burden of AKI will in turn increase the incidence of active TB. |
format | Online Article Text |
id | pubmed-3723893 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2013 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-37238932013-08-09 Increased Risk of Active Tuberculosis following Acute Kidney Injury: A Nationwide, Population-Based Study Wu, Vin-Cent Wang, Chen-Yi Shiao, Chih-Chung Chang, Chia-Hsui Huang, Hui-Yu Huang, Tao-Min Lai, Chun-Fu Lin, Meng-Chun Ko, Wen-Je Wu, Kwan-Dun Yu, Chong-Jen Shu, Chin-Chung Lee, Chih-Hsin Wang, Jann-Yuan PLoS One Research Article BACKGROUND: Profound alterations in immune responses associated with uremia and exacerbated by dialysis increase the risk of active tuberculosis (TB). Evidence of the long-term risk and outcome of active TB after acute kidney injury (AKI) is limited. METHODS: This population-based-cohort study used claim records retrieved from the Taiwan National Health Insurance database. We retrieved records of all hospitalized patients, more than 18 years, who underwent dialysis for acute kidney injury (AKI) during 1999–2008 and validated using the NSARF data. Time-dependent Cox proportional hazards model to adjust for the ongoing effect of end-stage renal disease (ESRD) was conducted to predict long-term de novo active TB after discharge from index hospitalization. RESULTS: Out of 2,909 AKI dialysis patients surviving 90 days after index discharge, 686 did not require dialysis after hospital discharge. The control group included 11,636 hospital patients without AKI, dialysis, or history of TB. The relative risk of active TB in AKI dialysis patients, relative to the general population, after a mean follow-up period of 3.6 years was 7.71. Patients who did (hazard ratio [HR], 3.84; p<0.001) and did not (HR, 6.39; p<0.001) recover from AKI requiring dialysis had significantly higher incidence of TB than patients without AKI. The external validated data also showed nonrecovery subgroup (HR = 4.37; p = 0.049) had high risk of developing active TB compared with non-AKI. Additionally, active TB was associated with long-term all-cause mortality after AKI requiring dialysis (HR, 1.34; p = 0.032). CONCLUSIONS: AKI requiring dialysis seems to independently increase the long-term risk of active TB, even among those who weaned from dialysis at discharge. These results raise concerns that the increasing global burden of AKI will in turn increase the incidence of active TB. Public Library of Science 2013-07-25 /pmc/articles/PMC3723893/ /pubmed/23936044 http://dx.doi.org/10.1371/journal.pone.0069556 Text en © 2013 Wu et al http://creativecommons.org/licenses/by/4.0/ 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 properly credited. |
spellingShingle | Research Article Wu, Vin-Cent Wang, Chen-Yi Shiao, Chih-Chung Chang, Chia-Hsui Huang, Hui-Yu Huang, Tao-Min Lai, Chun-Fu Lin, Meng-Chun Ko, Wen-Je Wu, Kwan-Dun Yu, Chong-Jen Shu, Chin-Chung Lee, Chih-Hsin Wang, Jann-Yuan Increased Risk of Active Tuberculosis following Acute Kidney Injury: A Nationwide, Population-Based Study |
title | Increased Risk of Active Tuberculosis following Acute Kidney Injury: A Nationwide, Population-Based Study |
title_full | Increased Risk of Active Tuberculosis following Acute Kidney Injury: A Nationwide, Population-Based Study |
title_fullStr | Increased Risk of Active Tuberculosis following Acute Kidney Injury: A Nationwide, Population-Based Study |
title_full_unstemmed | Increased Risk of Active Tuberculosis following Acute Kidney Injury: A Nationwide, Population-Based Study |
title_short | Increased Risk of Active Tuberculosis following Acute Kidney Injury: A Nationwide, Population-Based Study |
title_sort | increased risk of active tuberculosis following acute kidney injury: a nationwide, population-based study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3723893/ https://www.ncbi.nlm.nih.gov/pubmed/23936044 http://dx.doi.org/10.1371/journal.pone.0069556 |
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