-
I-Kuan Wang,
Chih-Hsin Muo,
Yi-Chih Chang,
Jchih-Chia Liang,
Chiz-Tzung Chang,
Shih-Yi Lin,
Tzung-Hai Yen,
Feng-Rong Chuang, Pei-Chun Chen,
Chiu-Ching Huang,
Chi-Pang Wen,
Fung-Chang Sung,
Donald E Morisky
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND:Studies into the association between hypertensive disorders during pregnancy and end-stage renal disease are limited. We investigated the risk of end-stage renal disease after delivery among women with hypertensive disorders during pregnancy. METHODS:We used insurance claims data from 1998 to 2009 to identify 26 651 women aged 19-40 years old who experienced hypertensive disorders during pregnancy; these women had no history of hypertension, diabetes, kidney disease or lupus. We also randomly selected 213 397 women without hypertensive disorders during pregnancy as a comparison cohort; the frequency was matched by age and index year of pregnancy. We compared the incidence of end-stage renal disease in the 2 cohorts. We calculated hazard ratios (HRs) and 95% confidence intervals (CIs) after controlling for demographic and clinical factors. RESULTS:Women with hypertensive disorders during pregnancy had a greater risk of chronic kidney disease and end-stage renal disease, with adjusted HRs of 9.38 (95% CI 7.09-12.4) and 12.4 (95% CI 8.54-18.0), respectively, after controlling for urban status, coronary artery disease, congestive heart failure, hyperlipidemia and abruption. The HR for end-stage renal disease was 2.72 (95% CI 1.76-4.22) after we also controlled for hypertension and diabetes. Women with preeclampsia or eclampsia had a higher risk of end-stage renal disease (adjusted HR 14.0, 95% CI 9.43-20.7) than women who had gestational hypertension only (adjusted HR 9.03, 95% CI 5.20-15.7). INTERPRETATION:Women with hypertensive disorders during pregnancy were at a high risk of end-stage renal disease. The risk was much greater for women who had preeclampsia or eclampsia than those who had gestational hypertension only.
Canadian Medical Association Journal 01/2013; · 8.22 Impact Factor
-
I-Kuan Wang,
Chih-Hsin Muo,
Yi-Chih Chang,
Chih-Chia Liang,
Shih-Yi Lin,
Chiz-Tzung Chang,
Tzung-Hai Yen,
Feng-Rong Chuang, Pei-Chun Chen,
Chiu-Ching Huang,
Fung-Chang Sung
[show abstract]
[hide abstract]
ABSTRACT: To compare risks, subtypes, and hospitalization costs of stroke between cohorts with and without systemic lupus erythematosus (SLE).
From the catastrophic illnesses registry of Taiwan's universal health insurance claims data, we identified 13,689 patients with SLE diagnosed in 1997-2008 and selected 54,756 non-SLE controls, frequency-matched with age (every 5 years), sex, and index year. Age-specific and type-specific stroke incidence, hazard, and cost of stroke were compared between the 2 cohorts to the end of 2008.
Compared with the non-SLE cohort, the risk of stroke was 3.2-fold higher in the SLE cohort (5.53 vs 1.74 per 1000 person-years) with an overall adjusted HR of 2.90 (95% CI 2.52-3.33). The age-specific risk was the highest in patients 1-17 years old (HR 163, 95% CI 22.2-1197) and decreased as age increased (p = 0.004). Hypertension and renal disease were the most important comorbidities in the SLE cohort predicting stroke risk (HR 1.75, 95% CI 1.28-2.39 and HR 1.66, 95% CI 1.32-2.10, respectively). There were more hemorrhagic strokes in the SLE cohort than in the non-SLE cohort, but not significantly (28.0% vs 23.4%; p = 0.10). The hospitalization cost for stroke patients was more than twice the cost for those with SLE than for those without (p < 0.0001).
Stroke risk and hospital care costs are considerably greater for patients with SLE than without. The relative risk of stroke is the highest in young patients with SLE.
The Journal of Rheumatology 07/2012; 39(8):1611-8. · 3.69 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The effect of different renal replacement therapies on the risk of developing herpes zoster in renal failure patients is unknown. We aimed to investigate the incidence of herpes zoster attack among renal failure patients who were receiving different dialysis modalities, renal transplantation (RT), or not receiving any of the above mentioned therapies yet.
A retrospective cohort study of the national health insurance register database was conducted. This observational cohort study involved 79,581 study controls, 15,802 chronic kidney disease patients, 3,694 hemodialysis (HD) patients, 317 peritoneal dialysis (PD) patients, and 159 RT patients.
The RT group had the worst risk of herpes zoster (hazard ratio, HR, 8.46; 95% CI 5.85-12.2), followed by PD (HR 3.61; 95% CI 2.49-4.83) and HD (HR 1.35; 95% CI 1.18-1.55), compared with the comparison group (p < 0.0001). The RT group had also the highest risk of developing herpes zoster with complications among all groups (adjusted HR 15.3). The HRs of the PD group were higher than the HRs of the HD group in terms of herpes zoster or its complications (p < 0.0001 and p = 0.0002, respectively).
This study suggests that different treatment modalities are associated with different risks of herpes zoster attacks in renal failure patients. PD patients had higher risks than the HD group in terms of herpes zoster or its complications.
American Journal of Nephrology 06/2012; 36(1):27-33. · 2.54 Impact Factor
-
I-Kuan Wang,
I-Ju Tsai, Pei-Chun Chen,
Chih-Chia Liang,
Che-Yi Chou,
Chiz-Tzung Chang,
Huey-Liang Kuo,
I-Wen Ting,
Chung-Chih Lin,
Feng-Rong Chuang,
Chiu-Ching Huang,
Fung-Chang Sung
[show abstract]
[hide abstract]
ABSTRACT: Cohort study on the association between hypertensive disorders in pregnancy (HDP) and postpartum diabetes is limited. This retrospective cohort study investigated the incidence of diabetes mellitus after delivery among women with HDP using claims data of a universal insurance system.
We defined the HDP group as women aged 19-40 years with their first HDP in 2003, excluding those with a history of gestational diabetes mellitus, diabetes mellitus, or hypertension before the date of diagnosis with HDP. Women who had normal pregnancy without HDP were randomly chosen as our comparison group, frequency matched with age and index year of the HDP group. Both groups were followed until December 31, 2008 to evaluate the occurrence of diabetes.
This study consisted of 1139 women with HDP cases and 4527 non-HDP pregnant women. Overall, the subsequent incidence of diabetes mellitus was 5.08-fold higher in the HDP group than in the non-HDP group, with an adjusted hazard ratio of 3.42 (95% confidence interval [CI], 2.07-5.64) after controlling for age, occupation, income, and comorbidity. The hazard ratio of developing diabetes increased to 39.5 (95% CI, 13.0-120.6) for women having HDP, hyperlipidemia, and obesity simultaneously.
Women with HDP have a high risk of subsequent diabetes. HDP women with obesity and hyperlipidemia are at an extremely high risk of diabetes mellitus. Early identification of women with HDP is needed for prevention, particularly those with other comorbidities.
The American journal of medicine 03/2012; 125(3):251-7. · 4.47 Impact Factor
