Long-term renal outcomes in patients with traumatic brain injury: A nationwide population-based cohort study.

Chia-Lin Wu,Chew-Teng Kor,Ie-Bin Lian,Chun-Chieh Tsai,Tao-Hsiang Yang,Chia-Chu Chang,Der-Cherng Tarng,Ping-Fang Chiu,Effie C Tsilibary

doi:10.1371/journal.pone.0171999

Abstract

BackgroundTraumatic brain injury (TBI) is an important cause of death and disability worldwide. The relationship between TBI and kidney diseases is largely unknown.MethodsWe 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.ResultsThe 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.ConclusionsTBI 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.

Highlights

Traumatic brain injury (TBI) is a common disorder and an important cause of death and disability, exerting substantial impact on public health
The incidence rate of Chronic kidney disease (CKD) was higher in the TBI than in the control cohort (8.99 vs. 7.4 per 1000 person-years)
The TBI patients showed higher risks of CKD and composite endpoints than the control groups, but the end-stage renal disease (ESRD) was not significantly different between the groups

Summary

Introduction

Traumatic brain injury (TBI) is a common disorder and an important cause of death and disability, exerting substantial impact on public health. Chronic kidney disease (CKD) is another important cause of death and disability. CKD gradually and inevitably progresses toward end-stage renal disease (ESRD) or mortality. Significant risk factors for CKD include old age, cigarette smoking, elevated blood pressure, diabetes, dyslipidemia, proteinuria and anemia [3,4]. Despite improved care for hypertension, diabetes and hyperlipidemia, CKD prevalence has increased throughout the past two decades [5]. It is critical to identify the potential risk factors and improve the current health care system in Taiwan, where the prevalence and incidence rates of end-stage renal disease (ESRD) are the highest in the world [6]. Traumatic brain injury (TBI) is an important cause of death and disability worldwide. The relationship between TBI and kidney diseases is largely unknown

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Results