Abstract
Schizophrenia is closely associated with cardiovascular risk factors which are consequently attributable to the development of chronic kidney disease and end-stage renal disease (ESRD). However, no study has been conducted to examine ESRD-related epidemiology and quality of care before starting dialysis for patients with schizophrenia. By using nationwide health insurance databases, we identified 54,361 ESRD-free patients with schizophrenia and their age-/gender-matched subjects without schizophrenia for this retrospective cohort study (the schizophrenia cohort). We also identified a cohort of 1,244 adult dialysis patients with and without schizophrenia (1:3) to compare quality of renal care before dialysis and outcomes (the dialysis cohort). Cox proportional hazard models were used to estimate the hazard ratio (HR) for dialysis and death. Odds ratio (OR) derived from logistic regression models were used to delineate quality of pre-dialysis renal care. Compared to general population, patients with schizophrenia were less likely to develop ESRD (HR = 0.6; 95% CI 0.4–0.8), but had a higher risk for death (HR = 1.2; 95% CI, 1.1–1.3). Patients with schizophrenia at the pre-ESRD stage received suboptimal pre-dialysis renal care; for example, they were less likely to visit nephrologists (OR = 0.6; 95% CI, 0.4–0.8) and received fewer erythropoietin prescriptions (OR = 0.7; 95% CI, 0.6–0.9). But they had a higher risk of hospitalization in the first year after starting dialysis (OR = 1.4; 95% CI, 1.0–1.8, P < .05). Patients with schizophrenia undertaking dialysis had higher risk for mortality than the general ESRD patients. A closer collaboration between psychiatrists and nephrologists or internists to minimize the gaps in quality of general care is recommended.
Highlights
Schizophrenia has been linked to many physical illnesses [1, 2]
Because of the fact that schizophrenia and chronic kidney disease (CKD) / end-stage renal disease (ESRD) shared many common cardiovascular risk factors, it is reasonable to speculate that the prevalence of CKD/ESRD might be higher in patients with schizophrenia
Compared with the control subgroup in the multivariate Cox regression model, the ESRD-free schizophrenia subgroup had a lower risk for dialysis (HR = 0.6, 95% confidence intervals (95% CIs) 0.5–0.8, P < .001), but a higher risk for death (HR = 1.2, 95% CI 1.2–1.3, P < .001)
Summary
Schizophrenia has been linked to many physical illnesses [1, 2]. Recent evidence has shown that schizophrenia is closely associated with hypertension [3], metabolic syndrome [4], obesity [5], type 2 diabetes [3, 6], and dyslipidemia [3, 5]. Higher risks of cardiovascular events such as coronary heart disease, stroke and congestive heart failure were reported in patients with schizophrenia [7,8,9]. A recent research reported 25% increased risk of CKD in patients with schizophrenia from a nationwide cohort study [10]. No study has investigated the risk of ESRD and the quality of pre-dialysis renal care in patients with schizophrenia. In an analysis of the relationship between type 2 diabetes mellitus and schizophrenia, Schoepf et al reported chronic renal failure to be an important disease contributing to death in patients with schizophrenia [11]. CKD/ESRD might be a hidden risk factor contributing to survival and healthcare outcome in schizophrenia. Our first aim was to investigate the incidence of ESRD and mortality in patients with schizophrenia
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