Risk factors and their interaction on chronic kidney disease: A multi-centre case control study in Taiwan

Abstract

Background: Chronic kidney disease (CKD) is highly prevalent in Taiwan. More than two-thirds of end-stage renal disease is associated with diabetes mellitus (DM) or hypertension (HTN). Therefore, the formulation of a special preventative policy of CKD in these patients is essential. This study surveyed 14 traditional risk factors and identified their effects on CKD in patients with HTN/DM and compared these with their effects in the general population.

Methods: This study included 5328 cases and 5135 controls in the CKD/HTN/DM outpatient and health centres of 10 hospitals from 2008 to 2010. Fourteen common effect factors were surveyed (four demographic, five disease and five lifestyle), and their effects on CKD were tested. Significance tests were adjusted by the Bonferroni method. Results of the stratified analyses in the variables were presented with significant heterogeneity between patients with different comorbidities.

Results: Male, ageing, low income, hyperuricemia and lack of exercise habits were risk factors for CKD, and their effects in people with different comorbidities were identical. Anaemia was a risk factor, and there was an additive effect between anaemia and HTN on CKD. Patients with anaemia had a higher risk when associated with HTN [odds ratio (OR) = 6.75, 95% confidence limit (95% CI) 4.76-9.68] but had a smaller effect in people without HTN (OR 2.83, 95% CI 2.16-3.67). The association between hyperlipidaemia-related factors and CKD was also moderated by HTN. It was a significant risk factor in people without HTN (OR = 1.67, 95% CI 1.38-2.01) but not in patients with HTN (OR =1.03, 95% CI 0.89-1.19). Hepatitis B, hepatitis C, betel nut chewing, smoking, alcohol intake and groundwater use were not associated with CKD in multivariate analysis.

Conclusions: We considered that patients with HTN and anaemia were a high CKD risk population. Physicians with anaemic patients in outpatient clinics need to recognise that patients who also have HTN might be latent CKD cases.

Fig. 1

Recruitment Process Flow Chart HTN: hypertension; DM: diabetes mellitus; CKD: chronic kidney disease;n: number of participants were meeting for specific group. We recruited participants without CKD from the HTN/DM outpatient and health centres in each hospital as a control group. The CKD cases were recruited from both the nephrology and HTN/DM outpatient clinics in each hospital and from health centres

Fig. 2

Stratified analyses for variables with significant heterogeneity between the four groups using multivariable analyses. (a) shows coefficients of anaemia and (b) shows coefficients of hyperlipidaemia using multivariate analyses and their heterogeneity caused by HTN in the different groups. Amount of heterogeneity accounted for by HTN was 93.71 %/100 %. The odds ratios and 95 % CI of anaemia in patients with or without HTN were 6.75 (4.76–9.68) and 2.83 (2.16–3.67), respectively. The odds ratios (95 % CI) of hyperlipidaemia in patients with or without HTN were 1.03 (0.89–1.19) and 1.67 (1.38–2.01), respectively HTN: hypertension; DM: diabetes mellitus; log (OR): natural logarithm of the odds ratio; 95 % CI: 95 % confidence interval of log (OR)