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. 2023 Feb 2:10:1116489.
doi: 10.3389/fmed.2023.1116489. eCollection 2023.

Rheumatoid arthritis and the risk of end-stage renal disease: A nationwide, population-based study

Sang Heon Suh  1 , Jin Hyung Jung  2 , Tae Ryom Oh  1 , Eun Mi Yang  3 , Hong Sang Choi  1 , Chang Seong Kim  1 , Eun Hui Bae  1 , Seong Kwon Ma  1 , Kyung-Do Han  4 , Soo Wan Kim  1
Affiliations

Rheumatoid arthritis and the risk of end-stage renal disease: A nationwide, population-based study

Sang Heon Suh et al. Front Med (Lausanne). .

Abstract

Introduction: Despite the risk of incident chronic kidney disease among the patients with rheumatoid arthritis (RA), the association of RA and the risk of end-stage renal disease (ESRD) has not been clearly elucidated. We aimed to investigate the association of RA and the risk of ESRD.

Materials and methods: A total of 929,982 subjects with (n = 154,997) or without (n = 774,985) RA from the National Health Insurance Service (NHIS) database in Koreas (corresponding to the period between 2009 and 2017) were retrospectively analyzed. RA was defined by the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), codes plus any dispensing of disease-modifying anti-rheumatic drugs. The primary outcome was incident ESRD, identified by a combination of the ICD-10-CM codes and a special code assigned to patients receiving maintenance dialysis for ≥ 3 months or those with a transplant kidney.

Results: Compared to the subjects without RA, the subjects with RA resulted in an increased incidence of ESRD (incidence rates of 0.374 versus 0.810 cases per 1,000 person-years). Accordingly, compared to the subjects without RA, the risk of ESRD was significantly increased among the subjects with RA (adjusted hazard ratio 2.095, 95% confidence interval 1.902-2.308). Subgroup analyses revealed that the risk of ESRD imposed by RA is relatively higher in relatively young and healthy individuals.

Conclusion: Rheumatoid arthritis (RA) increase the risk of ESRD. As the risk of ESRD imposed by RA is relatively higher in relatively young and healthy individuals, kidney-protective treatment, such as biologic agents, should be preferentially considered among these patients with RA.

Keywords: chronic kidney disease; disease-modifying anti-rheumatic drugs; end-stage renal disease; nation-wide population-based study; rheumatoid arthritis.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of the study population. ESRD, end-stage renal disease; RA, rheumatoid arthritis.
Figure 2
Figure 2
Kaplan–Meier curve for cumulative incidence of ESRD by RA. p value by Log-rank test. ESRD, end-stage renal disease; RA, rheumatoid arthritis.
See this image and copyright information in PMC

Comment in

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