Risk of intracranial hemorrhage associated with autosomal dominant polycystic kidney disease in patients with end stage renal disease

BMC Nephrology

Robert Nee²  Kevin C Abbott²  Christina M Yuan²  Lawrence Agodoa¹  David J Yoo² 

[1] NIDDK, National Institutes of Health, Bethesda, MD, USA;Nephrology, Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD, USA

关键词: Competing risk;    USRDS;    Dialysis;    Stroke;    Autosomal dominant polycystic kidney disease;    Intracranial aneurysm;    Intracranial hemorrhage;   

Others  :  1082720
DOI  :  10.1186/1471-2369-15-39

 received in 2013-10-23, accepted in 2014-02-12,  发布年份 2014

【 摘 要 】

Background

An analysis of intracranial hemorrhage (ICH) in a national sample of autosomal dominant polycystic kidney disease (ADPKD) patients receiving long-term dialysis has not been reported. It is often assumed that patients with ADPKD are not at increased risk of ICH after starting dialysis. We hypothesized that patients with ADPKD would have a higher subsequent risk of ICH even after the start of chronic dialysis.

Methods

Retrospective cohort study of Medicare primary patients with and without ADPKD in the United States Renal Data System (USRDS), initiated on chronic dialysis or transplanted between 1 January 1999 and 3 July 2009, and followed until 31 December 2009. Covariates included age, gender, race, prior stroke, diabetes mellitus, dialysis modality, body mass index, serum albumin and other co-morbid conditions from the Medical Evidence Form. Primary outcome was ICH, based on inpatient and outpatient Medicare claims, and all-cause mortality. Kaplan-Meier analysis was used for unadjusted assessment of time to events. Cox regression was used for assessment of factors associated with ICH and mortality. We performed competing risk regression using kidney transplant and death as competing risks. Kidney transplant was also modeled as a time-dependent covariate in Cox regression.

Results

Competing risk regression demonstrated that ADPKD had a subhazard ratio 2.97 for ICH (95% CI 2.27-3.89). Adjusted Cox analysis showed that ADPKD patients had an AHR for death of 0.59 vs. non-ADPKD patients (95% CI 0.57-0.61).

Conclusions

ADPKD is a significant risk factor for ICH among patients on maintenance dialysis. Our Medicare primary cohort was older than in previous studies of intracranial aneurysm rupture among ADPKD patients. There are also limitations inherent to using the USRDS database.

【 授权许可】

   
2014 Yoo et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Davies F, Coles GA, Harper PS, Williams AJ, Evans C, Cochlin D: Polycystic kidney disease re-evaluated: a population-based study. Q J Med 1991, 79(290):477-485. PubMed PMID: 1946928
• [2]Gabow PA: Autosomal dominant polycystic kidney disease. N Engl J Med 1993, 329:332.
• [3]Levy M, Feingold J: Estimating prevalence in single-gene kidney diseases progressing to renal failure. Kidney Int 2000, 58:925-943.
• [4]Helal I, Reed B, Mettler P, Mc Fann K, Tkachenko O, Yan XD, Schrier RW: Prevalence of cardiovascular events in patients with autosomal dominant polycystic kidney disease. Am J Nephrol 2012, 36(4):362-370.
• [5]Torres VE, Cai Y, Chen X, Wu GQ, Geng L, Cleghorn KA, Johnson CM, Somlo S: Vascular expression of polycystin-2. J Am Soc Nephrol 2001, 12(1):1-9.
• [6]Zhang B, Fugleholm K, Day LB, Ye S, Weller RO, Day IN: Molecular pathogenesis of subarachnoid haemorrhage. Int J Biochem Cell Biol 2003, 35(9):1341-1360.
• [7]Xu HW, Yu SQ, Mei CL, Li MH: Screening for intracranial aneurysm in 355 Patients with autosomal dominant polycystic kidney disease. Stroke 2011, 42(1):204-206. doi: 10.1161/STROKEAHA.110.578740. Epub 2010 Dec 16
• [8]Brisman JL, Song JK, Newell DW: Cerebral aneurysms. N Engl J Med 2006, 355:928-939.
• [9]Schievink WI, Prendergast V, Zabramski JM: Rupture of a previously documented small asymptomatic intracranial aneurysm in a patient with autosomal dominant polycystic kidney disease. Neurosurgery 1998, 89:479-482.
• [10]Agrawal A, Dwivedi S, Singh BR, Banode PJ: Simultaneous hemorrhage in intracranial aneurysms and in renal cyst in a case of polycystic kidney disease. Saudi J Kidney Dis Transpl 2012, 23(4):794-798.
• [11]Huston J 3rd, Torres VE, Sulivan PP, Offord KP, Wiebers DO: Value of magnetic resonance angiography for the detection of intracranial aneurysms in autosomal dominant polycystic kidney disease. J Am Soc Nephrol 1993, 3(12):1871-1877.
• [12]Chauveau D, Pirson Y, Verellen-Dumoulin C, Macnicol A, Gonzalo A, Grünfeld JP: Intracranial aneurysms in autosomal dominant polycystic kidney disease. Kidney Int 1994, 45(4):1140-1146. PubMed PMID: 8007584
• [13]Belz MM, Hughes RL, Kaehny WD, Johnson AM, Fick-Brosnahan GM, Earnest MP, Gabow PA: Familial clustering of ruptured intracranial aneurysms in autosomal dominant polycystic kidney disease. Am J Kidney Dis 2001, 38(4):770-776. PubMed PMID: 11576880
• [14]Graf S, Schischma A, Eberhardt KE, Istel R, Stiasny B, Schulze BD: Intracranial aneurysms and dolichoectasia in autosomal dominant polycystic kidney disease. Nephrol Dial Transplant 2002, 17(5):819-823.
• [15]Johnston SC, Selvin S, Gress DR: The burden, trends, and demographics of mortality from subarachnoid hemorrhage. Neurology 1998, 50:1413-1418.
• [16]Ferro JM, Canhão P, Peralta R: Update on subarachnoid haemorrhage. J Neurol 2008, 255(4):465-479.
• [17]Van Gijn J, Kerr RS, Rinkel GJ: Subarachnoid haemorrhage. Lancet 369(9558):306-318.
• [18]Van Asch CJ, Luitse MJ, Rinkel GJ, Van der Tweel I, Algra A, Klijn CJ: Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis. Lancet Neurol 2010, 9(2):167-176.
• [19]Feigin VL, Lawes CM, Bennett DA, Barker-Collo SL, Parag V: Worldwide strokeincidence and early case fatality reported in 56 population-based studies: a systematic review. Lancet Neurol 2009, 8(4):355-369.
• [20]Labovitz DL, Halim A, Boden-Albala B, Hauser WA, Sacco RL: The incidence of deep and lobar intracerebral hemorrhage in whites, blacks, and Hispanics. Neurology 2005, 65(4):518-522.
• [21]Ariesen MJ, Claus SP, Rinkel GJ, Algra A: Risk factors for intracerebral hemorrhage in the general population: a systematic review. Stroke 2003, 34(8):2060-2065.
• [22]Matsukawa H, Shinoda M, Fujii M, Takahashi O, Yamamoto D, Murakata A, Ishikawa R: Factors associated with lobar vs. non-lobar intracerebral hemorrhage. Acta Neurol Scand 2012, 126(2):116-121.
• [23]Biffi A, Sonni A, Anderson CD, Kissela B, Jagiella JM, Schmidt H, Jimenez-Conde J, Hansen BM, Fernandez-Cadenas I, Cortellini L, Ayres A, Schwab K, Juchniewicz K, Urbanik A, Rost NS, Viswanathan A, Seifert-Held T, Stoegerer EM, Tomás M, Rabionet R, Estivill X, Brown DL, Silliman SL, Selim M, Worrall BB, Meschia JF, Montaner J, Lindgren A, Roquer J, Schmidt R, et al.: Variants at APOE influence risk of deep and lobar intracerebral hemorrhage. Ann Neurol 2010, 68(6):934-943.
• [24]United States Renal Data System. Available at http://www.usrds.org webcite, annual data report, accessed 2/28/2014
• [25]Longenecker JC, Coresh J, Klag MJ, Levey AS, Martin AA, Fink NE, Powe NR: Validation of comorbid conditions on the end-stage renal disease medical evidence report: the CHOICE study. Choices for healthy outcomes in caring for ESRD. J Am Soc Nephrol 2000, 11(3):520-529.
• [26]Schievink WI: Intracranial aneurysms. N Engl J Med 1997, 336(1):28-40. Review. Erratum in: N Engl J Med 1997 Apr 24;336(17):1267
• [27]Seliger SL, Gillen DL, Tirschwell D, Wasse H, Kestenbaum BR, Stehman-Breen CO: Risk factors for incident stroke among patients with end-stage renal disease. J Am Soc Nephrol 2003, 14(10):2623-2631.
• [28]Pirson Y, Christophe JL, Goffin E: Outcome of renal replacement therapy in autosomal dominant polycystic kidney disease. Nephrol Dial Transplant 1996, 11(Suppl 6):24-28.
• [29]Schievink WI, Torres VE, Piepgras DG, Wiebers DO: Saccular intracranial aneurysms in autosomal dominant polycystic kidney disease. J Am Soc Nephrol 1992, 3(1):88-95.
• [30]Smeeton NC, Heuschmann PU, Rudd AG, McEvoy AW, Kitchen ND, Sarker SJ, Wolfe CD: Incidence of hemorrhagic stroke in black Caribbean, black AArican, and white populations: the South London, stroke register, 1995–2004. Stroke 2007, 38(12):3133-3138.
• [31]Broderick JP, Brott T, Tomsick T, Huster G, Miller R: The risk of subarachnoid and intracerebral hemorrhages in blacks as compared with whites. N Engl J Med 1992, 326:733-736.
• [32]Flaherty ML, Woo D, Haverbusch M, Sekar P, Khoury J, Sauerbeck L, Moomaw CJ, Schneider A, Kissela B, Kleindorfer D, Broderick JP: Racial variations in location and risk of intracerebral hemorrhage. Stroke 2005, 36:934-937.
• [33]Sood P, Sinson GP, Cohen EP: Subdural hematomas in chronic dialysis patients: Significant and increasing. Clin J Am Soc Nephrol 2007, 2(5):956-959.
• [34]Fick GM, Johnson AM, Hammond WS, Gabow PA: Causes of death in autosomal dominant polycystic kidney disease. J Am Soc Nephrol 1995, 5(12):2048-2056.
• [35]Chapman AB, Rubinstein D, Hughes R, Stears JC, Earnest MP, Johnson AM, Gabow PA, Kaehny WD: Intracranial aneurysms in autosomal dominant polycystic kidney disease. N Engl J Med 1992, 327(13):916-920.
• [36]Ruggieri PM, Poulos N, Masaryk TJ, Ross JS, Obuchowski NA, Awad IA, Braun WE, Nally J, Lewin JS, Modic MT: Occult intracranial aneurysms in polycystic kidney disease: screening with MR angiography. Radiology 1994, 191(1):33-39.
• [37]Caranci F, Briganti F, Cirillo L, Leonardi M, Muto M: Epidemiology and genetics of intracranial aneurysms. Eur J Radiol 2013, 82(10):1598-1605.
• [38]Rossetti S, Harris PC: The genetics of vascular complications in autosomal dominant polycystic kidney disease (ADPKD). Curr Hypertens Rev 2013, 9(1):37-43.
• [39]Barua M, Pei Y: Diagnosis of autosomal-dominant polycystic kidney disease: an integrated approach. Semin Nephrol 2010, 30(4):356-365.
• [40]Torra R, Badenas C, Darnell A, Nicolau C, Volpini V, Revert L, Estivill X: Linkage, clinical features, and prognosis of autosomal dominant polycystic kidney disease types 1 and 2. J Am Soc Nephrol 1996, 7(10):2142-2151.