Increased chronic kidney disease development and progression in diabetic patients after appendectomy: a population-based cohort study

PeerJ

article

Chin-Hua Chang¹  Chew-Teng Kor²  Chia-Lin Wu¹  Ping-Fang Chiu¹  Jhao-Rong Li¹  Chun-Chieh Tsai¹  Teng-Hsiang Chang¹  Chia-Chu Chang¹ 

[1] Department of Internal Medicine, Changhua Christian hospital;Department of Internal Medicine Research Center, Changhua Christian hospital;Graduate Institute of Statistics and Information Science, National Changhua University of Education;Department of Environmental and Precision Medicine Laboratory, Changhua Christian Hospital;Institute of Clinical Medicine, National Yang-Ming University;School of Medicine, Chung-Shan Medical University;Department of Internal Medicine, Kuang Tien General Hospital;Department of Nutrition, Hungkuang University

关键词: Appendectomy;    Microbiota;    Charlson Comorbidity Index scores;    Interaction analyses;    Uremic toxins;    Chronic kidney disease;    DM;    Dysbiotic;    End-stage renal disease;    Propensity-score-matching;   

DOI  :  10.7717/peerj.5019

学科分类：社会科学、人文和艺术（综合）

来源: Inra

【 摘 要 】

BackgroundThe vermiform appendix serves as a “safe house” for maintaining normal gut bacteria and appendectomy may impair the intestinal microbiota. Appendectomy is expected to profoundly alter the immune system and modulate the pathogenic inflammatory immune responses of the gut. Recent studies have shown that a dysbiotic gut increases the risk of cardiovascular disease and chronic kidney disease (CKD). Therefore, we hypothesized that appendectomy would increase the risk of CKD.MethodsThis nationwide, population-based, propensity-score-matched cohort study included 10,383 patients who underwent appendectomy and 41,532 propensity-score-matched controls. Data were collected by the National Health Insurance Research Database of Taiwan from 2000 to 2013. We examined the associations between appendectomy and CKD and end-stage renal disease (ESRD). The major outcome was a new diagnosis of CKD based on an outpatient diagnosis made at least three times or hospital discharge diagnosis made once during the follow-up period. ESRD was defined as undergoing dialysis therapy for at least 90 days, as in previous studies.ResultsThe incidence rates of CKD and ESRD were higher in the appendectomy group than in the control cohort (CKD: 6.52 vs. 5.93 per 1,000 person-years, respectively; ESRD: 0.49 vs. 0.31 per 1,000 person-years, respectively). Appendectomy patients also had a higher risk of developing CKD (adjusted hazard ratio [aHR] 1.13; 95% CI [1.01–1.26]; P = 0.037) and ESRD (aHR 1.59; 95% CI [1.06–2.37]; P = 0.024) than control group patients. Subgroup analysis showed that appendectomy patients with concomitant diabetes mellitus (aHR 2.08; P = 0.004) were at higher risk of incident ESRD than those without diabetes mellitus. The interaction effects of appendectomy and diabetes mellitus were significant for ESRD risk (P = 0.022); no interaction effect was found for CKD risk (P = 0.555).ConclusionsAppendectomy increases the risk of developing CKD and ESRD, especially in diabetic patients. Physicians should pay close attention to renal function prognosis in appendectomy patients.

【 授权许可】

CC BY