From the Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine (T.-M.Y., K.-T.S., S.-T.H., C.-H.C., C.-H.K.), Pediatric Dentistry, Dental Department (K.-T.S.), and College of Medicine (C.-L.L.), China Medical University, Taichung; Division of Nephrology (T.-M.Y., Y.-W.C., S.-T.H., C.-H.C.) and Department of Medical Research and Center of Quality Management (C.-H.C.), Taichung Veterans General Hospital, Taiwan; Connie Frank Transplant Center, Division of Nephrology, Department of Medicine (S.-C.K., B.K.L.), UCSF Medical Center, San Francisco, CA; Department of Pediatrics, Division of Nephrology (M.-C.Y.), Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan; Department of Life Science (C.-H.C.), Tunghai University; Management Office for Health Data (C.-L.L.) and Department of Nuclear Medicine and PET Center (C.-H.K.), China Medical University Hospital; and Department of Bioinformatics and Medical Engineering (C.-H.K.), Asia University, Taichung, Taiwan.
Neurology. 2017 Oct 3;89(14):1457-1463. doi: 10.1212/WNL.0000000000004434. Epub 2017 Aug 30.
Data on the risk of neurodegenerative diseases, including Alzheimer disease (AD) and Parkinson disease (PD), in patients with polycystic kidney disease (PKD) are lacking.
A total of 4,229 patients who were aged ≥20 years and had received a diagnosis of PKD were included in the PKD cohort. For each PKD case identified, 1 participant aged ≥20 years without a history of PKD, dementia, or PD was selected from the comparison cohort. For each patient with PKD, the corresponding controls were selected 1:1 on the basis of the nearest propensity score calculated using logistic regression.
The incidence density rates of dementia were 4.31 and 2.50 per 1,000 person-years in the PKD and control cohorts, respectively. A 2.04-fold higher risk of dementia was observed in patients with PKD than in controls (adjusted hazard ratio [aHR] 2.04; 95% confidence interval [CI] 1.46-2.85). Regarding the risk of different dementia subtypes, including AD and vascular dementia (VaD), the aHR for AD and presenile dementia was 2.71 (95% CI 1.08-6.75) and that for VaD was 0.90 (95% CI 0.43-1.87) in patients with PKD compared with controls, after adjustment for age, sex, and comorbidities. Compared with controls, the risk of PD increased by 1.78-fold (95% CI 1.14-2.79) in patients with PKD.
In clinical practice, health care professionals should be aware of the risk of neurodegenerative diseases in patients with PKD.
关于多囊肾病（PKD）患者发生神经退行性疾病（包括阿尔茨海默病[AD]和帕金森病[PD]）的风险，目前相关数据较为缺乏。
本研究纳入了年龄≥20 岁且被诊断为 PKD 的 4229 例患者，将每位确诊为 PKD 的患者与年龄≥20 岁、无 PKD 病史、痴呆或 PD 病史的 1 名对照者进行匹配。对于每位 PKD 患者，根据最近通过逻辑回归计算得出的倾向评分，以 1:1 的比例选择相应的对照者。
在 PKD 队列和对照组中，痴呆的发生率密度分别为 4.31 和 2.50/1000 人年。与对照组相比，PKD 患者发生痴呆的风险高 2.04 倍（校正后的危险比[HR]2.04；95%置信区间[CI]1.46-2.85）。对于不同痴呆亚型（包括 AD 和血管性痴呆[VaD]）的风险，与对照组相比，PKD 患者发生 AD 和早发性痴呆的校正 HR 分别为 2.71（95% CI 1.08-6.75）和 0.90（95% CI 0.43-1.87），VaD 的校正 HR 为 0.90（95% CI 0.43-1.87）。与对照组相比，PKD 患者发生 PD 的风险增加了 1.78 倍（95% CI 1.14-2.79）。
在临床实践中，医护人员应当注意到 PKD 患者发生神经退行性疾病的风险。
