Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan.
Mackay Memorial Hospital, Taipei, Taiwan.
PLoS One. 2018 Sep 6;13(9):e0203410. doi: 10.1371/journal.pone.0203410. eCollection 2018.
Alcohol use disorder (AUD) is a spectrum of high risk behaviors including alcohol abuse and dependence. Chronic kidney disease (CKD) is progressive loss of renal function for more or equal to 3 months or presence of any irreversible kidney damage. Common risk factors of CKD have been identified, but the impact of alcohol consumption on kidney function is controversial. The study aims to investigate the relationship between alcohol use disorder and CKD on a national scale.
This retrospective cohort study was conducted using Taiwan's National Health Insurance research database. Patients aged 20 years or older, without CKD and with the diagnosis of AUD (ICD-9-CM codes 303.X; 305.0, V113) from years 2000 to 2013 were enrolled. Control cohort was selected to match the demographics of the target population. Patients were followed until the end of 2013 or earlier if they developed CKD, died, or lost follow up. Baseline characteristics and comorbidities were identified for risk stratification.
We identified 11639 patients in the AUD cohort and 46556 patients in the control cohort. Compared to patients in the control cohort, those in the AUD group were more likely to have multiple comorbidities (p < 0.001 for all comorbidities). After adjustment of age, gender, baseline comorbidities, and nonsteroidal anti-inflammatory drug use, the diagnosis of AUD was associated with an increased risk of CKD development (aHR = 1.62, 95% CI, 1.46-1.81). During the mean follow up periods of 6.47 (standard deviation (SD) = 3.80) years for the AUD cohort and 7.23 (SD = 3.75) years for the control cohort, the overall incidence density of CKD was significantly higher in patients with AUD than those in the control cohort (3.48 vs 6.51 per 1000 person-years, aHR = 1.68, 95% CI, 1.50-1.87). Kaplan-Meier analysis showed that the AUD cohort had a higher cumulative incidence of CKD than the control cohort (log-rank test, p value < 0.001). Patients with AUD had higher risks of CKD in all the stratified groups, except for the subgroup with age over 65 years old.
Our study suggested that AUD was associated with an increased incidence of newly diagnosed CKD by nearly two folds. Young age, in particular, had a higher association between AUD and CKD. Considering the preventable nature of AUD, establishing effective health policies is imperative to reduce high-risk alcohol behaviors and thereby prevent alcohol-related kidney disease. Further prospective studies are warranted to further elucidate the causation of AUD on kidney function.
酒精使用障碍（AUD）是一种包括酒精滥用和依赖在内的高风险行为谱。慢性肾脏病（CKD）是指肾功能丧失超过或等于 3 个月或存在任何不可逆转的肾脏损害。已经确定了 CKD 的常见危险因素，但饮酒对肾功能的影响仍存在争议。本研究旨在在全国范围内调查 AUD 与 CKD 之间的关系。
本回顾性队列研究使用了台湾全民健康保险研究数据库。纳入 2000 年至 2013 年年龄在 20 岁或以上、无 CKD 且 AUD 诊断（ICD-9-CM 代码 303.X；305.0，V113）的患者。选择对照队列以匹配目标人群的人口统计学特征。患者随访至 2013 年底或更早，若发生 CKD、死亡或失访。确定基线特征和合并症以进行风险分层。
我们在 AUD 队列中识别出 11639 名患者，在对照队列中识别出 46556 名患者。与对照队列的患者相比，AUD 组的患者更有可能患有多种合并症（所有合并症均<0.001）。在调整年龄、性别、基线合并症和非甾体抗炎药使用后，AUD 的诊断与 CKD 发展风险增加相关（调整后 HR=1.62，95%CI，1.46-1.81）。在 AUD 队列的平均随访期为 6.47 年（标准差[SD]=3.80）和对照队列的 7.23 年（SD=3.75）期间，AUD 组的 CKD 总体发生率明显高于对照组（每 1000 人年 3.48 比 6.51，调整后 HR=1.68，95%CI，1.50-1.87）。Kaplan-Meier 分析显示，AUD 组的 CKD 累积发生率高于对照组（对数秩检验，p 值<0.001）。除年龄>65 岁的亚组外，AUD 组在所有分层组中均有更高的 CKD 风险。
我们的研究表明，AUD 与新诊断 CKD 的发病率增加近两倍有关。尤其是年轻患者，AUD 与 CKD 之间的关联更高。鉴于 AUD 具有可预防性，制定有效的卫生政策对于减少高危饮酒行为从而预防酒精相关性肾脏疾病至关重要。需要进一步的前瞻性研究来进一步阐明 AUD 对肾功能的因果关系。
