Graduate Institute of Medical Science, College of Health Science, Chang Jung Christian University, Tainan, Taiwan.
Department of Pediatrics, Chi Mei Medical Center, Liouying, Tainan, Taiwan.
BMC Nephrol. 2021 Mar 25;22(1):109. doi: 10.1186/s12882-021-02307-z.
Both keratoconus (KCN) and chronic kidney disease (CKD) are multifactorial conditions with multiple aetiologies and share several common pathophysiologies. However, the few studies that have described the relationship between KCN and CKD are limited to case reports and small case series. This study aimed to evaluate the association between KCN and CKD.
The study cohort included 4,609 new-onset keratoconus patients ≥ 12 years identified by the International Classification of Diseases, Ninth Revision, Clinical Modification, code 371.6 and recruited between 2004 and 2011 from the Taiwan National Health Insurance Research Database. The age-, sex-, and comorbidity-matched control group included 27,654 non-KCN patients, selected from the Taiwan Longitudinal Health Insurance Database, 2000. Information for each patient was collected and tracked from the index date until December 2013. The incidence and risk of CKD were compared between the two groups. The adjusted hazard ratios (HRs) for CKD were calculated with Cox proportional hazard regression analysis. Kaplan-Meier analysis was used to calculate the cumulative CKD incidence rate.
The incidence rate of CKD was 1.36 times higher in KCN patients than in controls without statistically significant difference (95 % confidence interval [CI] = 0.99-1.86, p = 0.06). In total, 29 male KCN patients and 90 male controls developed CKD during the follow-up period. The incidence rate of CKD was 1.92 times (95 % [CI] = 1.26-2.91; p = 0.002) higher in male KCN patients than in controls. After adjusting for potential confounders, including age, hypertension, hyperlipidaemia, and diabetes mellitus, male KCN patients were 1.75 times (adjusted HR = 1.75, 95 % [CI] = 1.14-2.68, p < 0.05) more likely to develop CKD.
We found that male KCN patients have an increased risk of CKD. Therefore, it is recommended that male KCN patients should be aware of CKD.
圆锥角膜（KCN）和慢性肾脏病（CKD）均为多因素疾病，具有多种病因，并具有一些共同的病理生理学特征。然而，少数描述 KCN 与 CKD 之间关系的研究仅限于病例报告和小病例系列。本研究旨在评估 KCN 与 CKD 之间的关联性。
研究队列纳入了 2004 年至 2011 年期间通过国际疾病分类，第九修订版，临床修正版代码 371.6 在台湾全民健康保险研究数据库中识别出的≥12 岁的 4609 例新诊断的圆锥角膜患者。并从台湾纵向健康保险数据库 2000 年中选择年龄、性别和合并症相匹配的 27654 例非圆锥角膜患者作为对照组。从索引日期到 2013 年 12 月，收集并跟踪每位患者的信息。比较两组患者 CKD 的发病情况和风险。采用 Cox 比例风险回归分析计算 CKD 的调整后的危险比（HR）。Kaplan-Meier 分析用于计算累积 CKD 发病率。
KCN 患者的 CKD 发病率比对照组高 1.36 倍，但无统计学差异（95%置信区间[CI]：0.99-1.86，p=0.06）。在整个随访期间，共有 29 名男性 KCN 患者和 90 名男性对照者发生 CKD。男性 KCN 患者的 CKD 发病率比对照组高 1.92 倍（95%CI：1.26-2.91；p=0.002）。在调整了年龄、高血压、高血脂和糖尿病等潜在混杂因素后，男性 KCN 患者发生 CKD 的风险是对照组的 1.75 倍（调整后的 HR=1.75，95%CI：1.14-2.68，p<0.05）。
我们发现男性 KCN 患者发生 CKD 的风险增加。因此，建议男性 KCN 患者应注意 CKD。
