Department of Medical Research, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan.
Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
PLoS One. 2022 Aug 26;17(8):e0273646. doi: 10.1371/journal.pone.0273646. eCollection 2022.
Diabetes mellitus (DM) is an important risk factor in patients with end-stage renal disease (ESRD). DM is associated with the development of cardiovascular diseases, such as atrial fibrillation (AF), due to poor glycemic control. However, few studies have focused on the risk of developing ESRD among DM patients with and without AF. This study evaluated ESRD risk among DM patients with and without AF in Taiwan. Data were retrieved from one million patients randomly sampled from Taiwan's National Health Insurance Research Database, including 6,105 DM patients with AF propensity score-matched with 6,105 DM patients without AF. Both groups were followed until death, any dialysis treatment, or December 31, 2013, whichever occurred first. AF was diagnosed by a qualified physician according to the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), using the diagnostic code 427.31. Patients aged <20 years or diagnosed with ESRD before the index date were excluded. A Cox proportional hazard regression model was used to calculate the relative ESRD risk. Among DM patients, those with AF have more comorbidities than those without AF. We also found a 1.18-fold (95% confidence interval [CI]: 1.01-1.46) increase in ESRD risk among patients with AF compared with those without AF. In addition, DM patients with hypertension, chronic kidney disease (CKD), or higher Charlson Comorbidity Index scores also have significantly increased ESRD risks than those without these complications. A 1.39-fold (95% CI: 1.04-1.86) increase in risk was observed for patients with AF among the non-CKD group. Our findings suggest that patients with DM should be closely monitored for irregular or rapid heart rates.
糖尿病（DM）是终末期肾病（ESRD）患者的一个重要危险因素。由于血糖控制不佳，DM 与心血管疾病的发生有关，如心房颤动（AF）。然而，很少有研究关注 DM 患者中有无 AF 的 ESRD 发病风险。本研究评估了台湾地区 DM 患者中有无 AF 的 ESRD 发病风险。数据来自台湾全民健康保险研究数据库的 100 万名患者随机抽样，包括 6105 例有 AF 倾向的 DM 患者和 6105 例无 AF 的 DM 患者，进行倾向性评分匹配。两组患者均随访至死亡、任何透析治疗或 2013 年 12 月 31 日，以先发生者为准。AF 由合格医师根据国际疾病分类，第 9 版，临床修订版（ICD-9-CM），使用诊断代码 427.31 进行诊断。排除年龄<20 岁或指数日期前诊断为 ESRD 的患者。使用 Cox 比例风险回归模型计算相对 ESRD 风险。在 DM 患者中，AF 患者比无 AF 患者有更多的合并症。我们还发现，与无 AF 患者相比，AF 患者的 ESRD 风险增加了 1.18 倍（95%置信区间 [CI]：1.01-1.46）。此外，患有高血压、慢性肾脏病（CKD）或更高 Charlson 合并症指数评分的 DM 患者与无这些并发症的患者相比，ESRD 风险显著增加。在非 CKD 组中，AF 患者的风险增加了 1.39 倍（95%CI：1.04-1.86）。我们的研究结果表明，DM 患者应密切监测不规则或快速的心率。
