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

ABSTRACT: Background:The 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. Methods:This 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. Results:The 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). Conclusions:Appendectomy increases the risk of developing CKD and ESRD, especially in diabetic patients. Physicians should pay close attention to renal function prognosis in appendectomy patients.

SUBMITTER: Chang CH

PROVIDER: S-EPMC6004103 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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

Chang Chin-Hua CH Kor Chew-Teng CT Wu Chia-Lin CL Chiu Ping-Fang PF Li Jhao-Rong JR Tsai Chun-Chieh CC Chang Teng-Hsiang TH Chang Chia-Chu CC

PeerJ 20180613

<h4>Background</h4>The 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.<h4>Met ...[more]

PMID: 29915707

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Project description:OBJECTIVE:To determine ethnic differences in the progression of chronic kidney disease (CKD) and risk of end-stage renal failure (ESRF) and death in adults with type 2 diabetes mellitus (T2DM), and to identify predictors of rapid renal decline. DESIGN:Observational community-based cohort study undertaken from 2006 to 2016 with nested case-control study. SETTING:135 inner London primary care practices contributing to the east London Database. PARTICIPANTS:General practice-registered adults aged 25-85 years with established T2DM and CKD at baseline. OUTCOMES:The annual rate of renal decline was compared between white, south Asian and black groups, and stratified by proteinuria and raised blood pressure (BP) at baseline. Predictors of rapid renal decline were identified in a nested case-control study. Cox proportional hazards regression was used to determine ethnic differences in the risk of ESRF and death. RESULTS:Age-sex adjusted annual decline was greatest in the Bangladeshi population. There was stepwise increase in the rate of decline when stratifying the cohort by baseline proteinuria and BP control, with south Asian groups being most sensitive to the combined effect of proteinuria and raised BP after accounting for key confounders.The odds of rapid renal decline were increased for individuals of Bangladeshi, African and Caribbean ethnicity, those with hypertension, proteinuria, cardiovascular disease and with increasing duration of diabetes. Rapid progression was more frequent in younger age groups. Risk of developing ESRF was highest in the black group compared with the white group (HR 1.88, 95%?CI 1.11 to 3.19). Risk of death from any cause was 29% lower in the south Asian group compared with the white group (HR 0.71, 95%?CI 0.56 to 0.91). CONCLUSIONS:Proteinuria and hypertension trigger accelerated estimated glomerular filtration rate decline differentially by ethnicity. Active monitoring of younger adults, who have greater odds of rapid progression and the most to gain from interventions, is essential.

Dataset Information

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

Publications

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

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