Increased risk of end-stage renal disease in patients with systemic sclerosis

Abstract

Objective

Systemic sclerosis (SSc) is a systemic autoimmune disease affecting multiple organs, including the kidneys. There is a lack of long-term renal prognosis studies on patients with SSc. The aim of this study was to assess the risk of end-stage renal disease (ESRD) in patients with SSc.

Method

We designed a prospective cohort study based on the National Health Insurance Research Database of Taiwan. Patients with SSc and a non-SSc control group were selected from 1 January 2000 to 31 December 2013. The SSc cohort and control group were matched on the propensity score in a 1:2 ratio. The primary outcome was development of ESRD. Cox proportional hazard regression was performed to assess the effects of SSc on ESRD.

Results

After propensity score matching, we enrolled 2012 patients in the SSc group and 4024 patients in the control group. During a mean follow-up of 6.5 years, 86 individuals [SSc group, n = 41 (2.04%); control group, n = 45 (1.12%)] had developed ESRD. The risk of ESRD in the SSc group was approximately two times higher than that in the control group [hazard ratio (HR) = 2.12, 95% confidence interval (CI) 1.39–3.24]. Subgroup analysis revealed that the higher risk of ESRD was predominantly in males (HR = 4.14, 95% CI 1.97–8.71) and the younger population (HR = 7.09, 95% CI 2.31–21.80).

Conclusion

There was a significantly higher risk of ESRD among SSc patients than among the general population, with males and younger generations being the most vulnerable groups.

Acknowledgements

We would like to thank the Taiwan Health Insurance Bureau for providing an NHIRD for analysis, and Alfred Hsing-Fen Lin for his help in drawing the figures.

This study was supported by Chang Gung Memorial Hospital [grant number CMRPG8G0501].

Disclosure statement

No potential conflict of interest was reported by the authors.

Supporting information

Additional Supporting Information may be found in the online version of this article.

Supplementary Figure 1. The probability of survival between systemic sclerosis (SSc) and controls.

Supplementary Figure 2. The probability of survival after end-stage renal disease (ESRD).

Supplementary Table 1. ICD-9-CM code used in the current study.

Supplementary Table 2. Subgroup analysis of risk for ESRD.

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