Reduced risk of new onset stroke after kidney transplantation in Asian dialysis patients: a propensity score-matched, competing risk study in Taiwan.

BACKGROUND: Kidney transplantation (KT) has been found to reduce cardiovascular events and mortality in chronic dialysis patients. There is little data, however, regarding the risk reduction of cerebrovascular events after KT in Asian populations. This study evaluates the risk of cerebrovascular events after KT in Taiwan. METHODS: Tapping Taiwan's National Health Insurance claims data of patients with a diagnosis of end-stage renal disease (ESRD), we enrolled all KT recipients from 1999 to 2011 (n = 2908). For each KT patient, four controls (patients also diagnosed with ESRD) without KT were propensity matched by birth date, sex, selected comorbidities and duration of dialysis. All subjects were followed to the end of 2011. RESULTS: The incidence rate for stroke in the KT recipients and comparison group were 52.63 and 137.26 per 10 000 person-years, respectively. After adjustment for age, gender and comorbidities with competing mortality, KT recipients had 60% reduction in all kinds of stroke, compared to those who did not receive procedure. They were found to have a 48 and 74% reduction in ischemic and hemorrhagic stroke risk, respectively. Subgroup analyses also showed similar trends in the improvement of stroke after KT. While elderly patients, men, and those with diabetes, hypertension and coronary artery disease are at increased risk for stroke, our log-rank test revealed those that received KT had significantly lower cumulative incidence rates of stroke than those that did not (P < 0.001). CONCLUSIONS: KT was associated with reduced risk of new onset stroke in chronic dialysis patients in Taiwan.

Long-term risk of stroke in type 2 diabetes patients with diabetic ketoacidosis: A population-based, propensity score-matched, longitudinal follow-up study.

AIM: To investigate the long-term risk of stroke in type 2 diabetes (T2D) patients with previous episodes of diabetic ketoacidosis (DKA). METHODS: This retrospective nationwide population-based cohort study was conducted using Taiwan's National Health Insurance database. Claims data from 2000 to 2002 were extracted for 3572 T2D patients with DKA and 7144 controls matched for age, gender, diabetes complications severity index, frequency of clinical visits and baseline comorbidities. Patients with type 1 diabetes (T1D), identified by glucagon C-peptide stimulation or glutamic acid decarboxylase (GAD) antibody blood tests and possession of a catastrophic illness certificate were excluded. All patients were tracked until a new stroke diagnosis, death or the end of 2011. RESULTS: Of the 3572 selected patients, 270 with DKA and 404 of the 7144 controls were diagnosed with a new stroke, giving an incidence rate ratio (IRR) of 1.56 (95% CI: 1.34-1.82; P<0.0001). DKA patients had a higher risk of ischaemic stroke than those without DKA (IRR: 1.62, 95% CI: 1.34-1.96; P<0.0001), and DKA patients with hypertension and hyperlipidaemia were at even greater risk of stroke. Also, DKA patients were at particular risk for stroke during the first half-year following DKA diagnosis. After adjusting for patient characteristics and comorbidities, these patients were 1.55 times more likely to have a stroke than those without DKA (95% CI: 1.332-1.813, P<0.0001). CONCLUSION: T2D patients with previous DKA have a higher risk of stroke, especially ischaemic strokes.

Hyperthyroidism and thyroid cancer risk: a population-based cohort study.

AIM: Thyroid hormones regulate the rate of metabolism and affect the differentiation and growth of many tissues in the body. We investigated the association between hyperthyroidism and cancer risk in Taiwan. PATIENTS AND METHODS: A random sample of 1 000 000 individuals from Taiwan's National Health Insurance database was enrolled. We found 17 033 patients to have newly diagnosed hyperthyroidism between 2000 and 2005. These patients were recruited along with a match cohort of 34 066 patients without hyperthyroidism. Starting from index date, we followed up all patients for 4 years to identify those who developed cancer. RESULTS: During the 4-year follow-up study, cancer was diagnosed in 1.23% of patients with hyperthyroidism and 1.02% of the member of the comparison cohort. Regression analysis showed that patients with hyperthyroidism were at greater risk of cancer incidence, especially thyroid cancer, compared the comparison cohort (HR: 1.213; 95% CI: 1.022-1.440; p<0.05 and HR: 7.355; 95% CI: 3.885-13.92; p<0.05, respectively). After adjusting for age, gender, diabetes mellitus, hypertension, hyperlipidemia, gout, geographic region, and income, patients with hyperthyroidism remained at increased risk of cancer incidence and thyroid cancer (Adjusted HR: 1.206; 95% CI: 1.015-1.433 and 6.803; 95% CI: 3.584-12.91, respectively) (both p<0.05). The longer the duration of hyperthyroidism, the greater the risk of thyroid cancer. CONCLUSIONS: This 4-year follow up study suggests that patients with hyperthyroidism are at increased risk of cancer, especially thyroid cancer.

Triglycerides are independently associated with albuminuria in Taiwanese Type 2 diabetic patients.

BACKGROUND: Lipid abnormalities in albuminuria in patients with Type 2 diabetes differ by race. AIM: To perform a biochemical investigation of association between dyslipidemia and albuminuria in Type 2 diabetes in Taiwan. MATERIALS/ SUBJECTS AND METHODS: We recruited a total of 2349 Chinese patients with Type 2 diabetes from two medical centers in Taiwan over a 1-yr period. Patients were categorized into those with normoalbuminuria, microalbuminuria, and macroalbuminuria defined as albumin-to-creatinine ratio of <30, 30- 299, and ≥300 µg/mg. We then investigated the significance of the clinical and biochemical parameters and risk of albuminuria. RESULTS: We found significant differences in total cholesterol (TC) between those with normoalbuminuria and micro/ macroalbuminuria, no significant difference in LDL cholesterol (LDL-C) among the 3 subgroups, a significant difference in HDL cholesterol (HDL-C) between those with normoalbuminuria and macroalbuminuria, and significant increases in triglyceride (TG) paralleling increases in albuminuria. TG was found by logistic regression to be significantly associated with micro/macroalbuminuria in our unadjusted model [odds ratio (OR) = 1.859 (1.596~2.165)], and remained significant after adjusting for various confounders [OR = 1.415 (1.123~1.784)]. Increases in albuminuria paralleled quartile increases in serum TG (p<0.001). CONCLUSIONS: We conclude that TG increases significantly throughout the 3 stages of albuminuria in Taiwanese Type 2 diabetic patients, but TC, HDL-C, and LDL-C do not.

The relationship between diabetic autonomic neuropathy and diabetic risk factors in a Taiwanese population.

This study looked at spectral analysis of heart rate variability (HRV) between patients with type 2 diabetes mellitus (DM) and healthy controls. The association between diabetic autonomic neuropathy (DAN) with HRV parameter changes and DM risk factors (including nephropathy) was investigated. HRV parameters were compared between 271 patients with DM and 160 controls. A statistically significant difference was found between the two groups for each parameter. Patients with DM were then divided into three groups by the levels of individual risk factors: body mass index, total cholesterol, 2-h postprandial plasma glucose concentration, glycosylated haemoglobin, duration of DM and the albumin-creatinine ratio. HRV parameters decreased significantly in patients with DM as the risk factor level progressed. This study identified previously known and new potential risk factors for the development of DAN, which may be important for the development of risk reduction strategies.