Interaction between the stage of chronic kidney disease and diabetes mellitus as factors associated with mortality in chronic kidney disease patients: An external cohort study.

INTRODUCTION: Diabetic kidney disease is the main cause of chronic kidney disease (CKD) worldwide. Both CKD and diabetes mellitus (DMT2) are important risk factors for mortality. However, it is still unknown if the risk of death is modified by the simultaneous presence of these diseases. OBJECTIVE: To evaluate the presence of an interaction between DMT2 and CKD for mortality in a representative population of a Latin American country. METHODS: It is an analytical cohort study of patients with CKD, who were followed for 4 years (between 2004 and 2009). We calculated the incidence rate, progression, survival (using Kaplan-Meier curves), interaction (on the additive and multiplicative scales) and impact of the different stages of CKD in patients with and without DMT2 (using a cox proportional hazards model). RESULTS: In this population of 5663 individuals, both DMT2 and CKD are risk factors for mortality (p<0.001). We found a statistically significant difference in mortality between individuals with and without DMT2, who also had CKD stages 3-4 -5 (Log-rank p=0.0076). Additionally, we found a statistically significant interaction for mortality in both the additive and multiplicative scales between DMT2 and CKD (p=0.005). DMT2 was found to be a risk factor for mortality (Hazard Ratio 1.61 p<0.001), but in individuals with DMT2, the only risks significantly associated with mortality, were age, dyslipidemia and nephroprotective drugs. CONCLUSIóN: The interaction between CKD and DMT2 negatively modifies the risk of death of both diseases. This means that when the two diseases are present, the risk of mortality is lower than expected.

Interaction between the stage of chronic kidney disease and diabetes mellitus as factors associated with mortality in chronic kidney disease patients: An external cohort study. / Interacción entre el estadio de la enfermedad renal crónica y la diabetes mellitus como factores asociados con mortalidad en pacientes con enfermedad renal crónica: un estudio de cohortes externas.

INTRODUCTION: Diabetic kidney disease is the main cause of chronic kidney disease (CKD) worldwide. Both CKD and diabetes mellitus (DMT2) are important risk factors for mortality. However, it is still unknown if the risk of death is modified by the simultaneous presence of these diseases. OBJECTIVE: To evaluate the presence of an interaction between DMT2 and CKD for mortality in a representative population of a Latin American country. METHODS: It is an analytical cohort study of patients with CKD, who were followed for 4 years (between 2004 and 2009). We calculated the incidence rate, progression, survival (using Kaplan-Meier curves), interaction (on the additive and multiplicative scales) and impact of the different stages of CKD in patients with and without DMT2 (using a cox proportional hazards model). RESULTS: In this population of 5663 individuals, both DMT2 and CKD are risk factors for mortality (P < 0.001). We found a statistically significant difference in mortality between individuals with and without DMT2, who also had CKD stages 3 - 4 - 5 (Log-rank P = 0.0076). Additionally, we found a statistically significant interaction for mortality in both the additive and multiplicative scales between DMT2 and CKD (P = 0.005). DMT2 was found to be a risk factor for mortality (Hazard Ratio 1.61 P < 0.001), but in individuals with DMT2, the only risks significantly associated with mortality, were age, dyslipidemia and nephroprotective drugs. CONCLUSIóN: The interaction between CKD and DMT2 negatively modifies the risk of death of both diseases. This means that when the two diseases are present, the risk of mortality is lower than expected.

Interacción entre el estadio de la enfermedad renal crónica y la diabetes mellitus como factores asociados con mortalidad en pacientes con enfermedad renal crónica: un estudio de cohortes externas / Interaction between the stage of chronic kidney disease and diabetes mellitus as factors associated with mortality in chronic kidney disease patients: An external cohort study

Introducción: La enfermedad renal diabética es la principal causa de enfermedad renal crónica (ERC) en el mundo y tanto la diabetes mellitus (DMT2) como la ERC son importantes factores de riesgo para mortalidad. Sin embargo, se desconoce si la presencia simultánea de ambas enfermedades modifica el riesgo de muerte. Objetivo: Evaluar la presencia de interacción entre DMT2 y estadio ERC respecto a la mortalidad en una población representativa de un país latinoamericano. Métodos: Estudio analítico en dos cohortes de pacientes con diagnóstico de ERC con cuatro años de seguimiento entre 2004 y 2008. Se calculó la tasa de incidencia, progresión, supervivencia (Kaplan-Meier), interacción (aditiva y multiplicativa) e impacto de la presencia de los diferentes estadios de ERC en pacientes con y sin DMT2 mediante un análisis de riesgos proporcionales de Cox. Resultados: En esta población de estudio de 5.663 pacientes, tanto la DMT2 como el estadio de ERC son factores de riesgo para mortalidad (p < 0,001). La diferencia en la supervivencia entre diabéticos y no diabéticos en estadios 3 – 4 – 5 fue estadísticamente significativa (Log-rank p = 0,0076). Se encontró una interacción estadísticamente significativa en las escalas aditiva y multiplicativa entre la presencia de DMT2 y el estadio de ERC, con respecto a la mortalidad (p = 0,005). Se confirmó el impacto de la diabetes como factor de riesgo de mortalidad (Hazard Ratio 1,61 p < 0,001), pero en los pacientes con DMT2 solamente la edad, la dislipidemia y los nefroprotectores estuvieron asociados significativamente con la mortalidad. Conclusión: La interacción entre ERC y DMT2 modifica de forma negativa el riesgo de muerte de ambas enfermedades. Es decir que el efecto conjunto observado es menor al esperado. (AU)

Introduction: Diabetic kidney disease is the main cause of chronic kidney disease (CKD) worldwide. Both CKD and diabetes mellitus (DMT2) are important risk factors for mortality. However, it is still unknown if the risk of death is modified by the simultaneous presence of these diseases. Objective: To evaluate the presence of an interaction between DMT2 and CKD for mortality in a representative population of a Latin American country. Methods: It is an analytical cohort study of patients with CKD, who were followed for 4 years (between 2004 and 2009). We calculated the incidence rate, progression, survival (using Kaplan–Meier curves), interaction (on the additive and multiplicative scales) and impact of the different stages of CKD in patients with and without DMT2 (using a cox proportional hazards model). Results: In this population of 5663 individuals, both DMT2 and CKD are risk factors for mortality (P < 0.001). We found a statistically significant difference in mortality between individuals with and without DMT2, who also had CKD stages 3 – 4 – 5 (Log-rank P = 0.0076). Additionally, we found a statistically significant interaction for mortality in both the additive and multiplicative scales between DMT2 and CKD (P = 0.005). DMT2 was found to be a risk factor for mortality (Hazard Ratio 1.61 P < 0.001), but in individuals with DMT2, the only risks significantly associated with mortality, were age, dyslipidemia and nephroprotective drugs. Conclusión: The interaction between CKD and DMT2 negatively modifies the risk of death of both diseases. This means that when the two diseases are present, the risk of mortality is lower than expected. (AU)

Factores de riesgo asociados al desarrollo de pielonefritis aguda entre las gestantes afiliadas a una Empresa Administradora de Planes de Beneficio en cuatro ciudades de Colombia: Estudio de casos y controles / Risk factors associated with acute pyelonephritis in pregnant women, from third-party payer institutions in Colombia, between 2008 and 2012: A case-control study

Objetivo: identificar factores de riesgo relacionados con pielonefritis aguda durante la gestación en las gestantes de Barranquilla, Bogotá, Bucaramanga, Cali y Medellín (Colombia), afiliadas a una empresa administradora de planes de beneficio. Materiales y métodos: estudio de casos y controles, con dos controles por caso. Criterios de selección: gestantes que presentaron parto entre el 1 de enero de 2008 y 31 de diciembre de 2012, en las diferentes instituciones prestadoras de servicios de salud de una empresa administradora de planes de beneficio en Colombia; se excluyeron aquellas con anomalías del tracto urinario. Se definieron como caso aquellas que tenían diagnóstico de pielonefritis aguda durante el embarazo, y como control las gestantes con parto atendido en el mismo periodo, sin diagnóstico de pielonefritis. Los casos fueron seleccionados por conveniencia de manera consecutiva, los controles de manera aleatoria. Se midieron las variables gestacionales, sociodemográficas y las comorbilidades. Se evaluó la asociación con análisis bivariado y multivariado. Resultados: se halló una incidencia de 18 casos de pielonefritis por 10.000 gestantes. El diagnóstico se realizó entre la semana 5 y 38 de gestación, la mayoría durante el segundo (40,2 %) y tercer (48,0 %) trimestre. Ningún caso presentó antecedentes de pielonefritis. Se halló asociación entre pielonefritis aguda y primigestante (OR = 1,94; IC 95 %: 1,13- 3,33), adolescente (OR = 2,85 ; IC 95 %: 1,51-5,40) e infección del tracto urinario previa al embarazo (OR = 2,29; IC 95 %: 1,17-4,44). Conclusión: ser primigestante, adolescente y con antecedente de infección baja del tracto urinario previa al embarazo son factores de riesgo para pielonefritis aguda gestacional.

Objective: To identif y risk factors for the development of acute pyelonephritis in pregnant women in Barranquilla, Bogotá, Bucaramanga, Cali and Medellín (Colombia) covered by a health benefits management organization. Materials and methods: Case-control study with two controls for every case. Selection criteria: pregnant women presenting for delivery between January 1st, 2008 and December 31st, 2012 to the different healthcare institutions of a thrird-party payer. Women with urinary tract abnormalities were excluded. Cases were defined as those diagnosed with acute pyelonephritis during pregnancy. Controls were defined as pregnant women delivered during the same period, not diagnosed with pyelonephritis. Cases were selected consecutively on the basis of convenience, and controls were selected at random. Gestational, social and demographic variables, and comorbidities were measured. Association was assessed using bivariate and multivariate analysis. Results: An incidence of 3.5 cases of acute pye- lonephritis for every 10,000 pregnant women was found. The diagnosis was made between weeks 5 and 38 of gestation, the vast majority during the second (40.2%) and the third (48.0%) trimesters. None of the cases had a history of pyelonephritis. An association was found between acute pyelonephritis, first pregnancy (OR = 1.94; IC 95%: 1.13-3.33), being a teenager (OR = 2.85; IC 95%: 1.51-5.40), and urinary tract infection before pregnancy (OR 2.29; IC 95%: 1.17-4.44). Conclusion: Risk factors for acute gestational pyelonephritis include first pregnancy, being a teenager and having a history of urinary tract infection before pregnancy.