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Open AccessArticle

Long-Term Outcomes in Patients with Incident Chronic Obstructive Pulmonary Disease after Acute Kidney Injury: A Competing-Risk Analysis of a Nationwide Cohort

1
Division of Nephrology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231, Taiwan
2
School of Medicine, Tzu Chi University, Hualien 970, Taiwan
3
Department of Internal Medicine, National Taiwan University Hospital, Taipei 100, Taiwan
4
Department of Internal Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City 242, Taiwan
5
Institute of Population Health Sciences, National Health Research Institutes, Zhunan 350, Taiwan
6
Department of Surgery, National Taiwan University Hospital, National Taiwan University, Taipei 100, Taiwan
*
Author to whom correspondence should be addressed.
These authors contribute equally to this article.
Membership of National Taiwan University Study Group on Acute Renal Failure is provided in the Acknowledgments.
J. Clin. Med. 2018, 7(9), 237; https://doi.org/10.3390/jcm7090237
Received: 18 July 2018 / Revised: 16 August 2018 / Accepted: 17 August 2018 / Published: 24 August 2018
Both acute kidney injury (AKI) and chronic obstructive pulmonary disease (COPD) are associated with increased morbidity and mortality. However, the incidence of de novo COPD in patients with AKI, and the impact of concurrent COPD on the outcome during post-AKI care is unclear. Patients who recovered from dialysis-requiring AKI (AKI-D) during index hospitalizations between 1998 and 2010 were identified from nationwide administrative registries. A competing risk analysis was conducted to predict the incidence of adverse cardiovascular events and mortality. Among the 14,871 patients who recovered from temporary dialysis, 1535 (10.7%) were identified as having COPD (COPD group) one year after index discharge and matched with 1473 patients without COPD (non-COPD group) using propensity scores. Patients with acute kidney disease superimposed withs COPD were associated with a higher risk of incident ischemic stroke (subdistribution hazard ratio (sHR), 1.52; 95% confidence interval (95% CI), 1.17 to 1.97; p = 0.002) and congestive heart failure (CHF; sHR, 1.61; (95% CI), 1.39 to 1.86; p < 0.001). The risks of incident hemorrhagic stroke, myocardial infarction, end-stage renal disease, and mortality were not statistically different between the COPD and non-COPD groups. This observation adds another dimension to accumulating evidence regarding pulmo-renal consequences after AKI. View Full-Text
Keywords: acute kidney injury; chronic obstructive pulmonary disease; congestive heart failure; stroke acute kidney injury; chronic obstructive pulmonary disease; congestive heart failure; stroke
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Wu, C.-H.; Chang, H.-M.; Wang, C.-Y.; Chen, L.; Chen, L.-W.; Lai, C.-H.; Kuo, S.-W.; Wang, H.-C.; Wu, V.-C.; The National Taiwan University Study Group on Acute Renal Failure. Long-Term Outcomes in Patients with Incident Chronic Obstructive Pulmonary Disease after Acute Kidney Injury: A Competing-Risk Analysis of a Nationwide Cohort. J. Clin. Med. 2018, 7, 237.

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