慢性腎臟疾病與上泌尿道癌之關聯-以全國人口為基礎的世代研究
陳建升1、呂瑾立2,3、黃立中4、沈正煌5、陳志成2,6
衛生福利部新營醫院泌尿科1；國立成功大學醫學院公衛所2；嘉義基督教醫院醫學研究部3；嘉義基督教醫院精神科4；嘉義基督教醫院泌尿科5；嘉義基督教醫院小兒科6
Chronic kidney disease is associated with upper tract urothelial carcinoma – A nationwide population-based cohort study in Taiwan
Jeng-Sheng Chen1, Chin-Li Lu2,3, Li-Chung Huang4, Cheng-Huang Shen5 and Solomon Chih-Cheng Chen2,6
1 Department of Urology, Sinying Hospital, Ministry of Health and Welfare, Sinying, Taiwan;2 Department of Medical Research, Ditmanson Chia-Yi Christian Hospital, Chia-Yi, Taiwan; 3 Department of Public Health, Medical College, National Cheng-Kung University, Tainan, Taiwan; 4 Department of Psychiatric, Ditmanson Chia-Yi Christian Hospital, Chia-Yi, Taiwan; 5. Department of Urology, Ditmanson Chia-Yi Christian Hospital, Chia-Yi, Taiwan; 6. Department of Pediatrics, Ditmanson Chia-Yi Christian Hospital, Chia-Yi, Taiwan.
Purpose: Increased urinary tract malignancy has been reported in end-stage renal disease (ESRD). However, little is known about chronic kidney disease (CKD). This study is designed to explore the association between CKD and upper tract urothelial carcinoma (UTUC).
Materials and Methods: Using Taiwan’s Longitudinal Health Insurance Database, we studied CKD patients between January 2000 and December 2011. The non-CKD controls were selected at a ratio of 4:1 and frequency matched by gender, age group and index date. We used Chi-square test and t-test to analyze the sociodemographic information and comorbidities. Cox regression analysis was used to calculate the hazard ratio (HR) and 95% confidence interval (CI).
Results: The selected cases included 45,321 CKD cases and 181,284 controls. A significantly higher incidence of UTUC was noted in the CKD group (0.22% vs. 0.07%, p<0.001). In univariate analysis, CKD, female gender, age, hypertension, hematuria, repeated urinary tract infection, bladder cancer and ESRD were all associated with UTUC. In multivariate analysis, only CKD, female gender, age, hematuria, bladder cancer and ESRD were significantly associated. The HR for CKD was 1.63 (95% CI: 1.26-2.13). Females had a higher HR of 1.38 (95% CI: 1.11-1.71). After excluding those patients who progressed to dialysis or kidney transplantation, the risk for CKD was still high, with a HR of 1.72 (95% CI: 1.33-2.33).
Conclusions: CKD is a significant factor associated with UTUC. We should pay attention to the possibility of UTUC for CKD patients before they progress to ESRD.