title: Risk factors and their interaction on chronic kidney disease: A multi-centre case control study in Taiwan.
abstract: BACKGROUND
  Chronic kidney disease (CKD) is highly prevalent in Taiwan. More than two-thirds of end-stage renal disease is associated with diabetes mellitus (DM) or hypertension (HTN). Therefore, the formulation of a special preventative policy of CKD in these patients is essential. This study surveyed 14 traditional risk factors and identified their effects on CKD in patients with HTN/DM and compared these with their effects in the general population.
  
  
  METHODS
  This study included 5328 cases and 5135 controls in the CKD/HTN/DM outpatient and health centres of 10 hospitals from 2008 to 2010. Fourteen common effect factors were surveyed (four demographic, five disease and five lifestyle), and their effects on CKD were tested. Significance tests were adjusted by the Bonferroni method. Results of the stratified analyses in the variables were presented with significant heterogeneity between patients with different comorbidities.
  
  
  RESULTS
  Male, ageing, low income, hyperuricemia and lack of exercise habits were risk factors for CKD, and their effects in people with different comorbidities were identical. Anaemia was a risk factor, and there was an additive effect between anaemia and HTN on CKD. Patients with anaemia had a higher risk when associated with HTN [odds ratio (OR) = 6.75, 95% confidence limit (95% CI) 4.76-9.68] but had a smaller effect in people without HTN (OR 2.83, 95% CI 2.16-3.67). The association between hyperlipidaemia-related factors and CKD was also moderated by HTN. It was a significant risk factor in people without HTN (OR = 1.67, 95% CI 1.38-2.01) but not in patients with HTN (OR =1.03, 95% CI 0.89-1.19). Hepatitis B, hepatitis C, betel nut chewing, smoking, alcohol intake and groundwater use were not associated with CKD in multivariate analysis.
  
  
  CONCLUSIONS
  We considered that patients with HTN and anaemia were a high CKD risk population. Physicians with anaemic patients in outpatient clinics need to recognise that patients who also have HTN might be latent CKD cases.
authors.affiliation: School of Public Health, National Defense Medical Center, Taipei, Taiwan. a131419@gmail.com.
authors.forename: Sui-Lung
authors.initials: SL
authors.lastname: Su
authors.affiliation: Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan. xup6fup@hotmail.com.
authors.forename: Chin
authors.initials: C
authors.lastname: Lin
authors.affiliation: School of Public Health, National Defense Medical Center, Taipei, Taiwan. kao@mail.ndmctsgh.edu.tw.
authors.forename: SenYeong
authors.initials: S
authors.lastname: Kao
authors.affiliation: Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan. wucc@mail.ndmctsgh.edu.tw.
authors.forename: Chia-Chao
authors.initials: CC
authors.lastname: Wu
authors.affiliation: Division of Nephrology, Department of Medicine, Cardinal Tien Hospital, School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan. kuochenglu@gmail.com.
authors.forename: Kuo-Cheng
authors.initials: KC
authors.lastname: Lu
authors.affiliation: School of Public Health, National Defense Medical Center, Taipei, Taiwan. lgh@mail.ndmctsgh.edu.tw.
authors.forename: Ching-Huang
authors.initials: CH
authors.lastname: Lai
authors.affiliation: School of Public Health, National Defense Medical Center, Taipei, Taiwan. b262728@gmail.com.
authors.forename: Hsin-Yi
authors.initials: HY
authors.lastname: Yang
authors.affiliation: School of Public Health, National Defense Medical Center, Taipei, Taiwan. long_ruth0624@mail.ndmctsgh.edu.tw.
authors.forename: Yu-Lung
authors.initials: YL
authors.lastname: Chiu
authors.affiliation: Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan. dgschen@ndmctsgh.edu.tw.
authors.forename: Jin-Shuen
authors.initials: JS
authors.lastname: Chen
authors.affiliation: School of Public Health, Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan. fcsung@mail.cmu.edu.tw.
authors.forename: Fung-Chang
authors.initials: FC
authors.lastname: Sung
authors.affiliation: School of Public Health, Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan. ycko@mail.cmu.edu.tw.
authors.forename: Ying-Chin
authors.initials: YC
authors.lastname: Ko
authors.affiliation: Division of Nephrology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung Medical University, Kaohsiung, Taiwan. chientel@gmail.com.
authors.forename: Chien-Te
authors.initials: CT
authors.lastname: Lee
authors.affiliation: The Division of Nephrology, Changhua Christian Hospital, Changhua, Taiwan. 2219@cch.org.tw.
authors.forename: Yu
authors.initials: Y
authors.lastname: Yang
authors.affiliation: School of Medicine, Chang Gung University, Taoyuan, Taiwan. cwyang@adm.cgmh.org.tw.
authors.forename: Chih-Wei
authors.initials: CW
authors.lastname: Yang
authors.affiliation: Division of Nephrology, Department of Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. sjhwang@kmu.edu.tw.
authors.forename: Shang-Jyh
authors.initials: SJ
authors.lastname: Hwang
authors.affiliation: Department of internal Medicine, Cheng Kung University Medicial Center, Tainan, Taiwan. wangmc@mail.ncku.edu.tw.
authors.forename: Ming-Cheng
authors.initials: MC
authors.lastname: Wang
authors.affiliation: Division of Nephrology, Department of Medicine, Shuang Ho Hospital, Graduate Institute of Clinical Medicine, Taipei Medical University, No. 250, Wuxing St., Xinyi District, Taipei, 110, Taiwan. yhhsu@tmu.edu.tw.
authors.forename: Yung-Ho
authors.initials: YH
authors.lastname: Hsu
authors.affiliation: Division of Nephrology, Department of Medicine, Shuang Ho Hospital, Graduate Institute of Clinical Medicine, Taipei Medical University, No. 250, Wuxing St., Xinyi District, Taipei, 110, Taiwan. e220121@gmail.com.
authors.forename: Mei-Yi
authors.initials: MY
authors.lastname: Wu
authors.affiliation: School of Public Health, Taipei Medical University, No. 250, Wuxing St., Xinyi District, Taipei, 110, Taiwan. ymhsueh@tmu.edu.tw.
authors.forename: Yu-Mei
authors.initials: YM
authors.lastname: Hsueh
authors.affiliation: School of Public Health, Taipei Medical University, No. 250, Wuxing St., Xinyi District, Taipei, 110, Taiwan. hychiou@tmu.edu.tw.
authors.forename: Hung-Yi
authors.initials: HY
authors.lastname: Chiou
authors.affiliation: Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan. linyf@s.tmu.edu.tw.|Division of Nephrology, Department of Medicine, Shuang Ho Hospital, Graduate Institute of Clinical Medicine, Taipei Medical University, No. 250, Wuxing St., Xinyi District, Taipei, 110, Taiwan. linyf@s.tmu.edu.tw.
authors.forename: Yuh-Feng
authors.initials: YF
authors.lastname: Lin
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology; D000740:Anemia / Q000453:epidemiology*; D001114:Areca; D016022:Case-Control Studies; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D060587:Groundwater; D006509:Hepatitis B / Q000453:epidemiology; D006526:Hepatitis C / Q000453:epidemiology; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology; D006973:Hypertension / Q000453:epidemiology*; D033461:Hyperuricemia / Q000453:epidemiology*; D007182:Income / Q000706:statistics & numerical data*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology*; D012307:Risk Factors; D057185:Sedentary Behavior; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology; D013624:Taiwan / Q000453:epidemiology