title: Lower Incidence of End-Stage Renal Disease but Suboptimal Pre-Dialysis Renal Care in Schizophrenia: A 14-Year Nationwide Cohort Study.
abstract: Schizophrenia is closely associated with cardiovascular risk factors which are consequently attributable to the development of chronic kidney disease and end-stage renal disease (ESRD). However, no study has been conducted to examine ESRD-related epidemiology and quality of care before starting dialysis for patients with schizophrenia. By using nationwide health insurance databases, we identified 54,361 ESRD-free patients with schizophrenia and their age-/gender-matched subjects without schizophrenia for this retrospective cohort study (the schizophrenia cohort). We also identified a cohort of 1,244 adult dialysis patients with and without schizophrenia (1:3) to compare quality of renal care before dialysis and outcomes (the dialysis cohort). Cox proportional hazard models were used to estimate the hazard ratio (HR) for dialysis and death. Odds ratio (OR) derived from logistic regression models were used to delineate quality of pre-dialysis renal care. Compared to general population, patients with schizophrenia were less likely to develop ESRD (HR = 0.6; 95% CI 0.4-0.8), but had a higher risk for death (HR = 1.2; 95% CI, 1.1-1.3). Patients with schizophrenia at the pre-ESRD stage received suboptimal pre-dialysis renal care; for example, they were less likely to visit nephrologists (OR = 0.6; 95% CI, 0.4-0.8) and received fewer erythropoietin prescriptions (OR = 0.7; 95% CI, 0.6-0.9). But they had a higher risk of hospitalization in the first year after starting dialysis (OR = 1.4; 95% CI, 1.0-1.8, P < .05). Patients with schizophrenia undertaking dialysis had higher risk for mortality than the general ESRD patients. A closer collaboration between psychiatrists and nephrologists or internists to minimize the gaps in quality of general care is recommended.
authors.affiliation: Department of Public Health and Department of Health Services Administration, China Medical University, Taichung City, Taiwan; Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City, Taiwan; Department of Nursing, Min-Hwei College of Health Care Management, Tainan City, Taiwan.
authors.forename: Yueh-Han
authors.initials: YH
authors.lastname: Hsu
authors.affiliation: Clinical Informatics and Medical Statistics Research Center, College of Medicine, Chang Gung University, Taoyuan City, Taiwan.
authors.forename: Jur-Shan
authors.initials: JS
authors.lastname: Cheng
authors.affiliation: Department of Psychiatry, Changhua Christian Hospital and Changhua Christian Healthcare System, Changhua, Taiwan; Lutung Christian Hospital, Changhua, Taiwan; Department of Nursing, College of Medicine and Life Science, Chung Hwa University of Medical Technology, Tainan, Taiwan; Department of Psychiatry, Kaohsiung Medicine University, Kaohsiung, Taiwan.
authors.forename: Wen-Chen
authors.initials: WC
authors.lastname: Ouyang
authors.affiliation: Taipei City Hospital Fuyou Branch; Taipei, Taiwan.
authors.forename: Chen-Li
authors.initials: CL
authors.lastname: Lin
authors.affiliation: Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County, Taiwan.
authors.forename: Chi-Ting
authors.initials: CT
authors.lastname: Huang
authors.affiliation: Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County, Taiwan; Department of Health Services Administration, China Medical University, Taichung City, Taiwan.
authors.forename: Chih-Cheng
authors.initials: CC
authors.lastname: Hsu
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012559:Schizophrenia / Q000150:complications*; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult