title: Long-term renal outcomes in patients with traumatic brain injury: A nationwide population-based cohort study.
abstract: BACKGROUND
  Traumatic brain injury (TBI) is an important cause of death and disability worldwide. The relationship between TBI and kidney diseases is largely unknown.
  
  
  METHODS
  We aimed to determine whether TBI is associated with long-term adverse renal outcomes. We performed a nationwide, population-based, propensity score-matched cohort study of 32,152 TBI patients and 128,608 propensity score-matched controls. Data were collected by the National Health Insurance Research Database of Taiwan from 2000 to 2012. Our clinical outcomes were chronic kidney disease (CKD), end-stage renal disease (ESRD) and the composite endpoint of ESRD or all-cause mortality.
  
  
  RESULTS
  The incidence rate of CKD was higher in the TBI than in the control cohort (8.99 vs. 7.4 per 1000 person-years). The TBI patients also showed higher risks of CKD (adjusted hazard ratio [aHR] 1.14, 95% confidence interval [CI] 1.08-1.20; P < 0.001) and composite endpoints (aHR 1.08, 95% CI 1.01-1.15; P = 0.022) than the control groups, but the ESRD was not significantly different between the groups. In subgroup analyses, the risks of incident CKD and composite endpoints were significantly raised in TBI patients aged < 65 years and/or without comorbidities. However, the risks of both CKD and composite outcome were little affected by the severity of TBI.
  
  
  CONCLUSIONS
  TBI has a modest but significant effect on incident CKD and composite endpoint, but not on ESRD alone. TBI patients under 65 are at greater risk of CKD and composite outcome than their older counterparts.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan.|School of Medicine, Chung-Shan Medical University, Taichung, Taiwan.|Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.|Internal Medicine Research Center, Changhua Christian Hospital, Changhua, Taiwan.|Environmental and Precision Medicine Laboratory, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Chia-Lin
authors.identifier: http://orcid.org/0000-0001-6045-6956
authors.initials: CL
authors.lastname: Wu
authors.affiliation: Internal Medicine Research Center, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Chew-Teng
authors.initials: CT
authors.lastname: Kor
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan.|School of Medicine, Chung-Shan Medical University, Taichung, Taiwan.|Internal Medicine Research Center, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Ping-Fang
authors.initials: PF
authors.lastname: Chiu
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan.|School of Medicine, Chung-Shan Medical University, Taichung, Taiwan.
authors.forename: Chun-Chieh
authors.initials: CC
authors.lastname: Tsai
authors.affiliation: Graduate Institute of Statistics and Information Science, National Changhua University of Education, Changhua, Taiwan.
authors.forename: Ie-Bin
authors.initials: IB
authors.lastname: Lian
authors.affiliation: Internal Medicine Research Center, Changhua Christian Hospital, Changhua, Taiwan.|Environmental and Precision Medicine Laboratory, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Tao-Hsiang
authors.initials: TH
authors.lastname: Yang
authors.affiliation: Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.|Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.|Institute of Physiology, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Der-Cherng
authors.initials: DC
authors.lastname: Tarng
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan.|School of Medicine, Chung-Shan Medical University, Taichung, Taiwan.|Internal Medicine Research Center, Changhua Christian Hospital, Changhua, Taiwan.|Environmental and Precision Medicine Laboratory, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Chia-Chu
authors.initials: CC
authors.lastname: Chang
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000070642:Brain Injuries, Traumatic / Q000150:complications* / Q000401:mortality*; D005260:Female; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000209:etiology* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology