Association Between Helicobacter pylori Infection and the Subsequent Risk of End-Stage Renal Disease: A Nationwide Population-Based Cohort Study

S.-Y. Lin; C.-L. Lin; J.-H. Liu; Y.-F. Yang; C.-C. Huang; C.-H. Kao

Disclosures

Int J Clin Pract. 2015;69(5):604-610. 

In This Article

Abstract and Introduction

Abstract

Background & Aims The association between Helicobacter pylori infection and end-stage renal disease (ESRD) events remains unknown. We assessed the relationship between H. pylori infection requiring hospital admission and the subsequent risks of ESRD.

Methods This was a retrospective cohort study in which data from the National Health Insurance system of Taiwan was used. The H. pylori-infected cohort comprised 20,068 patients. Each participant was frequency-matched by age and sex with 4 individuals from the general population without H. pylori-infected. Cox proportional hazards regression analysis was used to estimate the influence of H. pylori infection on the risk of ESRD.

Results The overall incidence of ESRD was 3.72 times greater in the H. pylori-infected cohort than in the non-infected cohort (11.1 vs. 2.96 per 1000 person-years), with an adjusted HR of 2.58 [95% confidence interval (CI) = 2.33–2.86]. The risk of ESRD markedly increased in patients with H. pylori infection combined with at least one of the following concomitant comorbidities: hypertension, diabetes, hyperlipidaemia and coronary artery disease.

Conclusions This is currently the largest nation-based study in which the risk of ESRD in H. pylori-infected patients was examined. H. pylori infection was associated with a subsequent risk of ESRD. H. pylori-infected patients with concomitant chronic kidney disease (CKD) or cardiovascular disease (CVD) risk factors were at higher risk of ESRD than were those who had a single CKD or CVD risk factor.

Introduction

Helicobacter pylori, a gram-negative spiral rod, inhabits mucus adherent to gastric mucosa. H. pylori infections affect more than 50% of the global population, and are implicated in the pathogenesis of many gastrointestinal diseases.[1] Numerous studies have demonstrated that H. pylori infection is closely associated with chronic gastritis, peptic ulcer, gastric cancer, hyperplastic polyps and mucosa-associated lymphoid tissue lymphoma.[2–5] Therefore, eradicating H. pylori infections has become a goal for preventing several gastrointestinal sequelae (i.e. recurrence of peptic ulcers, gastric cancer and MALT lymphoma).[6–8]

Epidemiological studies have also revealed a link between H. pylori infection and extragastric diseases, particularly those associated with low-grade systemic inflammation, including ischaemic heart diseases, modified lipid profiles, insulin resistance, neurodegenerative diseases and hematologic disorders.[8–11] Despite the recognised influence of H. pylori infections on organs other than the stomach, no definitive evidence linking H. pylori infections with a decline in renal function has been presented.

Previous studies have reported that patients with chronic kidney disease (CKD) or end-stage renal disease (ESRD) exhibit a low prevalence rate of H. pylori infection.[12,13] Sugimoto et al. assumed that uraemic milieu and dialysis itself lead to severe inflammation and progressive gastric atrophy, preventing H. pylori from residing in the gastric mucosa.[14] However, the backward causal relationship between H. pylori infection and CKD or ESRD has not been elucidated to date. Because the effect of ESRD on individual health and economic cost is substantial, conducting a population-based retrospective cohort study to determine whether H. pylori infection could be a risk factor for developing ESRD is worthwhile.

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