Increased Risk of Parkinson's Disease in Patients with End-Stage Renal Disease: A Retrospective Cohort Study

Abstract

Background: Studies on dyskinesia and Parkinson's syndrome associated with chronic kidney disease or end-stage renal disease (ESRD) have been mainly limited to case reports or case series studies. This population-based study investigated the risk of Parkinson's disease in patients with ESRD. Methods: From a universal insurance claims database of Taiwan, we established a cohort of 8,325 adults with newly diagnosed ESRD from 1997 to 2010 without a history of Parkinson's disease. A control cohort of 33,382 insured subjects without a history of kidney disease or Parkinson's disease was also selected, with frequency matched for age, sex and index date of the patients with ESRD. Both cohorts were followed up until the end of 2010. Results: The Parkinson's disease incidence was 1.55-fold higher in the cohort with ESRD than in the comparison cohort (48.8 vs. 31.7 per 10,000 person-years) with an adjusted hazard ratio of 1.73 (95% confidence interval, 1.39-2.15). Sex-specific and age-specific analysis showed a higher relative risk for women and younger patients with ESRD compared to the control cohort. Conclusions: ESRD is significantly associated with an increased risk of Parkinson's disease. Close surveillance for Parkinson's disease should be considered for patients with ESRD.

Chronic renal dysfunction, proteinuria, and risk of Parkinson's disease in the elderly

“…A 3‐year follow‐up study based on the Longitudinal Health Insurance Database in Taiwan reported that after adjusting for DM, uremic patients are associated with a 1.81‐fold higher risk of developing parkinsonism than are nonuremic patients . In addition, a 2.56‐year follow‐up cohort study from the same database reported that ESRD was associated with an increased risk of PD, with an adjusted HR of 1.73 (95% CI, 1.39–2.15) . Consistent with these previous study results, our findings provide additional evidence that elderly uremic patients are more vulnerable to the development of PD than are nonuremic individuals, using a population‐based larger sample and with a longer duration of follow‐up.…”

“…Although CKD and proteinuria are well known to be related to cardiovascular risk, they have been indicated to also be associated with noncardiovascular complications, cognitive dysfunction, and poor physical functioning in older adults . In addition, 2 recent cohort studies in Taiwan reported an association between chronic uremia and parkinsonism . One study showed that uremic patients had an increased risk of the occurrence of parkinsonism compared with nonuremic patients .…”

“…One study showed that uremic patients had an increased risk of the occurrence of parkinsonism compared with nonuremic patients . The other study reported a positive association between end‐stage renal disease (ESRD) and the incidence of PD . Therefore, it may be of interest to investigate whether chronic renal dysfunction and proteinuria are independently associated with the incidence of PD.…”

“…However, there is limited epidemiological evidence regarding this issue. To the best of our knowledge, only the 2 aforementioned studies reported the association between chronic renal dysfunction and parkinsonism . Moreover, only a few case studies have reported dyskinesia or Parkinson's syndrome related to basal ganglion lesions in patients with CKD or ESRD …”

Association between Trimetazidine and Parkinsonism: A Population-Based Study

“…Sociodemographic data including age, sex, and insurance type, and medical data including the presence of comorbid diseases and concurrent medications known to cause parkinsonism were collected [14][15][16][17][18]. Comorbid diseases included diabetes mellitus (ICD-10 codes E10-E14), stroke (ICD-10 codes I60-I66), endstage renal disease (ICD-10 code N18.5), and Alzheimer's disease (ICD-10 code G30).…”