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.

Comparison of Elixhauser and Charlson Methods for Discriminative Performance in Mortality Risk in Patients with Schizophrenic Disorders

“…In the United States, it has been found that patients with schizophrenia have a higher mortality rate than the general population not only due to unnatural deaths such as suicide, homicide, and accidents but also due to natural deaths [31]. In Taiwan, it has been found that these patients are more likely to die from physical illnesses such as myocardial infarction [32], strokes [33], diabetic mellitus [34], renal disease [35], and cancer [36]. Patients with schizophrenia in Taiwan have shorter lives than the general population when they have comorbid physical illnesses [31,37].…”

A cross-sectional study on metabolic similarities and differences between inpatients with schizophrenia and those with mood disorders

“…There are other reports that the prevalence of CKD is not different between schizophrenic patients and control [4], and the incidence of end-stage renal disease is low in schizophrenic patients [42]. Rej S [43] and Kessing LV [44] showed that Li, mood stabilizing treatment for bipolar disorder, had an effect on renal function and induced CKD.…”

A cross-sectional study on metabolic similarities and differences between inpatients with schizophrenia and those with mood disorders

“…Tzeng et al [ 42 ] reported that schizophrenia is associated with a 25% increase in the risk of developing CKD for 3 years follow up period. There are other reports that the prevalence of CKD is not different between schizophrenic patients and control [ 4 ], and the incidence of end-stage renal disease is low in schizophrenic patients [ 43 ]. Rej [ 44 ] and Kessing [ 45 ] showed that Lithium, mood stabilizing treatment for bipolar disorder, had an effect on renal function and induced CKD.…”