Risk of dialysis and renal diseases in patients with anorexia nervosa in Taiwan

Abstract

Objective: To investigate the incidence and risk of renal-related complications in a nationwide cohort of Taiwanese patients with anorexia nervosa (AN).Method: This longitudinal cohort study analyzed the data of 43,951 individualscomprising 2091 patients with AN and their controls matched (1:20) using propensity scores according to sex, age, degree of urbanization of residence, socioeconomic status, and year of diagnosis-from a population-based health insurance database; the study lasted 16 years. We used Kaplan-Meier curves to estimate the cumulative incidence of renal events. We also performed Cox proportional regression and constructed a risk model with death as a competing event (both adjusted for basic characteristics, renal diseases, and psychiatric comorbidities) to examine the risk of dialysis and renal outcomes in the AN group relative to the control group.Results: In total, 204 and 10 patients with AN had renal-related outcomes and endstage renal disease (ESRD), respectively. The cumulative incidence rates of all renal outcomes and ESRD in the AN group were 10.72% and .64%, respectively, at 10-year follow-up. Compared with the control group, the AN group had a significantly higher risk of acute dialysis (adjusted hazard ratio 2.10 [95% confidence interval 1.19-3.68]), hypokalemia, hypovolemia, nephritis, acute renal failure, and chronic renal failure. The AN group did not have a significantly higher risk of ESRD.Discussion: The elevated risks of acute dialysis and some renal outcomes in AN highlight the importance of monitoring electrolyte imbalance and renal malfunctioning.Public Significance: Malnutrition and purging behaviors may cause renal complications in patients with AN. In this longitudinal cohort study, we found that the 10-year

Outcomes in people with eating disorders: a transdiagnostic and disorder‐specific systematic review, meta‐analysis and multivariable meta‐regression analysis

“…AN had the most severe outcomes among EDs, including highest relapse and chronicity of weight loss, and highest rates of hospitalization. These outcomes are consistent with the numerous physical health complications that are associated with underweight and malnourishment 72‐77 , and with the importance of early weight gain for a positive disease course 78,79 . BN, instead, had the highest rates of overall improvement and relapse, suggesting a more episodic course compared to other EDs.…”

Determinants and risk factors for renal damage: where do patients hospitalized for severe anorexia nervosa stand? A multi-center study

“…Even though all studies highlight an improvement in renal function with refeeding, some participants still presented varying degrees of impairment, which seemed to worsen with the severity and recurrences of undernutrition, leading to long-term kidney dysfunction with a risk of terminal renal failure in adulthood [ 13 , 16 , 35 – 37 ].…”

“…Over 70% of subjects with AN (independently from the subtypes AN-R or BP) have renal complications at some point in their lives [ 15 ], with a 5.2% prevalence of severe kidney disease, including terminal renal failure after 21 years of AN [ 13 ]. Recently, a cohort study from Taiwan reported that when compared with a control group, 2091 out of over 43,951 individuals had AN and a significantly higher risk of requiring acute dialysis (adjusted hazard ratio 2.10 [95% confidence interval 1.19–3.68]), hypokalaemia, hypovolemia, nephritis, acute renal failure, and chronic renal failure, but no significantly higher risk of end-stage renal disease [ 16 ]. The mortality study by Fichter et al [ 17 ] found that kidney failure was the cause of death for 2 out of 31 AN patients who died from natural causes.…”