Impact of Chronic Kidney Disease on Aortic Dissection in Patients with Polycystic Kidney Disease: A Fifteen-year Nationwide Population-based Cohort Study in Taiwan

Abstract

Background: Aortic dissection is a life-threatening condition associated with polycystic kidney disease (PKD). Additionally, PKD often progresses to chronic kidney disease (CKD), a known risk factor for cardiovascular disease. However, the impact of CKD on aortic dissection, particularly in patients with PKD, remains unclear. This study aims to investigate the effects of both CKD and PKD on aortic dissection. Materials and methods: This nationwide, population-based, retrospective cohort study used data from the National Health Insurance Research Database (NHIRD) in Taiwan. The primary outcome evaluated in this study was the cumulative incidence of aortic dissection, compared between PKD patients and a control group without PKD over a 15-year follow-up period. CKD subgroup analyses were performed to further assess the impact of CKD progression on the development of aortic dissection. Results: From 2000 to 2015, this study included 9,192 PKD patients and 36,768 matched controls without PKD from the NHIRD. Our findings demonstrated that PKD patients who developed aortic dissection had a higher incidence of comorbidities, including hypertension and coronary artery disease. Aortic dissection was more prevalent among male patients, individuals over 45 years of age, and those in the lowest insured premium group. PKD patients had a 2.53-fold higher adjusted hazard ratio (HR) for developing aortic dissection compared to the control group (95% CI: 1.74 to 3.66, p < 0.001). Notably, PKD patients with concurrent hypertension had a 7.77-fold increased risk of aortic dissection (95% CI: 4.97 to 12.13, p < 0.001). In CKD subgroup analyses, PKD patients without CKD and those with CKD had adjusted HRs of 1.74 and 3.38, respectively (p < 0.001). Among PKD patients with CKD, those who initiated hemodialysis (HD) and those who did not showed adjusted HRs of 3.95 and 2.74, respectively, for aortic dissection (p < 0.001). Conclusion: These findings indicate that the risk of aortic dissection in PKD patients significantly increases with CKD progression. Additionally, hypertension is an independent risk factor for aortic dissection in PKD patients. Careful management of blood pressure and strategies to prevent CKD progression may reduce the incidence of aortic dissection in this population.

Keywords: aortic dissection; cardiovascular risk; chronic kidney disease; end-stage renal disease; hemodialysis; polycystic kidney disease.