Increased Risk of Chronic Kidney Disease in Rheumatoid Arthritis Associated with Cardiovascular Complications - A National Population-Based Cohort Study

PLoS One. 2015 Sep 25;10(9):e0136508. doi: 10.1371/journal.pone.0136508. eCollection 2015.


Background and objectives: There have been few large population-based studies of the association between rheumatoid arthritis (RA) and chronic kidney disease (CKD) and glomerulonephritis. This nationwide cohort study investigated the risks of developing CKD and glomerulonephritis in patients with RA, and the associated risks for cardiovascular complications.

Methods: From the Taiwan National Health Insurance Research Database, we identified a study cohort of 12,579 patients with RA and randomly selected 37,737 subjects without RA as a control cohort. Each subject was individually followed for up for 5 years, and the risk of CKD was analyzed using Cox proportional hazards regression models.

Results: During the follow-up period, after adjusting for traditional cardiovascular risk factors RA was independently associated with a significantly increased risk of CKD (adjusted hazard ratio [aHR] 1.31; 95% confidence interval [CI] 1.23-1.40) and glomerulonephritis (aHR 1.55; 95% CI 1.37-1.76). Increased risk of CKD was also associated with the use of non-steroidal anti-inflammatory drugs, cyclosporine, glucocorticoids, mycophenolate mofetil, and cyclophosphamide. Patients with comorbidities had even greater increased risk of CKD. Moreover, RA patients with concurrent CKD had significantly higher likelihood of developing ischemic heart disease and stroke.

Conclusions: RA patients had higher risk of developing CKD and glomerulonephritis, independent of traditional cardiovascular risk factors. Their increased risk of CKD may be attributed to glomerulonephritis, chronic inflammation, comorbidities, and renal toxicity of antirheumatic drugs. Careful monitoring of renal function in RA patients and tight control of their comorbid diseases and cardiovascular risk factors are warranted.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antirheumatic Agents / adverse effects
  • Antirheumatic Agents / therapeutic use
  • Arthritis, Rheumatoid / complications*
  • Arthritis, Rheumatoid / drug therapy
  • Arthritis, Rheumatoid / epidemiology
  • Cardiovascular Diseases / complications*
  • Cardiovascular Diseases / epidemiology
  • Cohort Studies
  • Comorbidity
  • Databases, Factual
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Population Surveillance*
  • Proportional Hazards Models
  • Renal Insufficiency, Chronic / epidemiology*
  • Renal Insufficiency, Chronic / etiology*
  • Renal Insufficiency, Chronic / mortality
  • Risk
  • Taiwan / epidemiology
  • Urbanization
  • Young Adult


  • Antirheumatic Agents

Grant support

This work was funded by the Cathay General Hospital (Grant number: MR-A10324;, the National Science Council of Taiwan under contract number MOST-103-2221-E-009-117-, and the Center forBioinformatics Research of Aiming for the Top University Program of the National Chiao Tung University and Ministry of Education, Taiwan, R.O.C. for the project 104W962. This work was also supported in part by UST-UCSD International Center of Excellence in Advanced Bioengineering, sponsored by the Ministry of Science and Technology with I-RiCE Program under Grant Number: MOST 103-2911-I-009-101. 2. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.