SLR - April 2016 - Brandon Tucker

Title: Association Between Chronic Osteomyelitis and Risk of End-Stage Renal Disease: A Nationwide Population-Based Cohort Study

Reference: Lin SY, Lin CL, Tseng CH, Chang YJ, Wang IK, Yeh HC, Kao CH. Association Between Chronic Osteomyelitis and Risk of End-Stage Renal Disease: A Nationwide Population-Based Cohort Study. Medicine (Baltimore). 2015 Jul;94(27)

Scientific Literature Review

Reviewed By: Brandon Tucker, DPM
Residency Program: University Hospital, Newark, NJ

Podiatric Relevance: Chronic osteomyelitis (COM) is often seen by a practicing foot and ankle surgeon. If the patient is unstable and unable to be brought to the OR six weeks of IV antibiotics are often used. This article’s main objective was to examine the association between chronic osteomyelitis and development of End-Stage Renal Disease.

Methods: This study is a retrospective cohort study of patients aged greater than or equal to 20 years with newly diagnosed COM between the years 1997 and 2010. The data was extracted from the National Health Insurance Research Database of the Taiwan National Health Insurance program. The comparison cohort compromised patients who had no history of chronic osteomyelitis, chronic kidney disease, or end-stage renal disease. The cohorts were followed until a diagnosis of ESRD or until loss to follow-up, death, termination of insurance, or the end of 2010. Conditions diagnosed before the index date, namely, diabetes, hypertension, coronary heart disease, hyperuricemia, gout, and proteinuria were identified as comorbidities.

Results: Identified 24,267 patients placed in the study cohort and 97,068 patients were placed in the comparison cohort. The mean follow up years of the study cohort was 5.29 +/- 3.96 years and in the comparison cohort was 6.21 +/- 3.88 years. More than half the patients were >= 55 years old and 66.5 percent were male. Patients in the study cohort were more likely to have diabetes, hypertension, hyperlipidemia, hyperuriemia, gout, and proteinuria. Incidence of ESRD in the study cohort was 4.55-fold higher than in the comparison cohort. Both women and men had a higher chance of developing ESRD in the study cohort. Their study demonstrated that the highest incidence rate ratio was found in the younger adults aged 20 to 34 years. A higher incidence rate of ESRD was observed in patients having any comorbidity in both cohorts. Patients with no comorbidities in the study cohort had a higher risk of developing ESRD.

Conclusion: Numerous studies have demonstrated a link between ESRD risk and old age, male sex, diabetes, hypertension, hyperlipidemia, coronary artery disease, and chronic heart failure. This study demonstrated that there is an increased risk of developing ESRD in any patient with one of these comorbidities and chronic osteomyelitis when compared to a patient with one of these comorbidities without chronic osteomyelitis. This study also demonstrated that chronic osteomyelitis is potentially an independent risk factor for development of ESRD. The exact physiopathological mechanisms accounting for chronic osteomyelitis increasing the risk for ESRD are unknown; possible infection-associated glomerulonephritis, glomerulosclerosis, or antibiotics used causing nephrotoxicity. Regardless of the cause this study demonstrates that chronic osteomyelitis can increase a patient’s risk for ESRD and it’s something that should be considered in our patients that present with chronic osteomyelitis.

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