Studies comparing mortality for Asian populations with end-stage renal disease (ESRD) on hemodialysis (HD) and peritoneal dialysis (PD) are limited. We compared mortality between patients treated with PD and HD in Taiwan, the population with the highest incidence of ESRD worldwide. Using the population-based insurance claims data of Taiwan from 1997 to 2006, we identified 4721 patients treated with PD and randomly selected 4721 patients treated with HD who were frequency-matched to the PD patients based on their propensity scores. In follow-up analyses we measured mortalities and hazard ratios associated with comorbidities in 2 different 5-year cohorts (1997-2001 and 2002-2006).In the 10-year period from 1997 to 2006, the overall mortality rates were similar in patients treated with PD and in patients treated with HD (12.0 vs. 11.7 per 100 person-years, respectively), with a PD-to-HD hazard ratio of 1.02 (95% confidence interval [CI], 0.96-1.08). In the first 5-year period (1997-2001), the hazard ratio for mortality was higher for PD (1.33; 95% CI, 1.21-1.46), but there was no difference between PD and HD in the 2002-2006 cohort. Of note, younger patients who received PD had better survival than younger patients who received HD; this was especially true for patients aged younger than 40 years.In summary, in this Asian population, no significant survival differences were noted between propensity score-matched PD and HD patients. The selection of a dialysis modality must be tailored to the individual patient. Studies in which patients who are appropriate for either modality are randomly assigned to HD or PD may provide helpful information to clinicians and patients.

BACKGROUND:

The effect of different renal replacement therapies on the risk of developing herpes zoster in renal failure patients is unknown. We aimed to investigate the incidence of herpes zoster attack among renal failure patients who were receiving different dialysis modalities, renal transplantation (RT), or not receiving any of the above mentioned therapies yet.

METHODS:

A retrospective cohort study of the national health insurance register database was conducted. This observational cohort study involved 79,581 study controls, 15,802 chronic kidney disease patients, 3,694 hemodialysis (HD) patients, 317 peritoneal dialysis (PD) patients, and 159 RT patients.

RESULTS:

The RT group had the worst risk of herpes zoster (hazard ratio, HR, 8.46; 95% CI 5.85-12.2), followed by PD (HR 3.61; 95% CI 2.49-4.83) and HD (HR 1.35; 95% CI 1.18-1.55), compared with the comparison group (p < 0.0001). The RT group had also the highest risk of developing herpes zoster with complications among all groups (adjusted HR 15.3). The HRs of the PD group were higher than the HRs of the HD group in terms of herpes zoster or its complications (p < 0.0001 and p = 0.0002, respectively).

CONCLUSIONS:

This study suggests that different treatment modalities are associated with different risks of herpes zoster attacks in renal failure patients. PD patients had higher risks than the HD group in terms of herpes zoster or its complications.

BACKGROUND:

Controversy still exists regarding whether alendronate (ALN) use increases the risk of esophageal cancer or breast cancer.

METHODS:

This paper explores the possible association between the use of oral ALN in osteoporosis patients and subsequent cancerrisk using the National Health Insurance (NHI) system database of Taiwan with a Cox proportional-hazard regression analysis. The exposure cohort contained 5,624 osteoporosis patients used ALN and randomly frequency-matched by age and gender of 3 osteoporosis patients without any kind of anti-osteoporosis drugs in the same period.

RESULTS:

For a dose ≥ 1.0 g/year, the risk of developing overall cancer was significantly higher (hazard ratio: 1.69, 95% confidence ratio: 1.39-2.04) than in osteoporosis patients without any anti-osteoporosis drugs. The risks for developing liver, lung, and prostate cancers and lymphoma were also significantly higher than in the control group.

CONCLUSIONS:

This population-based retrospective cohort study did not find a relationship between ALN use and either esophageal or breast cancer, but unexpectedly discovered that use of ALN with dose ≥ 1.0 g/year significantly increased risks of overall cancer incidence, as well as liver, lung, and prostate cancers and lymphoma. Further large population-based unbiased studies to enforce our findings are required before any confirmatory conclusion can be made.

Recent studies in Western nations have shown inverse associations between body mass index (BMI, measured as weight (kg)/height (m)²) and suicide. However, it is uncertain whether the association is similar in non-Western settings, and the biologic pathways underlying the association are unclear. The authors investigated these issues in a cohort of 542,088 Taiwanese people 20 years of age or older who participated in a health check-up program (1994–2008); there were 573 suicides over a mean 8.1 years of follow up. There was a J-shaped association between BMI and suicide risk (P for the quadratic term = 0.033) but limited evidence of a linear association (adjusted hazard ratio per 1-standard-deviation increase = 0.95 (95% confidence interval: 0.85, 1.06)); compared with individuals whose BMI was 18.5–22.9, adjusted hazard ratios for those with a BMI <18.5 or ≥35 were 1.56 (95% confidence interval: 1.07, 2.28) and 3.62 (95% confidence interval: 1.59, 8.22), respectively. A high waist-to-hip ratio was associated with an increased risk of suicide. There was some evidence for a reverse J-shaped association of systolic blood pressure and high density lipoprotein cholesterol with suicide and an association of higher triglyceride level with increased suicide risk; these associations did not appear to mediate the associations of BMI and waist-to-hip ratio with suicide.