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Epidemiology
Research
Second-generation antipsychotic medications and risk of chronic kidney disease in schizophrenia: population-based nested case–control study
  1. Hsien-Yi Wang1,2,
  2. Charles Lung-Cheng Huang3,4,
  3. I Jung Feng5,
  4. Hui-Chun Tsuang6
  1. 1 Division of Nephrology, Chi Mei Medical Center, Yung Kang, Taiwan
  2. 2 Department of Sport Management, College of Leisure and Recreation Management, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan
  3. 3 Division of Psychiatry, Chi Mei Medical Center, Yung Kang, Taiwan
  4. 4 Department of Social Work, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan
  5. 5 Department of Medical Research, Chi Mei Medical Center, Yung Kang, Taiwan
  6. 6 Center of General Education, Chang Jung Christian University, Tainan, Taiwan
  1. Correspondence to Dr Hui-Chun Tsuang; hctsuang{at}gmail.com

Abstract

Objectives The study aims to compare the risk of chronic kidney diseases (CKDs) between patients with schizophrenia using first and second-generation antipsychotics.

Setting Datasets of 2000–2013 National Health Insurance in Taiwan were used.

Participants The National Health Insurance reimbursement claims data have been transferred to and managed by the National Health Research Institute in Taiwan since 1996. We used the Psychiatric Inpatient Medical Claims database, a subset of the National Health Insurance Research Database, comprising a cohort of patients hospitalised for psychiatric disorders between 2000 and 2013 (n=2 67 807). The database included patients with at least one psychiatric inpatient record and one discharge diagnosis of mental disorders coded by the International Classification of Diseases, Ninth Revision (ICD-9) codes 290–319. The age of patients at first admission was restricted to 18–65 years.

Primary outcome CKD (ICD-9 code 582, 583, 585, 586, 588) requiring hospitalisation or three outpatient visits. The diagnosis of CKD follows the criteria of ‘Kidney Disease: Improving Global Outcomes’ in Taiwan. CKD is defined as a kidney damage as albumin-to-creatinine ratio >30 mg/g in two of three spot urine specimens or glomerular filtration rate <60 mL/min/1.73 m2 for 3 months or more.

Results We found that the risks for CKD were higher for those who used second-generation antipsychotics (SGAs) longer cumulatively than those who did not. Using non-users, patients did not have any SGA records, as reference group, the risks for CKD comparing those using SGAs for 90 to 180 days with non-users and those using SGAs for more than 1000 days were 1.42 (1.06–1.91) and 1.30 (1.13–1.51), respectively.

Conclusions The current study suggests the relationship between using SGAs and risk of CKD.

  • second-generation antipsychotics
  • chronic kidney disease
  • schizophrenia

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2017-019868

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    Footnotes

    • Contributors H-CT and H-YW initiated the study. H-CT, H-YW and CL-CH designed the study. IJF analysed the data. H-CT wrote the manuscript and H-YW, CL-CH and IJF approved the final manuscript.

    • Funding This study was funded by Chi-Mei Medical Center (grant number: CMFHR 10537).

    • Competing interests None declared.

    • Patient consent Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Datasets of National Health Insurance in Taiwan were used. All investigators should sign an agreement that guarantees patient confidentiality before using the data.