Background Cholesterol crystal embolism (CCE) causes renal damage, and there is an extremely high risk of end-stage renal disease. However, the time course of CCE-related renal deterioration varies and little is known about the subsequent risk of dialysis among patients with biopsy-proven CCE. Methods We performed a retrospective cohort study of 38 Japanese patients in whom a histological diagnosis of CCE was made from September 1992 to July 2005. Competing risk regression analysis was used to investigate the association between declining renal function ( >= 1.5 elevation of serum creatinine within 26 weeks after CCE) or its subtypes (acute < 1 week after CCE, subacute 1 to < 6 weeks, and chronic 6 to < 26 weeks) and the risk of dialysis, with adjustment for age, baseline serum creatinine, and the precipitating event (iatrogenic or spontaneous). Results During a median follow-up period of 25.9 weeks, 14 patients (35.9) started dialysis. Multivariable analysis showed that patients with declining renal function had a higher risk of commencing dialysis than those without declining function (subdistribution hazard ratio SHR 9.47; 95 confidence interval CI 1.34-66.8). Patients with different renal presentations had a similarly increased risk of commencing dialysis, with the risk being significantly higher for the subacute and chronic patterns of declining renal function (adjusted SHR 95 CI for acute, subacute, and chronic declining renal functionvs. no decline: 7.36 0.85-63.6, 11.9 1.36-101, and 10.7 1.49-77.0, respectively). Conclusion Declining renal function after CCE, even later than 6 weeks, was significantly associated with the subsequent risk of dialysis.
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