Racial differences in the progression from chronic renal insufficiency to end-stage renal disease in the United States
Racial differences in the progression from chronic renal insufficiency to end-stage renal disease in the United States
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DOI：
10.1097/01.asn.0000091586.46532.b4
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发表时间：
2003-11-01
影响因子：
13.6
通讯作者：
Shlipak, MG
中科院分区：
文献类型：
--
作者：
Hsu, CY;Lin, F;Shlipak, MG
与白人相比，美国黑人承受着不成比例的终末期肾病负担。研究人员调查了这是否是由于黑人中慢性肾功能不全 (CRI) 患病率增加所致，或者是由于慢性肾功能不全 (CRI) 进展为 ESRD 的增加所致。使用第三次全国健康和营养检查调查和美国肾脏数据系统的数据进行出生队列分析。假设1996年25岁至79岁的ESRD患者来自第三次全国健康和营养调查（1991年中点）中抽样的20岁至74岁的CRI来源人群。 GFR 使用肾病饮食调整研究方程进行估算。与成年白人相比，黑人的 CRI 患病率（GFR 15 至 59 ml/min 每 1.73 m(2)）没有差异（每 100,000 人分别为 2060 例和 2520 例；P = 0.14）。 1991 年，每 100 名患有 CRI 的黑人中，1996 年会出现 5 例新的 ESRD 病例，而每 100 名患有 CRI 的白人中，只有 1 例出现 ESRD（风险比，4.8；95% 置信区间，2.9 至 8.4）。与白人相比，黑人的风险增加仅受到年龄、性别和糖尿病调整的轻微影响。患有 CRI 的黑人的收缩压（147 毫米汞柱与 136 毫米汞柱；P = 0.001）和舒张压（82 毫米汞柱与 77 毫米汞柱；P = 0.02）血压较高，白蛋白尿较多（422 杯尿白蛋白/毫克尿肌酐相对于 158 杯尿白蛋白/毫克尿肌酐；P = 0.01）。黑人 ESRD 发病率较高并不是因为黑人 CRI 患病率较高。了解黑人与白人 ESRD 发病率差异的关键在于了解他们从 CRI 发展为 ESRD 的极端差异。
Black Americans experience a disproportionate burden of ESRD compared with whites. Whether this is caused by the increased prevalence of chronic renal insufficiency (CRI) among blacks or by their increased progression from CRI to ESRD was investigated. A birth cohort analysis was performed using data from the Third National Health and Nutrition Examination Survey and the United States Renal Data System. It was assumed that those who developed ESRD in 1996 aged 25 to 79 yr came from the source population with CRI aged 20 to 74 yr that was sampled in the Third National Health and Nutrition Examination Survey (midpoint 1991). GFR was estimated using the Modification of Diet in Renal Disease study equation. The prevalence of CRI (GFR 15 to 59 ml/min per 1.73 m(2)) was not different among black compared with white adults (2060 versus 2520 per 100,000; P = 0.14). For each 100 blacks with CRI in 1991, five new cases of ESRD developed in 1996, whereas only one case of ESRD developed per 100 whites with CRI (risk ratio, 4.8; 95% confidence interval, 2.9 to 8.4). The increased risk for blacks compared with whites was only modestly affected by adjustment for age, gender, and diabetes. Blacks with CRI had higher systolic (147 versus 136 mmHg; P = 0.001) and diastolic (82 versus 77 mmHg; P = 0.02) BP and greater albuminuria (422 versus 158 mug urine albumin/mg urine creatinine; P = 0.01). The higher incidence of ESRD among blacks is not due to a greater prevalence of CRI among blacks. The key to understanding black-white differences in ESRD incidence lies in understanding the extreme differences in their progression from CRI to ESRD.