Survival advantage in black versus white men with CKD: effect of estimated GFR and case mix.
Survival advantage in black versus white men with CKD: effect of estimated GFR and case mix.
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DOI：
10.1053/j.ajkd.2012.12.012
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发表时间：
2013-08
期刊：
影响因子：
--
通讯作者：
Kalantar-Zadeh K
中科院分区：
文献类型：
--
作者：
Kovesdy CP;Quarles LD;Lott EH;Lu JL;Ma JZ;Molnar MZ;Kalantar-Zadeh K
与白人患者相比，黑人透析患者的死亡率显著降低，这与普通人群中黑人的高死亡率形成了鲜明对比。目前尚不清楚在非透析依赖型慢性肾脏病中是否存在类似的悖论，如果存在，其潜在原因是什么。历史上的同龄人。518,406名白人和52,402名黑人男性美国退伍军人，患有非透析依赖型CKD 3-5期。黑人种族。我们使用参数生存模型检验了总体和CKD阶段特定的全因死亡率。在多变量模型中探讨了社会人口学特征、合并症和实验室特征对观察到的差异的影响。在4.7年的中位随访期内，172,093名患者死亡(死亡率为每1000人年71.0[95%可信区间，70.6-71.3])。黑人种族与显著较低的粗死亡率相关(HR，0.95；95%CI，0.94-0.97；P<；0.001)。经年龄调整后，生存优势减弱(HR，1.14；95%CI，1.12~1.16)，但经完全多变量调整后，生存优势有所放大(HR，0.72；95%CI，0.70~0.73；p<；0.001)。黑人的未调整生存优势在CKD分期较晚期的患者中更为突出，但CKD阶段特异性差异被多变量调整所削弱。仅限男性患者。与白人患者相比，黑人CKD患者的死亡率较低。黑人的生存优势在CKD晚期患者中得到加强，这可能是由于肾脏疾病过程中病例组合和实验室特征的变化造成的。
Black dialysis patients have significantly lower mortality compared to white patients, in contradistinction to the higher mortality seen in blacks in the general population. It is unclear if a similar paradox exists in non–dialysis-dependent CKD, and if it does, what its underlying reasons are. Historical cohort. 518,406 white and 52,402 black male US veterans with non-dialysis dependent CKD stages 3–5. Black race. We examined overall and CKD stage-specific all-cause mortality using parametric survival models. The effect of sociodemographic characteristics, comorbidities and laboratory characteristics on the observed differences was explored in multivariable models. Over a median follow-up of 4.7 years 172,093 patients died (mortality rate, 71.0 [95% CI, 70.6–71.3] per 1000 patient-years). Black race was associated with significantly lower crude mortality (HR, 0.95; 95% CI, 0.94–0.97; p<0.001). The survival advantage was attenuated after adjustment for age (HR, 1.14; 95% CI, 1.12–1.16), but was even magnified after full multivariable adjustment (HR, 0.72; 95% CI, 0.70–0.73; p<0.001). The unadjusted survival advantage of blacks was more prominent in those with more advanced stages of CKD, but CKD stage-specific differences were attenuated by multivariable adjustment. Exclusively male patients. Black patients with CKD have lower mortality compared to white patients. The survival advantage seen in blacks is accentuated in patients with more advanced stages of CKD, which may be explained by changes in case mix and laboratory characteristics occurring during the course of kidney disease.
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DOI：
10.1126/science.1193032
发表时间：
2010-08-13
期刊：
Science (New York, N.Y.)
影响因子：
--
作者：
Genovese G;Friedman DJ;Ross MD;Lecordier L;Uzureau P;Freedman BI;Bowden DW;Langefeld CD;Oleksyk TK;Uscinski Knob AL;Bernhardy AJ;Hicks PJ;Nelson GW;Vanhollebeke B;Winkler CA;Kopp JB;Pays E;Pollak MR
通讯作者：
Pollak MR
影响因子：
5.3
作者：
Bostrom MA;Lu L;Chou J;Hicks PJ;Xu J;Langefeld CD;Bowden DW;Freedman BI
通讯作者：
Freedman BI
影响因子：
7.2
作者：
DEYO, RA;CHERKIN, DC;CIOL, MA
通讯作者：
CIOL, MA
影响因子：
3.3
作者：
Levine, RS;Foster, JE;Hennekens, CH
通讯作者：
Hennekens, CH
影响因子：
--
作者：
Krop, JS;Coresh, J;Brancati, FL
通讯作者：
Brancati, FL