Association of CKD With Disability in the United States
Association of CKD With Disability in the United States
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DOI：
10.1053/j.ajkd.2010.08.016
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发表时间：
2011-02-01
影响因子：
13.2
通讯作者：
Powe, Neil R.
中科院分区：
文献类型：
--
作者：
Plantinga, Laura C.;Johansen, Kirsten;Powe, Neil R.
背景：对早期慢性肾病的残疾知之甚少。研究设计：横断面全国性调查(国家健康和营养检查调查19992006)。地点和参与者：对16,011名非住院的美国平民成人(年龄20岁)进行基于社区的调查。预测因素：慢性肾病，分类为无慢性肾脏病，1期和2期(蛋白尿和估计的肾小球滤过率；=60mL/min/1.73m(2)，3级和4级(EGFR，15-59mL/min/1.73m(2))。结果：自我报告的残疾，定义为工作、行走和认知方面的限制，以及日常生活活动(ADL)、工具性ADL、休闲和社会活动、下肢活动和一般体力活动方面的困难。结果：年龄调整后的慢性肾脏病患者报告的受限发生率明显更高：例如，在65岁的老年人中，日常生活能力障碍的发生率分别为17.6%、24.7%和23.9%，在没有慢性肾脏病的年轻人(20-岁)中，分别为6.8%、11.9%和11.0%。在年龄调整后，CKD还与报告的其他活动中更大的限制和困难有关，包括工具性ADL、休闲和社交活动、下肢活动和一般体力活动。其他人口统计学因素、社会经济状况和获得护理的机会通常仅轻微减弱了观察到的关联，特别是在老年人中；心血管疾病、关节炎和癌症的调整减弱了大多数关联，以至于不再具有统计学意义。限制：无法确定因果关系和可能的未测量的混淆。结论：慢性肾脏病在美国与更高的残疾患病率有关。年龄和其他并存的疾病是这种联系的主要原因，但不是全部。我是J·肯尼·迪斯。57(2)：212-227。(C)2011由国家肾脏基金会，Inc.出版，Elsevier Inc.保留所有权利。
Background: Little is known about disability in early-stage chronic kidney disease (CKD).Study Design: Cross-sectional national survey (National Health and Nutrition Examination Survey 19992006).Setting & Participants: Community-based survey of 16,011 noninstitutionalized US civilian adults (aged >20 years).Predictor: CKD, categorized as no CKD, stages 1 and 2 (albuminuria and estimated glomerular filtration rate [eGFR] >= 60 mL/min/1.73 m(2)), and stages 3 and 4 (eGFR, 15-59 mL/min/1.73 m(2)).Outcome: Self-reported disability, defined by limitations in working, walking, and cognition and difficulties in activities of daily living (ADL), instrumental ADL, leisure and social activities, lower-extremity mobility, and general physical activity.Measurements: Albuminuria and eGFR assessed from urine and blood samples; disability, demographics, access to care, and comorbid conditions assessed using a standardized questionnaire.Results: Age-adjusted prevalence of reported limitations generally was significantly greater with CKD: for example, difficulty with ADL was reported by 17.6%, 24.7%, and 23.9% of older (>= 65 years) and 6.8%, 11.9%, and 11.0% of younger (20-64 years) adults with no CKD, stages 1 and 2, and stages 3 and 4, respectively. CKD also was associated with greater reported limitations and difficulty in other activities after age adjustment, including instrumental ADL, leisure and social activities, lower-extremity mobility, and general physical activity. Other demographics, socioeconomic status, and access to care generally only slightly attenuated the observed associations, particularly in older individuals; adjustment for cardiovascular disease, arthritis, and cancer attenuated most associations such that statistical significance no longer was achieved.Limitations: Inability to establish causality and possible unmeasured confounding.Conclusion: CKD is associated with a higher prevalence of disability in the United States. Age and other comorbid conditions account for most, but not all, of this association. Am J Kidney Dis. 57(2):212-227. (C) 2011 by the National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.