Risks for end-stage renal disease, cardiovascular events, and death in Hispanic versus non-Hispanic white adults with chronic kidney disease
Risks for end-stage renal disease, cardiovascular events, and death in Hispanic versus non-Hispanic white adults with chronic kidney disease
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DOI：
10.1681/asn.2005101122
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发表时间：
2006-10-01
影响因子：
13.6
通讯作者：
Go, Alan S.
中科院分区：
文献类型：
--
作者：
Peralta, Carmen A.;Shlipak, Michael G.;Go, Alan S.
西班牙裔人群终末期肾病（ESRD）的发病率上升速度比非西班牙裔白人更快，但原因尚不清楚。西班牙裔和非西班牙裔白人慢性肾脏病（CKD）患者心血管事件发生率和死亡率是否存在差异也未得到很好的理解。因此，本研究探讨了西班牙裔与慢性肾脏病患者终末期肾病、心血管事件和死亡风险之间的关联。研究共纳入了来自北加利福尼亚凯撒医疗集团的39550名3 - 4期慢性肾脏病患者。西班牙裔身份通过自我报告并辅以姓氏匹配来确定。肾小球滤过率（GFR）通过简化的肾脏病饮食改良公式估算，临床结果、患者特征以及长期用药情况通过健康计划数据库和州死亡档案确定。在对社会人口统计学特征进行调整后，与非西班牙裔白人患者相比，西班牙裔与终末期肾病风险增加相关（风险比[HR]为1.93；95%置信区间[CI]为1.72 - 2.17），在控制糖尿病和胰岛素使用情况后，这种相关性减弱（HR为1.50；95%CI为1.33 - 1.69）。在对潜在混杂因素进一步调整后，西班牙裔仍然独立地与终末期肾病风险增加（HR为1.33；95%CI为1.17 - 1.52）以及心血管事件风险降低（HR为0.82；95%CI为0.76 - 0.88）和死亡风险降低（HR为0.72；95%CI为0.66 - 0.79）相关。在一大群慢性肾脏病患者中，西班牙裔与较低的死亡和心血管事件发生率以及较高的终末期肾病进展率相关。西班牙裔患者中糖尿病患病率较高只是部分解释了终末期肾病风险增加的原因。需要进一步的研究来阐明慢性肾脏病相关结局中种族差异的原因。
Rates of ESRD are rising faster in Hispanic than non-Hispanic white individuals, but reasons for this are unclear. Whether rates of cardiovascular events and mortality differ among Hispanic and non-Hispanic white patients with chronic kidney disease (CKD) also is not well understood. Therefore, this study examined the associations between Hispanic ethnicity and risks for ESRD, cardiovascular events, and death in patients with CKD. A total of 39,550 patients with stages 3 to 4 CKD from Kaiser Permanente of Northern California were included. Hispanic ethnicity was obtained from self-report supplemented by surname matching. GFR was estimated from the abbreviated Modification of Diet in Renal Disease equation, and clinical outcomes, patient characteristics, and longitudinal medication use were ascertained from health plan databases and state mortality files. After adjustment for sociodemographic characteristics, Hispanic ethnicity was associated with an increased risk for ESRD (hazard ratio [HR] 1.93; 95% confidence interval [CI] 1.72 to 2.17) when compared with non-Hispanic white patients, which was attenuated after controlling for diabetes and insulin use (HR 1.50; 95% CI 1.33 to 1.69). After further adjustment for potential confounders, Hispanic ethnicity remained independently associated with an increased risk for ESRD (HR 1.33; 95% CI 1.17 to 1.52) as well as a lower risk for cardiovascular events (HR 0.82; 95% CI 0.76 to 0.88) and death (HR 0.72; 95% CI 0.66 to 0.79). Among a large cohort of patients with CKD, Hispanic ethnicity was associated with lower rates of death and cardiovascular events and a higher rate of progression to ESRD. The higher prevalence of diabetes among Hispanic patients only partially explained the increased risk for ESRD. Further studies are required to elucidate the cause(s) of ethnic disparities in CKD-associated outcomes.