Association of Fitness With Racial Differences in Chronic Kidney Disease.
Association of Fitness With Racial Differences in Chronic Kidney Disease.
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DOI：
10.1016/j.amepre.2019.02.016
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发表时间：
2019-07
影响因子：
5.5
通讯作者：
Amanda E. Paluch;Lindsay R. Pool;T. Isakova;C. Lewis;Rupal Mehta;P. Schreiner;S. Sidney;M. Wolf;M. Carnethon
中科院分区：
文献类型：
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作者：
Amanda E. Paluch;Lindsay R. Pool;T. Isakova;C. Lewis;Rupal Mehta;P. Schreiner;S. Sidney;M. Wolf;M. Carnethon
简介非白人少数族裔患慢性肾病的风险高于非西班牙裔白人。更好的心肺健康与估计肾小球滤过率下降较慢和慢性肾病发病率较低有关。关于健康与慢性肾病种族差异之间的关系，我们知之甚少。方法 1985-1986 年，由 3,842 名没有慢性肾病的年轻人组成的前瞻性队列在基线时完成了最大跑步机测试。慢性肾病状态定义为在10年、15年、20年、25年和30年随访评估期间（截至2006年）估计肾小球滤过率<60 mL/min/1.73 m2。分析于 2019 年完成。多变量 Cox 模型用于确定慢性肾脏病发病率的风险比和 95% CI。多变量模型包括种族、性别、年龄、现场中心、教育程度、基线估计肾小球滤过率以及健康饮食指数、吸烟状况、酒精摄入量、BMI、收缩压和空腹血糖的时变协变量。衰减百分比量化了健康状况与慢性肾病种族差异之间的关系。结果黑人慢性肾病发病率（n=83/1,941，每 1,000 人年 1.61 例）高于白人（43/1,901，每 1,000 人年 0.82 例）。跑步时间每缩短 1 分钟，患慢性肾病的风险就会增加 1.14 倍（95% CI=1.04, 1.25）。与白人相比，黑人患慢性肾病的可能性是白人的 1.72 (95% CI=1.13, 2.63) 倍。随着适应性的增加，风险降低至 1.54 (95% CI=1.01, 2.39)。这表明，体能与 20.4% (95% CI=5.8, 43.0%) 因种族导致的慢性肾病超额风险相关。结论 体能低下是一个可改变的因素，可能导致慢性肾病的种族差异。
IntroductionNon-white minorities are at higher risk for chronic kidney disease than non-Hispanic whites. Better cardiorespiratory fitness is associated with slower declines in estimated glomerular filtration rate and a lower incidence of chronic kidney disease. Little is known regarding associations of fitness with racial disparities in chronic kidney disease.MethodsA prospective cohort of 3,842 young adults without chronic kidney disease completed a maximal treadmill test at baseline in 1985–1986. Chronic kidney disease status was defined as estimated glomerular filtration rate of <60 mL/min/1.73 m2during 10-, 15-, 20-, 25-, and 30-year follow-up assessments (through 2006). Analyses were completed in 2019. Multivariable Cox models were used to determine hazard ratios and 95% CI for incidence of chronic kidney disease. Multivariable models included race, gender, age, field center, education, baseline estimated glomerular filtration rate, and time-varying covariates of healthy diet index, smoking status, alcohol intake, BMI, systolic blood pressure, and fasting glucose. Percent attenuation quantified the association of fitness to racial disparities in chronic kidney disease.ResultsChronic kidney disease incidence was higher among blacks (n=83/1,941, 1.61 per 1,000 person years) than whites (43/1,901, 0.82 per 1,000 person years). Every 1-minute shorter treadmill duration was associated with 1.14 (95% CI=1.04, 1.25) times higher risk of chronic kidney disease. Blacks were 1.72 (95% CI=1.13, 2.63) times more likely to develop chronic kidney disease compared with whites. The risk was reduced to 1.54 (95% CI=1.01, 2.39) with fitness added. This suggests that fitness is associated with 20.4% (95% CI=5.8, 43.0%) of the excess risk of chronic kidney disease attributable to race.ConclusionsLow fitness is a modifiable factor that may contribute to the racial disparity in chronic kidney disease.