Risk factors for chronic kidney disease: A prospective study of 23,534 men and women in Washington County, Maryland
Risk factors for chronic kidney disease: A prospective study of 23,534 men and women in Washington County, Maryland
复制标题
DOI：
10.1097/01.asn.0000095249.99803.85
复制
发表时间：
2003-11-01
影响因子：
13.6
通讯作者：
Coresh, J
中科院分区：
文献类型：
--
作者：
Haroun, MK;Jaar, BG;Coresh, J
慢性肾脏病（CKD）是美国发病率和死亡率不断上升的原因。CKD风险因素的前瞻性数据仅限于男性，很少有研究探讨吸烟的重要性。作者在马里兰州华盛顿县的23,534名男性和女性中进行了一项为期20年的以社区为基础的前瞻性观察性研究，以检查高血压和吸烟对未来CKD风险的关系。CKD在卫生保健融资管理局数据库中被确定为终末期肾脏疾病或在死亡证明上列出的肾脏疾病。所有病例均经病历审查证实为CKD。采用考克斯比例风险回归模型对CKD的校正相对风险进行建模，包括年龄作为时间变量，基线BP、吸烟、性别和糖尿病状态作为风险因素。调整后的风险比（95%置信区间），女性中发生CKD的风险为2.5（0.05 - 12.0）正常血压，3.0（0.6至14.4）正常高血压，3.8（0.8至17.2）为1期高血压，6.3（1.3至29.0）为2期高血压，8.8（1.8至43.0）为3期或4期高血压与最佳血压的个人相比。在男性中，这种关系相似，但比女性略弱，相应的风险比分别为1.4（0.2至12.1）、3.3（0.4至25.6）、3.0（0.4至22.2）、5.7（0.8至43.0）和9.7（1.2至75.6）。目前吸烟也与男性和女性的CKD风险显著相关（女性风险比为2.9 [1.7至5.0]，男性风险比为2.4 [1.5至4.0]）。该人群中CKD的大部分归因风险与1期高血压（23%）和吸烟（31%）相关。总之，CKD风险与国家联合委员会（JNC-VI）关于预防、检测评估和治疗高血压标准的第六次报告、糖尿病和目前吸烟的分级关系在女性中至少与男性一样强。
Chronic kidney disease (CKD) is an increasing cause of morbidity and mortality in the United States. Prospective data on risk factors for CKD are limited to men, and few studies examine the importance of smoking. The authors performed a community-based, prospective observational study of 20-yr duration to examine the association between hypertension and smoking on the future risk of CKD in 23,534 men and women in Washington County, Maryland. CKD was identified as end-stage renal disease in the Health Care Financing Administration database or kidney disease listed on the death certificate. All cases were confirmed as CKD by medical chart review. Adjusted relative hazards of CKD were modeled using Cox proportional hazards regression including age as the time variable and baseline BP, cigarette smoking, gender, and diabetes status as risk factors. The adjusted hazard ratio (95% confidence interval) of developing CKD among women was 2.5 (0.05 to 12.0) for normal BP, 3.0 (0.6 to 14.4) for high-normal BP, 3.8 (0.8 to 17.2) for stage 1 hypertension, 6.3 (1.3 to 29.0) for stage 2 hypertension, and 8.8 (1.8 to 43.0) for stages 3 or 4 hypertension compared with individuals with optimal BP. In men, the relationship was similar but somewhat weaker than in women, with corresponding hazard ratios of 1.4 (0.2 to 12.1), 3.3 (0.4 to 25.6), 3.0 (0.4 to 22.2), 5.7 (0.8 to 43.0), and 9.7 (1.2 to 75.6), respectively. Current cigarette smoking was also significantly associated with risk of CKD in both men and women (hazard ratio in women 2.9 [1.7 to 5.0] and in men 2.4 [1.5 to 4.0]). A large proportion of the attributable risk of CKD in this population was associated with stage 1 hypertension (23%) and cigarette smoking (31%). In conclusion, CKD risk shows strong graded relationships to the sixth report of the Joint National Committee (JNC-VI) on Prevention, Detection Evaluation and Treatment of High BP criteria for BP, to diabetes, and to current cigarette smoking that are at least as strong in women as in men.