Racial Variation in Medical Outcomes among Living Kidney Donors
Racial Variation in Medical Outcomes among Living Kidney Donors
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DOI：
10.1056/nejmoa1000950
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发表时间：
2010-08-19
影响因子：
158.5
通讯作者：
Brennan, Daniel C.
中科院分区：
文献类型：
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作者：
Lentine, Krista L.;Schnitzler, Mark A.;Brennan, Daniel C.
关于活体肾脏捐赠者的健康结果的数据是缺乏的，特别是在nonwhite persons.METHODSWe链接从器官采购和移植网络（OPTN）的标识符与一个私人的美国的行政数据。S.健康保险公司，并进行了回顾性研究的4650人谁一直活着的肾脏捐赠者从1987年10月至2007年7月，谁捐赠后肾切除术的好处与该保险公司在2000年至2007年的某个时候。我们从账单索赔中确定了肾切除术后的医疗诊断和需要医疗治疗的情况。考克斯回归分析，左和右删失，以解释观察到的保险利益的时期被用来估计绝对患病率和患病率比诊断后肾切除术。然后，我们比较了2005-2006年全国健康和营养检查调查（NHANES）的流行模式，在一般人群中，76.3%的捐赠者是白色，13.1%的黑人，8.2%的西班牙裔，2.4%的其他种族或民族。从捐赠到保险福利结束的中位时间为7.7年。与白色捐献者相比，黑人捐献者在肾脏捐献后患高血压的风险增加（校正风险比，1.52; 95%置信区间[CI]，1.23 - 1.88），需要药物治疗的糖尿病（校正的风险比，2.31; 95% CI，1.33至3.98）和慢性肾脏疾病（校正的风险比，2.32; 95% CI，1.48至3.62）;西班牙裔供体的结果相似。糖尿病的绝对患病率在所有捐助者中没有超过一般人群，但高血压的患病率超过NHANES估计在一些亚组。在不到1%的捐献者中发现终末期肾病，但在黑人捐献者中比在白色捐献者中更常见。S.然而，在人口中，活体肾脏捐赠者的医疗条件存在种族差异。需要更多地关注人口统计学上不同的肾脏捐赠者的健康结果。
BACKGROUNDData regarding health outcomes among living kidney donors are lacking, especially among nonwhite persons.METHODSWe linked identifiers from the Organ Procurement and Transplantation Network (OPTN) with administrative data of a private U. S. health insurer and performed a retrospective study of 4650 persons who had been living kidney donors from October 1987 through July 2007 and who had post-donation nephrectomy benefits with this insurer at some point from 2000 through 2007. We ascertained post-nephrectomy medical diagnoses and conditions requiring medical treatment from billing claims. Cox regression analyses with left and right censoring to account for observed periods of insurance benefits were used to estimate absolute prevalence and prevalence ratios for diagnoses after nephrectomy. We then compared prevalence patterns with those in the 2005-2006 National Health and Nutrition Examination Survey (NHANES) for the general population.RESULTSAmong the donors, 76.3% were white, 13.1% black, 8.2% Hispanic, and 2.4% another race or ethnic group. The median time from donation to the end of insurance benefits was 7.7 years. After kidney donation, black donors, as compared with white donors, had an increased risk of hypertension (adjusted hazard ratio, 1.52; 95% confidence interval [CI], 1.23 to 1.88), diabetes mellitus requiring drug therapy (adjusted hazard ratio, 2.31; 95% CI, 1.33 to 3.98), and chronic kidney disease (adjusted hazard ratio, 2.32; 95% CI, 1.48 to 3.62); findings were similar for Hispanic donors. The absolute prevalence of diabetes among all donors did not exceed that in the general population, but the prevalence of hypertension exceeded NHANES estimates in some subgroups. End-stage renal disease was identified in less than 1% of donors but was more common among black donors than among white donors.CONCLUSIONSAs in the general U. S. population, racial disparities in medical conditions occur among living kidney donors. Increased attention to health outcomes among demographically diverse kidney donors is needed.