Peripheral arterial disease and renal transplantation
Peripheral arterial disease and renal transplantation
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DOI：
10.1681/asn.2006030201
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发表时间：
2006-07-01
影响因子：
13.6
通讯作者：
Maclean, R
中科院分区：
文献类型：
--
作者：
Snyder, JJ;Kasiske, BL;Maclean, R
据推测，肾移植后外周动脉疾病(PAD)的发生率低于等待已故供者名单上的可比患者。对1995年至2003年间被列入肾移植等待名单的43,427名成人移植受者和53,309名成年人的PAD累积发生率和危险因素进行了比较。所有患者都有联邦医疗保险的基本保险，并使用联邦医疗保险索赔来确定PAD。对于糖尿病患者，3年内新发PAD的累积发生率在等待名单上为24%，而在移植后为20%。对于非糖尿病患者，3年累积发病率在等待名单上为9%，而在移植后为5%。在非糖尿病患者中，移植人群与等待名单人群相比，调整后的PAD相对危险度(RR)为0.73(95%可信区间为0.66~0.80；P<；0.0001)，而在糖尿病患者中为0.88(95%CI为0.82~0.96；P=0.0024)。在等待名单上被诊断为PAD与非糖尿病患者(2.98；95%可信区间2.71至3.27；P<；0.0001)和糖尿病患者(2.92；95%可信区间2.71至3.15；P<；0.0001)死亡风险增加近三倍相关。移植后，在非糖尿病患者(1.92；95%可信区间1.63至2.26；P<；0.0001)和糖尿病患者(1.83；95%CI 1.58至2.12；P<；0.0001)中，De-nevo Pad使死亡风险增加了近两倍。与移植后相比，PAD在等待名单上的发病率更高，并且与糖尿病患者和非糖尿病患者死亡风险的增加有关。
It was hypothesized that peripheral arterial disease (PAD) is less frequent after kidney transplantation than among comparable patients who are on the deceased-donor waiting list. The cumulative incidences and risk factors for PAD were compared among 43,427 adult transplant recipients and 53,309 adults who were placed on the renal transplant waiting list between 1995 and 2003. All patients had Medicare primary insurance coverage, and Medicare claims were used to identify PAD. For patients with diabetes, the 3-yr cumulative incidence of de novo PAD was 24% on the waiting list versus 20% after transplantation. For patients without diabetes, the 3-yr cumulative incidence was 9% on the waiting list versus 5% after transplantation. The adjusted relative risk (RR) for PAD among patients without diabetes was 0.73 (95% confidence interval [CI] 0.66 to 0.80; P < 0.0001) in the transplant population versus the waiting list population, whereas among patients with diabetes, it was 0.88 (95% CI 0.82 to 0.96; P = 0.0024). A diagnosis of PAD on the waiting list was associated with an almost three-fold increase in the RR for death for patients without diabetes (2.98; 95% CI 2.71 to 3.27; P < 0.0001) and with diabetes (2.92; 95% CI 2.71 to 3.15; P < 0.0001). After transplantation, de novo PAD increased the RR for death almost two-fold in patients without diabetes (1.92; 95% CI 1.63 to 2.26; P < 0.0001) and with diabetes (1.83; 95% Cl 1.58 to 2.12; P < 0.0001). The incidence of PAD is higher on the waiting list than after transplantation and is associated with an increased risk for death among patients with and without diabetes.