Chronic kidney disease and the risk for cardiovascular disease, renal replacement, and death in the United States medicare population, 1998 to 1999
Chronic kidney disease and the risk for cardiovascular disease, renal replacement, and death in the United States medicare population, 1998 to 1999
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DOI：
10.1681/asn.2004030203
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发表时间：
2005-02-01
影响因子：
13.6
通讯作者：
Collins, AJ
中科院分区：
文献类型：
--
作者：
Foley, RN;Murray, AM;Collins, AJ
了解特定心血管综合征带来的过度风险有助于制定降低慢性肾脏病（CKD）患者过早死亡率的策略。比较了1998年和1999年美国医疗保险人群中5%样本（n = 1，091，201）的动脉粥样硬化性血管疾病、充血性心力衰竭、肾脏替代治疗和死亡率。患者分为以下组：1，无糖尿病，无CKD（79.7%）; 2，糖尿病，无CKD（16.5%）; 3，CKD，无糖尿病（2.2%）; 4，CKD和糖尿病（1.6%）。在2年的随访期间，（每100患者-年）分别为：动脉粥样硬化性血管疾病14.1、25.3、35.7和49.1;充血性心力衰竭8.6、18.5、30.7和52.3;肾脏替代治疗0.04、0.2、1.6和3.4;死亡率分别为5.5、8.1、17.7和19.9（P < 0.0001）。使用考克斯回归，相应的校正风险比如下：动脉粥样硬化性血管疾病，1，1.30，1.16和1.41（P < 0.0001）;充血性心力衰竭，1、1.44、1.28和1.79肾脏替代治疗组分别为1、2.52、23.1和38.9（P < 0.0001）;死亡组分别为1、1.21、1.38和1.56（P < 0.0001）。在相对基础上，CKD患者发生最不常见的研究结局（肾脏替代治疗）的风险要高得多。然而，在绝对基础上，CKD患者的高死亡率可能反映了动脉粥样硬化性血管疾病和充血性心力衰竭的加速发生率。
Knowledge of the excess risk posed by specific cardiovascular syndromes could help in the development of strategies to reduce premature mortality among patients with chronic kidney disease (CKD). The rates of atherosclerotic vascular disease, congestive heart failure, renal replacement therapy, and death were compared in a 5% sample of the United States Medicare population in 1998 and 1999 (n = 1,091,201). Patients were divided into the following groups: 1, no diabetes, no CKD (79.7%); 2, diabetes, no CKD (16.5%); 3, CKD, no diabetes (2.2%); and 4, both CKD and diabetes (1.6%). During the 2 yr of follow-up, the rates (per 100 patient-years) in the four groups were as follows: atherosclerotic vascular disease, 14.1, 25.3, 35.7, and 49.1; congestive heart failure, 8.6, 18.5, 30.7, and 52.3; renal replacement therapy, 0.04, 0.2, 1.6, and 3.4; and death, 5.5, 8.1, 17.7, and 19.9, respectively (P < 0.0001). With use of Cox regression, the corresponding adjusted hazards ratios were as follows: atherosclerotic vascular disease, 1, 1.30, 1.16, and 1.41 (P < 0.0001); congestive heart failure, 1, 1.44, 1.28, and 1.79 (P < 0.0001); renal replacement therapy, 1, 2.52, 23.1, and 38.9 (P < 0.0001); and death, 1, 1.21, 1.38, and 1.56 (P < 0.0001). On a relative basis, patients with CKD were at a much greater risk for the least frequent study outcome, renal replacement therapy. On an absolute basis, however, the high death rates of patients with CKD may reflect accelerated rates of atherosclerotic vascular disease and congestive heart failure.