Racial differences in the prevalence of chronic kidney disease among participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study
Racial differences in the prevalence of chronic kidney disease among participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study
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DOI：
10.1681/asn.2005111200
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发表时间：
2006-06-01
影响因子：
13.6
通讯作者：
Howard, George
中科院分区：
文献类型：
--
作者：
McClellan, William;Warnock, David G.;Howard, George
终末期肾病（ESRD）发病率存在种族差异，美国黑人患病风险比白人高3 - 4倍，但在肾功能受损较轻的患病率方面，黑人和白人之间却没有这种差异。采用肾脏病饮食改良研究（MDRD）的四变量方程，对“地理和种族差异对卒中的影响”（REGARDS）研究中的参与者进行评估，以了解随着肾功能受损严重程度增加，黑人和白人肾功能受损患病率的情况。REGARDS研究是一项具有全国代表性的、基于人群的队列研究，研究对象为45岁及以上人群。在20667名REGARDS研究参与者中，估计的肾小球滤过率（eGFR）<60 ml/min/1.73 m²的比例为43.3%，黑人患者中的患病率略低于白人患者（33.7%对49.9%；患病优势比为0.51；95%置信区间[CI]为0.48 - 0.54）。随着eGFR下降，黑人患者中较低的患病率并不一致。在控制其他患者特征后，当eGFR为50 - 59 ml/min/1.73 m²时，黑人与白人的优势比为0.42（95% CI为0.40 - 0.46），而当eGFR为10 - 19 ml/min/1.73 m²时，该优势比增加至1.73（95% CI为1.02 - 2.94）。随着肾功能受损严重程度增加，白人与黑人患者肾功能受损患病率的差异发生了逆转。导致黑人患者严重肾功能受损患病率增加的因素仍有待确定。
The racial disparity in the incidence of ESRD exemplified by the three- to four-fold excess risk among black compared with white individuals in the United States is not reflected in the prevalence of less severe degrees of impaired kidney function among black compared with white individuals. The four-variable Modification of Diet in Renal Disease study equation was used to evaluate the black-to-white prevalence of impaired kidney function with increasing severity of impairment among participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a nationally representative, population-based cohort of individuals who are 45 yr and older. An estimated GFR (eGFR) < 60 ml/min per 1.73 m(2) was present in 43.3% of the 20,667 REGARDS participants and was slightly less prevalent among black than white patients (33.7 versus 49.9%; prevalence odds ratio 0.51; 95% confidence interval [CI] 0.48 to 0.54). The lower prevalence among black patients was not uniform as eGFR declined. After controlling for other patient characteristics, the black-to-white odds ratio was 0.42 (95% CI 0.40 to 0.46) at an eGFR of 50 to 59 ml/min per 1.73 m(2) and increased to 1.73 (95% CI 1.02 to 2.94) at an eGFR of 10 to 19 ml/min per 1.73 m(2). The disparity in prevalence of impaired kidney function among white compared with black patients reversed as the severity of impaired kidney function increased. Factors that are responsible for the increasing prevalence of severely impaired kidney function among black patients remain to be determined.