Stehman-Breen Catherine O, Gillen Daniel, Steffes Michael, Jacobs David R, Lewis Cora E, Kiefe Catarina I, Siscovick David
Departments of Medicine and Epidemiology, Seattle VA Medical Center, Seattle, Washington 98108, USA.
J Am Soc Nephrol. 2003 Sep;14(9):2352-7. doi: 10.1097/01.asn.0000083392.11042.14.
Although 11 million people in the United States have chronic renal insufficiency, little is known about ethnic/racial disparities for early-onset renal impairment. This study sought to determine whether there is an independent association between race/ethnicity and early-onset renal impairment and to identify other risk factors that might account for observed disparities. All Coronary Artery Risk Development in Young Adults subjects in which serum creatinine was measured at the year 15 examination were identified (n = 3554), excluding those who were pregnant at year 15. Potential risk factors at study entry (ages 18 to 30 yr, 1985 to 1986) included age, weight, gender, race/ethnicity, glucose, uric acid, and systolic BP. Renal impairment was defined as creatinine > or =1.5 mg/dl for men and > or = 1.2 mg/dl for women at year 15 (ages 33 to 45 yr). Fifty-two (2.7%) women and 39 (2.4%) men had renal impairment at the year 15 examination. In bivariate analyses, the odds of renal impairment among black women was estimated to be 2.4-fold that of white women, and among black men, the odds of renal impairment were 9.0-fold that of white men. In multivariate analysis, the odds of an elevated creatinine among black women compared with white women reduced to a nonsignificant 1.5-fold, whereas among men, the odds of an elevated creatinine among blacks was 11.4-fold that of whites. Although adjustment for baseline glucose levels accounted for much of the association between ethnicity and elevated creatinine among women, adjustment for weight, systolic BP, uric acid, glucose, and socioeconomic status did not account for the association between ethnicity and renal impairment among men. The data suggest that there are ethnic differences in the development of early-onset renal dysfunction. Among women, these differences are modest and largely accounted for by differences in glucose levels early in adult life. Differences in race/ethnicity related risk of early-onset renal impairment are particularly large among men and are not accounted for by the metabolic or socioeconomic factors evaluated.
尽管美国有1100万人患有慢性肾功能不全，但对于早发性肾功能损害的种族差异却知之甚少。本研究旨在确定种族与早发性肾功能损害之间是否存在独立关联，并识别可能解释所观察到的差异的其他风险因素。确定了所有在15年检查时测量了血清肌酐的青年动脉粥样硬化风险发展研究受试者（n = 3554），排除了在15岁时怀孕的受试者。研究开始时（1985年至1986年，年龄18至30岁）的潜在风险因素包括年龄、体重、性别、种族、血糖、尿酸和收缩压。肾功能损害定义为15年时（年龄33至45岁）男性肌酐≥1.5mg/dl，女性肌酐≥1.2mg/dl。在15年检查时，52名（2.7%）女性和39名（2.4%）男性患有肾功能损害。在双变量分析中，黑人女性肾功能损害的几率估计是白人女性的2.4倍，黑人男性肾功能损害的几率是白人男性的9.0倍。在多变量分析中，与白人女性相比，黑人女性肌酐升高的几率降至无统计学意义的1.5倍，而在男性中，黑人肌酐升高的几率是白人的11.4倍。尽管对基线血糖水平进行调整可解释女性种族与肌酐升高之间的大部分关联，但对体重、收缩压、尿酸、血糖和社会经济地位进行调整并不能解释男性种族与肾功能损害之间的关联。数据表明，早发性肾功能不全的发生存在种族差异。在女性中，这些差异较小，主要由成年早期血糖水平的差异所解释。早发性肾功能损害的种族相关风险差异在男性中尤为明显，且未被所评估的代谢或社会经济因素所解释。
