Lopes Antonio Alberto
Department of Medicine of the Federal University of Bahia, Salvador, Brazil.
Adv Ren Replace Ther. 2004 Jan;11(1):14-23. doi: 10.1053/j.arrt.2003.10.006.
In the United States, the incidence of end-stage renal disease (ESRD) is much higher for blacks, Native Americans, and Asians than for whites. The incidence of kidney disease is also higher for populations of Hispanic ethnicity. ESRD attributed to diabetes (ESRD-DM), hypertension (ESRD-HT), and glomerulonephritis (ESRD-GN), in this order of frequency, are the major categories of ESRD in the United States for all race/ethnic groups. By using the incidence rates of ESRD, during the period from 1997 through 2000, and with whites as reference, the highest rate ratio (RR) was observed for ESRD-HT in blacks (RR = 5.96), ESRD-DM in Native Americans (RR = 5.11), and ESRD-GN in Asians (RR=2.20). The data suggest that the excess of ESRD observed for racial/ethnic minorities may be reduced by interventions aimed at prevention/control of hypertension and diabetes. The data suggest that before developing ESRD, patients with chronic renal failure from minority groups have to face more barriers to receive high-quality health care. This may explain why they see nephrologists later and are less likely to receive renal transplantation at initiation of renal replacement therapy (RRT). Improvements in quality of care after initiating RRT may explain the lower mortality and higher scores in heath-related quality of life observed for patients from racial/ethnic minorities.
在美国，黑人、美洲原住民和亚洲人终末期肾病（ESRD）的发病率远高于白人。西班牙裔人群的肾病发病率也较高。按发生频率依次排列，归因于糖尿病（ESRD-DM）、高血压（ESRD-HT）和肾小球肾炎（ESRD-GN）的ESRD是美国所有种族/族裔群体中ESRD的主要类型。通过使用1997年至2000年期间ESRD的发病率，并以白人为参照，黑人中ESRD-HT的发病率比值（RR）最高（RR = 5.96），美洲原住民中ESRD-DM的发病率比值最高（RR = 5.11），亚洲人中ESRD-GN的发病率比值最高（RR = 2.20）。数据表明，针对高血压和糖尿病的预防/控制干预措施可能会降低少数种族/族裔群体中观察到的ESRD超额发病率。数据表明，少数群体的慢性肾衰竭患者在发展为ESRD之前，在获得高质量医疗保健方面必须面对更多障碍。这可能解释了为什么他们看肾病专家的时间较晚，并且在开始肾脏替代治疗（RRT）时接受肾移植的可能性较小。开始RRT后护理质量的改善可能解释了少数种族/族裔患者观察到的较低死亡率和较高的健康相关生活质量评分。
