Kidney Research Institute, University of Washington, 325 Ninth Avenue, Box 359606, Seattle, WA 98104, USA.
Clin J Am Soc Nephrol. 2010 May;5(5):828-35. doi: 10.2215/CJN.09011209. Epub 2010 Mar 3.
In the United States, relatively little is known about clinical outcomes of chronic kidney disease (CKD) in vulnerable populations utilizing public health systems. The primary study objectives were to describe patient characteristics, incident ESRD, and mortality in adults with nondialysis-dependent CKD receiving care in the health care safety net.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Time to ESRD and time to death were examined among a cohort of 15,353 ambulatory adults with nondialysis-dependent CKD from the Community Health Network of San Francisco.
The mean age of the CKD cohort was 59.0 +/- 13.8 years; 50% of the cohort was younger than 60 years and 26% was younger than 50 years. Most (72%) were members of nonwhite racial-ethnic groups, 73% were indigent (annual income <$15,000) and 18% were uninsured. In adjusted analyses, blacks [hazard ratio (95% confidence interval), 4.00 (2.99 to 5.35)], Hispanics [2.20 (1.46 to 3.30)], and Asians/Pacific Islanders [3.84 (2.73 to 5.40)] had higher risks of progression to ESRD than non-Hispanic whites. The higher risk of progression to ESRD among nonwhite compared with white persons with CKD was not explained by lower relative mortality.
Adults with CKD stages 3 to 5 cared for within an urban public health system were relatively young and predominantly nonwhite-both factors associated with a higher risk of progression to ESRD. These findings call for targeted efforts to assess the burden and progression of CKD within other public and safety-net health systems in this country.
在美国，利用公共卫生系统，对弱势人群的慢性肾脏病（CKD）的临床结局知之甚少。主要研究目的是描述在医疗保健安全网中接受护理的非透析依赖型 CKD 成人患者的患者特征、ESRD 事件和死亡率。
设计、地点、参与者和测量方法：对旧金山社区卫生网络的 15353 名非透析依赖型 CKD 门诊成人队列的 ESRD 时间和死亡时间进行了研究。
CKD 队列的平均年龄为 59.0 +/- 13.8 岁；50%的队列年龄小于 60 岁，26%的队列年龄小于 50 岁。大多数（72%）是非白人种族群体，73%是贫困者（年收入<15000 美元），18%没有保险。在调整分析中，黑人[风险比（95%置信区间），4.00（2.99 至 5.35）]、西班牙裔[2.20（1.46 至 3.30）]和亚洲/太平洋岛民[3.84（2.73 至 5.40）]进展为 ESRD 的风险高于非西班牙裔白人。与 CKD 白人相比，非白人进展为 ESRD 的风险较高，这并不是因为相对死亡率较低。
在城市公共卫生系统中接受治疗的 CKD 3 至 5 期的成年人相对较年轻，且主要是非白人，这两个因素都与进展为 ESRD 的风险较高有关。这些发现呼吁在该国其他公共和安全网卫生系统中针对 CKD 的负担和进展情况进行有针对性的评估。
