Department of Medicine, University of British Columbia, Vancouver, Canada.
Nephrol Dial Transplant. 2010 Nov;25(11):3663-72. doi: 10.1093/ndt/gfq189. Epub 2010 Apr 5.
Ethnic differences in chronic kidney disease (CKD) progression are not well characterized but are of interest across and within countries.
We followed up a large CKD cohort of patients of three different ethnic origins [Caucasian, Oriental Asian (OA) and South Asian (SA)] from time of nephrology referral in a universal health care system. Key outcomes were time to death and/or renal replacement therapy (RRT) and rate of decline in estimated GFR (eGFR). The effects of known predictors (blood pressure, proteinuria, age, sex, diabetes, cardiovascular disease and medications) and of other laboratory abnormalities were assessed using multivariate modelling techniques, including both Cox proportional hazards and competing risk approach.
The cohort comprised 3444 patients (2626 Caucasians, 397 OA and 421 SA). All-cause mortality rates are higher in Caucasians than SA or OA [hazard ratio (HR) 0.693 and 0.803, P < 0.05]. OA and SA have higher risks of progressing to RRT (HR 1.281 and 1.349, P < 0.05) and lower risks of death before RRT (HR 0.718 and 0.520, P < 0.05) compared to Caucasians after adjustment for usual risk factors. However, when adjusted for additional laboratory abnormalities, differences did not persist for progression, but did for survival advantage of Asians. The median rate of decline in eGFR (in millilitres per minute per 1.73 m(2)) was significantly slower in Caucasians (-2.11) than in OA (-2.93) or SA (-3.56), P = 0.027.
Asians appear to have faster CKD progression and lower mortality rates compared to Caucasians. This effect is not explained by the usual variables, but rates of progression may be related to differences in severity of laboratory abnormalities at different CKD stages. Further research is needed to understand the implications of these findings.
慢性肾脏病（CKD）进展过程中的种族差异尚未得到充分描述，但在不同国家和同一国家内都具有重要意义。
我们对一个普遍的医疗保健系统中来自三个不同种族（白人、东方亚洲人（OA）和南亚人（SA））的大量 CKD 患者队列进行了随访。主要结局是死亡和/或肾脏替代治疗（RRT）的时间以及估计肾小球滤过率（eGFR）的下降速度。使用多元建模技术评估了已知预测因素（血压、蛋白尿、年龄、性别、糖尿病、心血管疾病和药物）以及其他实验室异常的影响，包括 Cox 比例风险和竞争风险方法。
该队列包括 3444 名患者（2626 名白人、397 名 OA 和 421 名 SA）。白人的全因死亡率高于 SA 或 OA [危险比（HR）0.693 和 0.803，P <0.05]。在调整了常见风险因素后，与白人相比，OA 和 SA 进展为 RRT 的风险更高（HR 1.281 和 1.349，P <0.05），而在接受 RRT 之前死亡的风险更低（HR 0.718 和 0.520，P <0.05）。然而，当调整了其他实验室异常后，进展差异不再存在，但亚洲人的生存优势仍然存在。eGFR 下降的中位数速率（以毫升/分钟/1.73m2 表示）在白种人（-2.11）中明显低于 OA（-2.93）或 SA（-3.56），P=0.027。
与白人相比，亚洲人似乎具有更快的 CKD 进展速度和更低的死亡率。这种影响不能用常见变量来解释，但进展速度可能与不同 CKD 阶段实验室异常严重程度的差异有关。需要进一步研究以了解这些发现的意义。
