巴西腹膜透析新发病例患者队列研究：民族与生存率的相关性。

Association of ethnicity and survival in peritoneal dialysis: a cohort study of incident patients in Brazil.

机构信息

Department of Medicine, Federal University of Juiz de Fora, Minas Gerais, Brazil.

出版信息

Am J Kidney Dis. 2013 Jul;62(1):89-96. doi: 10.1053/j.ajkd.2013.02.364. Epub 2013 Apr 13.

DOI:10.1053/j.ajkd.2013.02.364

PMID:23591290

Abstract

BACKGROUND

There are no available epidemiologic studies about the impact of ethnicity on outcomes of patients treated with peritoneal dialysis (PD) in South America. This study aims to assess the effect of ethnicity on the mortality of incident PD patients in Brazil.

STUDY DESIGN

Prospective observational cohort study of incident patients treated with PD.

SETTINGS & PARTICIPANTS: Patients 18 years or older who started PD therapy between December 2004 and October 2007 in 114 Brazilian dialysis centers.

PREDICTORS

Self-reported ethnicity defined by the Brazilian Institute of Geography and Statistics as black and brown versus white patients and baseline demographic, socioeconomic, clinical, and laboratory data were collected at baseline.

OUTCOME

Mortality, using cumulative mortality curves in which kidney transplantation and transfer to hemodialysis therapy were treated as competing end points. Multivariate Cox proportional hazards analysis was used to adjust for gradually more potential explanatory variables, censored for kidney transplantation and transfer to hemodialysis therapy. Analyses were performed for all patients, as well as stratified for elderly (aged ≥65 years) and nonelderly patients.

RESULTS

1,370 patients were white, 516 were brown, and 273 were black. The competing-risk model showed higher mortality in white patients compared with black and brown patients. With white patients as the reference, Cox proportional hazards analysis showed a crude HR for mortality of 0.77 (95% CI, 0.56-1.05) for black and 0.74 (95% CI, 0.59-0.94) for brown patients. After adjusting for potential explanatory factors, HRs were 0.67 (95% CI, 0.48-0.95) and 0.77 (95% CI, 0.43-1.01), respectively. The same results were observed in elderly and nonelderly patients.

LIMITATIONS

Ethnicity was self-determined and some misclassification might have occurred.

CONCLUSIONS

Black and brown Brazilian incident PD patients have a lower mortality risk compared with white patients.

摘要

背景

目前尚无关于南美人种对腹膜透析（PD）治疗患者结局影响的流行病学研究。本研究旨在评估人种对巴西 PD 患者死亡率的影响。

研究设计

对接受 PD 治疗的新发病例患者进行前瞻性观察队列研究。

研究地点和参与者

2004 年 12 月至 2007 年 10 月期间，在巴西 114 家透析中心接受 PD 治疗的年龄≥18 岁的患者。

预测因素

巴西地理统计局定义的自我报告人种，分为黑人和棕色人种与白人患者，基线人口统计学、社会经济学、临床和实验室数据在基线时收集。

结局

死亡率，采用累积死亡率曲线，将肾移植和转为血液透析治疗作为竞争终点。多变量 Cox 比例风险分析用于调整逐渐更多的潜在解释变量，对肾移植和转为血液透析治疗进行删失。对所有患者进行分析，并对老年（≥65 岁）和非老年患者进行分层分析。

结果

1370 例患者为白人，516 例为棕色人种，273 例为黑人。竞争风险模型显示，白人患者的死亡率高于黑人患者和棕色人种患者。以白人患者为参照，Cox 比例风险分析显示，黑人患者死亡率的粗 HR 为 0.77（95%CI，0.56-1.05），棕色人种患者为 0.74（95%CI，0.59-0.94）。调整潜在解释因素后，HR 分别为 0.67（95%CI，0.48-0.95）和 0.77（95%CI，0.43-1.01）。在老年和非老年患者中也观察到了相同的结果。