视网膜病变和慢性肾脏病作为全因和心血管死亡率的预测因素：1988-1994 年全国健康和营养调查（NHANES）。
Retinopathy and CKD as predictors of all-cause and cardiovascular mortality: National Health and Nutrition Examination Survey (NHANES) 1988-1994.
机构信息
Department of Medicine, University of Illinois at Chicago, Chicago, IL.
Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
出版信息
Am J Kidney Dis. 2014 Aug;64(2):198-203. doi: 10.1053/j.ajkd.2014.01.437. Epub 2014 Mar 19.
BACKGROUND
Retinopathy is associated with increased mortality risk in general populations. We evaluated the joint effect of retinopathy and chronic kidney disease (CKD) on mortality in a representative sample of U.S. adults.
STUDY DESIGN
Prospective cohort study.
SETTING & PARTICIPANTS: 7,640 adults from NHANES (National Health and Nutrition Examination Survey) 1988-1994 with mortality linkage through December 31, 2006.
PREDICTORS
CKD, defined as low estimated glomerular filtration rate (<60 mL/min/1.73 m2) or albuminuria (urine protein-creatinine ratio ≥30 mg/g), and retinopathy, defined as the presence of microaneurysms, hemorrhages, exudates, microvascular abnormalities, or other evidence of diabetic retinopathy by fundus photograph.
OUTCOMES
All-cause and cardiovascular mortality.
MEASUREMENTS
Multivariable-adjusted Cox proportional hazards.
RESULTS
Overall, 4.6% of participants had retinopathy and 15% had CKD. Mean age was 56 years, 53% were women, and 81% were non-Hispanic whites. The prevalence of retinopathy in patients with CKD was 11%. We identified 2,634 deaths during 14.5 years' follow-up. In multivariable analyses, compared with individuals with neither CKD nor retinopathy, HRs for all-cause mortality were 1.02 (95% CI, 0.75-1.38), 1.52 (95% CI, 1.35-1.72), and 2.39 (95% CI, 1.77-3.22) for individuals with retinopathy only, those with CKD only, and those with both CKD and retinopathy, respectively. Corresponding HRs for cardiovascular mortality were 0.96 (95% CI, 0.50-1.84), 1.72 (95% CI, 1.47-2.00), and 2.96 (95% CI, 2.11-4.15), respectively. There was a significant synergistic interaction between retinopathy and CKD on all-cause mortality (P=0.04).
LIMITATIONS
The presence of retinopathy was evaluated only once. Small sample size of some of the subpopulations studied.
CONCLUSIONS
In the presence of CKD, retinopathy is a strong predictor of mortality in this adult population.
背景
视网膜病变与一般人群的死亡风险增加有关。我们评估了视网膜病变和慢性肾脏病（CKD）对美国成年人代表性样本死亡率的联合影响。
研究设计
前瞻性队列研究。
研究地点和参与者
来自 NHANES（国家健康和营养检查调查）1988-1994 年的 7640 名成年人，通过 2006 年 12 月 31 日的死亡联系。
预测因素
CKD 定义为低估计肾小球滤过率（<60 mL/min/1.73 m2）或白蛋白尿（尿蛋白-肌酐比≥30 mg/g），视网膜病变定义为微动脉瘤、出血、渗出、微血管异常或眼底照片中其他糖尿病视网膜病变的证据。
结果
全因和心血管死亡率。
测量
多变量调整的 Cox 比例风险。
结果
总体而言，4.6%的参与者有视网膜病变，15%有 CKD。平均年龄为 56 岁，53%为女性，81%为非西班牙裔白人。CKD 患者中视网膜病变的患病率为 11%。在 14.5 年的随访中，我们共确定了 2634 例死亡。在多变量分析中，与既无 CKD 也无视网膜病变的个体相比，仅视网膜病变、仅 CKD 和同时患有 CKD 和视网膜病变的个体的全因死亡率的 HR 分别为 1.02（95%CI，0.75-1.38）、1.52（95%CI，1.35-1.72）和 2.39（95%CI，1.77-3.22）。心血管死亡率的相应 HR 分别为 0.96（95%CI，0.50-1.84）、1.72（95%CI，1.47-2.00）和 2.96（95%CI，2.11-4.15）。视网膜病变和 CKD 对全因死亡率存在显著协同交互作用（P=0.04）。
局限性
仅评估了一次视网膜病变的存在。研究的一些亚组样本量较小。
结论
在存在 CKD 的情况下，视网膜病变是该成年人群死亡率的一个强有力预测因素。
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