Fischer Michael J, Hsu Jesse Y, Lora Claudia M, Ricardo Ana C, Anderson Amanda H, Bazzano Lydia, Cuevas Magdalena M, Hsu Chi-Yuan, Kusek John W, Renteria Amada, Ojo Akinlolu O, Raj Dominic S, Rosas Sylvia E, Pan Qiang, Yaffe Kristine, Go Alan S, Lash James P
Department of Medicine, University of Illinois at Chicago, Chicago, Illinois;
Medical Service, Jesse Brown VA Medical Center, Chicago, Illinois.
J Am Soc Nephrol. 2016 Nov;27(11):3488-3497. doi: 10.1681/ASN.2015050570. Epub 2016 May 5.
Although recommended approaches to CKD management are achieved less often in Hispanics than in non-Hispanics, whether long-term outcomes differ between these groups is unclear. In a prospective longitudinal analysis of participants enrolled into the Chronic Renal Insufficiency Cohort (CRIC) and Hispanic-CRIC Studies, we used Cox proportional hazards models to determine the association between race/ethnicity, CKD progression (50% eGFR loss or incident ESRD), incident ESRD, and all-cause mortality, and linear mixed-effects models to assess differences in eGFR slope. Among 3785 participants, 13% were Hispanic, 43% were non-Hispanic white (NHW), and 44% were non-Hispanic black (NHB). Over a median follow-up of 5.1 years for Hispanics and 6.8 years for non-Hispanics, 27.6% of all participants had CKD progression, 21.3% reached incident ESRD, and 18.3% died. Hispanics had significantly higher rates of CKD progression, incident ESRD, and mean annual decline in eGFR than did NHW (P<0.05) but not NHB. Hispanics had a mortality rate similar to that of NHW but lower than that of NHB (P<0.05). In adjusted analyses, the risk of CKD progression did not differ between Hispanics and NHW or NHB. However, among nondiabetic participants, compared with NHB, Hispanics had a lower risk of CKD progression (hazard ratio, 0.61; 95% confidence interval, 0.39 to 0.95) and incident ESRD (hazard ratio, 0.50; 95% confidence interval, 0.30 to 0.84). At higher levels of urine protein, Hispanics had a significantly lower risk of mortality than did non-Hispanics (P<0.05). Thus, important differences in CKD progression and mortality exist between Hispanics and non-Hispanics and may be affected by proteinuria and diabetes.
尽管与非西班牙裔相比，西班牙裔患者较少采用推荐的慢性肾脏病（CKD）管理方法，但这两组患者的长期预后是否存在差异尚不清楚。在一项对纳入慢性肾功能不全队列（CRIC）和西班牙裔CRIC研究的参与者进行的前瞻性纵向分析中，我们使用Cox比例风险模型来确定种族/族裔、CKD进展（估计肾小球滤过率[eGFR]下降50%或新发终末期肾病[ESRD]）、新发ESRD和全因死亡率之间的关联，并使用线性混合效应模型来评估eGFR斜率的差异。在3785名参与者中，13%为西班牙裔，43%为非西班牙裔白人（NHW），44%为非西班牙裔黑人（NHB）。西班牙裔的中位随访时间为5.1年，非西班牙裔为6.8年，所有参与者中有27.6%出现CKD进展，21.3%达到新发ESRD，18.3%死亡。与NHW相比，西班牙裔的CKD进展、新发ESRD和eGFR平均年下降率显著更高（P<0.05），但与NHB相比则不然。西班牙裔的死亡率与NHW相似，但低于NHB（P<0.05）。在调整分析中，西班牙裔与NHW或NHB之间的CKD进展风险没有差异。然而，在非糖尿病参与者中，与NHB相比，西班牙裔的CKD进展风险较低（风险比，0.61；95%置信区间，0.39至0.95），新发ESRD风险也较低（风险比，0.50；95%置信区间，0.30至0.84）。在尿蛋白水平较高时，西班牙裔的死亡风险显著低于非西班牙裔（P<0.05）。因此，西班牙裔和非西班牙裔在CKD进展和死亡率方面存在重要差异，可能受蛋白尿和糖尿病影响。
