ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands.
UK Renal Registry, Southmead Hospital, Bristol, UK.
Nephrol Dial Transplant. 2019 Jul 1;34(7):1189-1196. doi: 10.1093/ndt/gfy155.
The epidemiology and prognosis of chronic kidney disease (CKD) differ by sex. We aimed to compare symptom prevalence and the clinical state in women and men of ≥65 years of age with advanced CKD receiving routine nephrology care.
The European QUALity study on treatment in advanced chronic kidney disease (EQUAL) study follows patients from six European countries of ≥65 years of age years whose estimated glomerular filtration rate (eGFR) dropped to ≤20 mL/min/1.73 m2 for the first time during the last 6 months. The Dialysis Symptom Index was used to assess the prevalence and severity of 33 uraemic symptoms. Data on the clinical state at baseline were collected from medical records. Prevalence was standardized using the age distribution of women as the reference.
The results in women (n = 512) and men (n = 967) did not differ with age (77.0 versus 75.7 years) or eGFR (19.0 versus 18.5). The median number of symptoms was 14 [interquartile range (IQR) 9-19] in women, and 11 (IQR 7-16) in men. Women most frequently reported fatigue {39% [95% confidence interval (CI) 34-45]} and bone/joint pain [37% (95% CI 32-42)] as severe symptoms, whereas more men reported difficulty in becoming sexually aroused [32% (95% CI 28-35)] and a decreased interest in sex [31% (95% CI 28-35)]. Anaemia [73% (95% CI 69-77) versus 85% (95% CI 82-87)] was less common in women than in men, as were smoking history and cardiovascular comorbidity. However, a diagnosis of liver disease other than cirrhosis, psychiatric disease and mild malnutrition were more common among women.
Women in secondary care with an incident eGFR ≤20 mL/min/1.73 m2 reported a higher symptom burden, while their clinical state was considered similar or even more favourable as compared with men.
慢性肾脏病（CKD）的流行病学和预后因性别而异。我们旨在比较接受常规肾病护理的≥65 岁患有晚期 CKD 的女性和男性患者的症状发生率和临床状况。
欧洲 ADVANCED 慢性肾脏病治疗质量研究（EQUAL）研究纳入了来自六个欧洲国家的年龄≥65 岁的患者，这些患者在过去 6 个月内首次出现估计肾小球滤过率（eGFR）降至≤20 mL/min/1.73 m2。使用透析症状指数评估 33 种尿毒症症状的发生率和严重程度。从病历中收集基线时的临床状况数据。使用女性年龄分布作为参考对患病率进行标准化。
女性（n=512）和男性（n=967）的结果在年龄（77.0 岁比 75.7 岁）或 eGFR（19.0 毫升/分钟/1.73 米 2 比 18.5 毫升/分钟/1.73 米 2）方面没有差异。女性报告的症状中位数为 14 项[四分位距（IQR）9-19]，男性为 11 项（IQR 7-16）。女性最常报告疲劳[39%（95%可信区间[CI] 34-45]）和骨/关节疼痛[37%（95% CI 32-42）]为严重症状，而更多的男性报告性欲减退[32%（95% CI 28-35）]和性兴趣降低[31%（95% CI 28-35）]。女性贫血[73%（95% CI 69-77）比男性贫血[85%（95% CI 82-87）]更为常见，吸烟史和心血管合并症也较少。然而，女性中除肝硬化以外的肝脏疾病、精神疾病和轻度营养不良的诊断更为常见。
在二级护理中接受 eGFR≤20 mL/min/1.73 m2 治疗的女性报告的症状负担更高，而她们的临床状况被认为与男性相似甚至更为有利。
