Division of Nephrology Kidney CARE Program, University of Cincinnati, Cincinnati, Ohio, USA,
Department of Family and Community Medicine, University of Cincinnati, Cincinnati, Ohio, USA.
Am J Nephrol. 2019;49(3):241-253. doi: 10.1159/000497446. Epub 2019 Feb 28.
Racial minorities and women constitute substantial portions of the incident and prevalent end-stage renal disease (ESRD) population in the United States. Although ESRD is characterized by high mortality, temporal trends, and race and sex differences in mortality have not been studied.
We evaluated 944,650 adult patients who initiated dialysis between January 1, 2005 and December 31, 2014, using the United States Renal Data System, for sex-related and race-related trends in mortality. Logistic regression models adjusted for pre-dialysis health status were used to examine associations among the predictors' sex, race, and year of incident dialysis, and the outcome all-cause mortality at 1-year post ESRD.
The mean age was 65 ± 14 years. The 1-year crude mortality rates in incident ESRD patients decreased by 28% from 2004 to 2015. Risk-adjusted 1-year mortality decreased by 3% for each later year of incident ESRD (p < 0.001). In general, from 2005 to 2014, mortality rates decreased across both sexes, and all races. White patients experienced the lowest reduction in adjusted 1-year mortality rates (16%). While women experienced a survival advantage over men in 2005, by 2014 it was reversed to survival advantage for men. Combining all years, the adjusted risk of dying at 1-year after initiating dialysis was lower in women than men (OR 0.98; 95% CI 0.97-0.99), and as compared to whites, was lower in blacks (OR 0.73; 95% CI -0.72-0.74), Hispanics (OR 0.64; 95% CI 0.63-0.65), Asians (OR 0.55; 95% CI 0.53-0.56), and Native Americans (OR 0.67; 95% CI 0.63-0.71).
The 1-year mortality rates among patients with ESRD have decreased steadily during a recent 10-year period across both men and women, and in all 5 races. Women have only a 2% lower risk of dying at 1-year after dialysis initiation than men. White patients had higher mortality as compared to other races. Our results suggest the need for sex, and race-specific treatment strategies in ESRD care.
在美国，少数族裔和女性在发病和普遍的终末期肾病（ESRD）人群中占很大比例。尽管 ESRD 的特点是死亡率高，但死亡率的时间趋势以及种族和性别差异尚未得到研究。
我们使用美国肾脏数据系统评估了 2005 年 1 月 1 日至 2014 年 12 月 31 日期间开始透析的 944,650 名成年患者，以研究死亡率的性别和种族相关趋势。使用逻辑回归模型调整了透析前的健康状况，以检查预测因子的性别、种族和透析发病年份与 ESRD 后 1 年全因死亡率之间的关联。
患者的平均年龄为 65±14 岁。从 2004 年到 2015 年，新发病 ESRD 患者的 1 年粗死亡率下降了 28%。风险调整后的 1 年死亡率每延迟一年发病 ESRD 下降 3%（p<0.001）。一般来说，从 2005 年到 2014 年，两性和所有种族的死亡率都有所下降。白人患者调整后 1 年死亡率下降幅度最小（16%）。虽然 2005 年女性的生存优势超过男性，但到 2014 年，男性的生存优势已转变为女性。综合所有年份，女性在开始透析后 1 年的死亡风险低于男性（OR 0.98；95%CI 0.97-0.99），与白人相比，黑人（OR 0.73；95%CI -0.72-0.74）、西班牙裔（OR 0.64；95%CI 0.63-0.65）、亚洲人（OR 0.55；95%CI 0.53-0.56）和美洲原住民（OR 0.67；95%CI 0.63-0.71）的风险较低。
在最近的 10 年期间，男性和女性以及所有 5 个种族的 ESRD 患者的 1 年死亡率均稳步下降。女性在透析开始后 1 年的死亡风险比男性低 2%。与其他种族相比，白人患者的死亡率更高。我们的研究结果表明，需要制定针对 ESRD 护理的性别和种族特异性治疗策略。
