社会经济劣势与晚期慢性肾脏病风险：一项涉及 140 万参与者的队列研究结果。
Socioeconomic disadvantage and the risk of advanced chronic kidney disease: results from a cohort study with 1.4 million participants.
机构信息
The George Institute for Global Health, Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK.
The George Institute for Global Health, Faculty of Medicine, University of New South Wales Sydney, Sydney, Australia.
出版信息
Nephrol Dial Transplant. 2020 Sep 1;35(9):1562-1570. doi: 10.1093/ndt/gfz059.
BACKGROUND
Several studies have investigated the effect of socioeconomic deprivation on cardiovascular disease (CVD) and diabetes; less is known about its effect on chronic kidney disease (CKD). We aimed to measure the association between deprivation, CKD Stages 4-5 and end-stage renal disease (ESRD) in a general population sample.
METHODS
This observational study examined 1 405 016 participants from the English Clinical Practice Research Datalink (2000-14), linked to hospital discharge data and death certification. Deprivation was assessed according to the participant's postcode. Cox models were used to estimate hazard ratios (HRs) for CKD Stages 4-5 and ESRD, adjusting for age and sex, and additionally for smoking status, body mass index, diabetes, systolic blood pressure, prior CVD and estimated glomerular filtration rate (eGFR) at baseline.
RESULTS
During 7.5 years of median follow-up, 11 490 individuals developed CKD Stages 4-5 and 1068 initiated ESRD. After adjustment for age and sex, the HRs and confidence interval (CI) comparing those in the 20% most deprived of the population to the 20% least deprived were 1.76 (95% CI 1.68-1.84) and 1.82 (95% CI 1.56-2.12) for CKD Stages 4-5 and ESRD, respectively. Further adjustment for known risk factors and eGFR substantially attenuated these HRs. Adding our results to all known cohort studies produced a pooled relative risk of 1.61 (95% CI 1.42-1.83) for ESRD, for comparisons between highest to lowest categories of deprivation.
CONCLUSION
Socioeconomic deprivation is independently associated with an increased hazard of CKD Stages 4-5 and ESRD, but in large part may be mediated by known risk factors.
背景
多项研究调查了社会经济贫困对心血管疾病（CVD）和糖尿病的影响，而对其对慢性肾脏病（CKD）的影响知之甚少。我们旨在衡量一般人群样本中贫困与 CKD 4-5 期和终末期肾病（ESRD）之间的关联。
方法
本观察性研究检查了来自英国临床实践研究数据链接（2000-14 年）的 1405016 名参与者，该链接与医院出院数据和死亡证明相关联。根据参与者的邮政编码评估贫困程度。使用 Cox 模型估计 CKD 4-5 期和 ESRD 的风险比（HR），调整年龄和性别，另外还调整吸烟状况、体重指数、糖尿病、收缩压、基线时的心血管疾病和估计肾小球滤过率（eGFR）。
结果
在中位随访 7.5 年期间，有 11490 人发展为 CKD 4-5 期，有 1068 人开始进行 ESRD 治疗。在校正年龄和性别后，与人口中最贫困的 20%相比，人群中最贫困的 20%的 HR 和置信区间（CI）分别为 1.76（95%CI 1.68-1.84）和 1.82（95%CI 1.56-2.12），用于 CKD 4-5 期和 ESRD。进一步调整已知风险因素和 eGFR 大大降低了这些 HR。将我们的结果加入所有已知的队列研究中，得到了一个用于 ESRD 的汇总相对风险，即最高和最低贫困类别之间的比较为 1.61（95%CI 1.42-1.83）。
结论
社会经济贫困与 CKD 4-5 期和 ESRD 的发生风险增加独立相关，但在很大程度上可能是由已知的风险因素介导的。
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