Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Kidney Int. 2019 Nov;96(5):1217-1233. doi: 10.1016/j.kint.2019.07.024. Epub 2019 Aug 30.
Rates of chronic kidney disease (CKD) progression, end stage kidney disease (ESKD), all-cause mortality, and cardiovascular (CVD) events among individuals with CKD vary widely across countries. Well-characterized demographic, comorbidity, and laboratory markers captured for prospective cohorts may explain, in part, such differences. To investigate whether core characteristics of individuals with CKD explain differences in rates of outcomes, we conducted an individual-level analysis of eight studies that are part of iNET-CKD, an international network of CKD cohort studies. Overall, the rate of CKD progression was 40 events/1000 person-year (95% confidence interval 39 - 41), 28 (27 - 29) for ESKD, 41 (40 - 42) for death, and 29 (28 - 30) for CVD events. However, standardized rates were highly heterogeneous across studies (over 92.5%). Interactions by study group on the association between baseline characteristics and outcomes were then identified. For example, the adjusted hazard ratio for CKD progression was 0.44 (95% confidence interval 0.35 - 0.56) for women vs. men among the Japanese (CKD-JAC), while it was 0.66 (0.59 - 0.75) among the Uruguayan (NRHP). The adjusted hazard ratio for ESKD was 2.02 (95% CI 1.88 - 2.17) per 10 units lower baseline eGFR among Americans (CRIC), while it was 3.01 (2.57 - 3.53) among Canadians (CanPREDDICT) (significant interaction for comparisons across all studies). The risks of CKD progression, ESKD, death, and CVD vary across countries even after accounting for the distributions of age, sex, comorbidities, and laboratory markers. Thus, our findings support the need for a better understanding of specific factors in different populations that explain this variation.
在患有慢性肾脏病（CKD）的个体中，CKD 进展、终末期肾脏病（ESKD）、全因死亡率和心血管（CVD）事件的发生率在各国之间差异很大。前瞻性队列研究中捕获的特征明确的人口统计学、合并症和实验室标志物可以部分解释这些差异。为了研究 CKD 个体的核心特征是否可以解释结局发生率的差异，我们对 iNET-CKD 国际 CKD 队列研究网络的 8 项研究进行了个体水平分析。总体而言，CKD 进展的发生率为 40 例/1000 人年（95%置信区间 39-41），ESKD 为 28（27-29），死亡为 41（40-42），CVD 事件为 29（28-30）。然而，标准化率在研究之间差异很大（超过 92.5%）。然后确定了基于研究组的基线特征与结局之间的关联的交互作用。例如，在日本（CKD-JAC）人群中，与男性相比，女性的 CKD 进展调整后风险比为 0.44（95%置信区间 0.35-0.56），而在乌拉圭（NRHP）人群中为 0.66（0.59-0.75）。在美国（CRIC）人群中，基线 eGFR 每降低 10 个单位，ESKD 的调整后风险比为 2.02（95%CI 1.88-2.17），而在加拿大（CanPREDDICT）人群中为 3.01（2.57-3.53）（所有研究比较的显著交互作用）。即使考虑到年龄、性别、合并症和实验室标志物的分布，CKD 进展、ESKD、死亡和 CVD 的风险在各国之间也存在差异。因此，我们的研究结果支持需要更好地了解不同人群中解释这种差异的特定因素。
