成人脊柱裂患者发生晚期慢性肾脏病的风险。
Risk of advanced chronic kidney disease among adults with spina bifida.
机构信息
Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI.
Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI.
出版信息
Ann Epidemiol. 2020 Mar;43:71-74.e1. doi: 10.1016/j.annepidem.2020.01.003. Epub 2020 Jan 10.
PURPOSE
Adults with spina bifida (SB) may be susceptible to accelerated progression of chronic kidney disease (CKD) to advanced stages. However, little is known regarding risk of advanced CKD for this underserved population. The objective was to estimate the risk of advanced CKD among adults with vs. without SB.
METHODS
Data were from Optum Clinformatics Data Mart. Adults (18+ years) without advanced CKD (CKD stages 4+) in 2013 were followed from 01/01/2014 to advanced CKD, death, loss to follow-up, or 12/31/2017. Diagnostic, procedure, and diagnosis-related group codes were used to identify SB, advanced CKD, and baseline cardiovascular diseases, hypertension, and diabetes. Incidence rate (IR) and IR ratio and their 95% confidence intervals (CIs) of advanced CKD were estimated. Cox regression estimated adjusted hazard ratio (HR) for incidence of advanced CKD.
RESULTS
The crude IR of advanced CKD was 7.40 for adults with SB (n = 4295) and 6.25 for adults without SB (n = 6.6 M). After adjusting for demographics, adults with SB had greater risk of advanced CKD compared to adults without SB (HR = 2.12; 95% CI = 1.72-2.60), which remained elevated with further adjustment for cardiovascular diseases, hypertension, and diabetes (HR = 1.91; 95% CI = 1.55-2.35).
CONCLUSIONS
Adults with SB may have greater risk of advanced CKD incidence compared to adults without SB.
目的
患有脊柱裂（SB）的成年人可能更容易使慢性肾脏病（CKD）进展为晚期。然而，对于这一服务不足的人群，关于晚期 CKD 的风险知之甚少。本研究的目的是评估患有 SB 的成年人与无 SB 的成年人相比，发生晚期 CKD 的风险。
方法
数据来自 Optum Clinformatics Data Mart。2013 年无晚期 CKD（CKD 分期 4+）的成年人，从 2014 年 1 月 1 日开始随访，直至发生晚期 CKD、死亡、失访或 2017 年 12 月 31 日。使用诊断、程序和诊断相关组代码来识别 SB、晚期 CKD 以及基线心血管疾病、高血压和糖尿病。估计了晚期 CKD 的发生率（IR）和发病率比及其 95%置信区间（CI）。Cox 回归估计了发生晚期 CKD 的调整后的危险比（HR）。
结果
患有 SB 的成年人的晚期 CKD 的粗发病率为 7.40（n=4295），而无 SB 的成年人的发病率为 6.25（n=6600 万）。在调整了人口统计学因素后，与无 SB 的成年人相比，患有 SB 的成年人发生晚期 CKD 的风险更高（HR=2.12；95%CI=1.72-2.60），在进一步调整了心血管疾病、高血压和糖尿病后，这种风险仍然较高（HR=1.91；95%CI=1.55-2.35）。
结论
与无 SB 的成年人相比，患有 SB 的成年人发生晚期 CKD 的风险可能更高。
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