Paudyal Sunita, Waller Jennifer L, Oliver Alyce, Le Brian, Zleik Nour, Nahman N Stanley, Carbone Laura
From the Division of Rheumatology, University of South Carolina School of Medicine, Columbia, SC.
Department of Population Health Sciences, Division of Biostatistics and Data Science, Medical College of Georgia at Augusta University, Augusta, GA.
J Clin Rheumatol. 2020 Mar;26(2):48-53. doi: 10.1097/RHU.0000000000000916.
To determine whether rheumatoid arthritis (RA) is a risk factor for cardiovascular disease (CVD) events, all-cause mortality and cardiovascular mortality in End Stage Renal Disease (ESRD).
Cohort study of adult patients with ESRD in the United States Renal Data System (USRDS) with RA and a 5% random sample of those without RA. CVD events, all-cause mortality and cardiovascular mortality were determined in those with RA compared to those without RA using Cox Proportional Hazards modeling.
2,824 subjects, 407 with RA and 2,417 without RA, were included in the analyses. The duration of the study was up to 5 years, depending on mortality and initiation of dialysis. There were no significant differences in CVD events by RA status (n = 311 [76.4% RA] vs. n = 1936 [80.1% without RA], p = 0.09). Subjects with RA had a significantly shorter mean time in months from start of dialysis to an incident CVD event (20.1 ± 12.2 vs. 21.2 ± 14.1, p < 0.01) than those without RA. In multivariable adjusted models, RA was not associated with an increased risk for all-cause mortality (aHR = 1.09, 95%CI 0.94-1.27) or cardiovascular mortality (aHR = 0.95, 95% CI 0.74-1.22) within 5 years. Risk factors for all-cause mortality and cardiovascular mortality in RA included older age and a higher Charlson comorbidity index (CCI).
Clinicians should be aware that persons with RA who develop ESRD incur cardiac events sooner than the general population. However, RA is not an independent risk factor for all-cause or cardiovascular mortality in ESRD.
确定类风湿关节炎（RA）是否为终末期肾病（ESRD）患者发生心血管疾病（CVD）事件、全因死亡率和心血管死亡率的危险因素。
对美国肾脏数据系统（USRDS）中患有RA的成年ESRD患者以及5%无RA患者的随机样本进行队列研究。使用Cox比例风险模型比较患有RA和未患有RA的患者发生CVD事件、全因死亡率和心血管死亡率的情况。
分析纳入了2824名受试者，其中407名患有RA，2417名未患有RA。根据死亡率和透析开始时间，研究持续时间最长为5年。按RA状态划分，CVD事件无显著差异（n = 311 [76.4% 患有RA] 对 n = 1936 [80.1% 未患有RA]，p = 0.09）。与未患有RA的患者相比，患有RA的患者从开始透析到发生CVD事件的平均月时间显著更短（20.1 ± 12.2 对 21.2 ± 14.1，p < 0.01）。在多变量调整模型中，RA与5年内全因死亡率（校正风险比[aHR] = 1.09，95%置信区间[CI] 0.94 - 1.27）或心血管死亡率（aHR = 0.95，95% CI 0.74 - 1.22）升高无关。RA患者全因死亡率和心血管死亡率的危险因素包括年龄较大和查尔森合并症指数（CCI）较高。
临床医生应意识到，发生ESRD的RA患者比普通人群更早发生心脏事件。然而，RA并非ESRD患者全因或心血管死亡率的独立危险因素。
