CKD 进展和男女患者死亡率：瑞典全国研究。

CKD Progression and Mortality Among Men and Women: A Nationwide Study in Sweden.

机构信息

Department of Medicine, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden.

Renal unit, Department of Clinical Sciences, Interventions and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Swedish Renal Registry, Department of Internal Medicine, Ryhov Regional Hospital, Jönköping, Sweden.

出版信息

Am J Kidney Dis. 2021 Aug;78(2):190-199.e1. doi: 10.1053/j.ajkd.2020.11.026. Epub 2021 Jan 9.

DOI:10.1053/j.ajkd.2020.11.026

PMID:33434591

Abstract

RATIONALE & OBJECTIVE: Chronic kidney disease (CKD) is a global health problem with increasing prevalence. Several sex-specific differences have been reported for disease progression and mortality. Selection and survival bias might have influenced the results of previous cohort studies. The objective of this study was to investigate sex-specific differences of CKD progression and mortality among patients with CKD not receiving maintenance dialysis.

STUDY DESIGN

Observational cohort study.

SETTING & PARTICIPANTS: Adult patients with incident CKD glomerular filtration rate categories 3b to 5 (G3b-G5) identified between 2010 and 2018 within the nationwide Swedish Renal Registry-CKD (SRR-CKD).

EXPOSURE

Sex.

OUTCOMES

Time to CKD progression (defined as a change of at least 1 CKD stage or initiation of kidney replacement therapy [KRT]) or death. Repeated assessments of estimated glomerular filtration rate (eGFR).

ANALYTICAL APPROACH

CKD progression and mortality before KRT were assessed by the cumulative incidence function methods and Fine and Gray models, with death handled as a competing event. Sex differences in eGFR slope were estimated using mixed effects linear regression models.

RESULTS

7,388 patients with incident CKD G3b, 18,282 with incident CKD G4, and 9,410 with incident CKD G5 were identified. Overall, 19.6 (95% CI, 19.2-20.0) patients per 100 patient-years progressed, and 10.1 (95% CI, 9.9-10.3) patients per 100 person-years died. Women had a lower risk of CKD progression (subhazard ratio [SHR], 0.88 [95% CI, 0.85-0.92]), and a lower all-cause (SHR, 0.90 [95% CI, 0.85-0.94]) and cardiovascular (SHR, 0.83 [95% CI, 0.76-0.90]) mortality risk. Risk factors related to a steeper decline in eGFR included age, sex, albuminuria, and type of primary kidney disease.

LIMITATIONS

Incomplete data for outpatient visits and laboratory measurements and regional differences in reporting.

CONCLUSIONS

Compared to women, men had a higher rate of all-cause and cardiovascular mortality, an increased risk of CKD progression, and a steeper decline in eGFR.

摘要

背景与目的

慢性肾脏病（CKD）是一个全球性的健康问题，其患病率正在不断上升。已有研究报道了疾病进展和死亡率方面的一些性别特异性差异。选择偏倚和生存偏倚可能会影响之前队列研究的结果。本研究的目的是探讨未接受维持性透析的 CKD 患者中，CKD 进展和死亡率的性别特异性差异。

研究设计

观察性队列研究。

研究地点和参与者

2010 年至 2018 年期间，在全国性的瑞典肾脏登记处-CKD（SRR-CKD）中发现的肾小球滤过率（GFR）类别为 3b 至 5（G3b-G5）的成人 CKD 患者。

暴露因素

性别。

研究结果

共纳入了 7388 例 CKD G3b 患者、18282 例 CKD G4 患者和 9410 例 CKD G5 患者。总的来说，每 100 例患者年有 19.6（95%CI，19.2-20.0）例患者发生 CKD 进展，每 100 人年有 10.1（95%CI，9.9-10.3）例患者死亡。女性的 CKD 进展风险较低（风险比[HR]，0.88[95%CI，0.85-0.92]），全因（HR，0.90[95%CI，0.85-0.94]）和心血管（HR，0.83[95%CI，0.76-0.90]）死亡率风险也较低。与 eGFR 下降更明显相关的危险因素包括年龄、性别、白蛋白尿和原发性肾脏疾病类型。