Winitzki Doris, Zacharias Helena U, Nadal Jennifer, Baid-Agrawal Seema, Schaeffner Elke, Schmid Matthias, Busch Martin, Bergmann Manuela M, Schultheiss Ulla, Kotsis Fruzsina, Stockmann Helena, Meiselbach Heike, Wolf Gunter, Krane Vera, Sommerer Claudia, Eckardt Kai-Uwe, Schneider Markus P, Schlieper Georg, Floege Jürgen, Saritas Turgay
Division of Nephrology and Clinical Immunology, University Hospital RWTH Aachen, Aachen, Germany.
Department of Obstetrics and Gynecology, Krankenhaus der Augustinerinnen, Cologne, Germany.
Kidney Int Rep. 2022 Feb 14;7(5):1004-1015. doi: 10.1016/j.ekir.2022.02.001. eCollection 2022 May.
Prospective data on impact of educational attainment on prognosis in patients with chronic kidney disease (CKD) are scarce. We investigated the association between educational attainment and all-cause mortality, major adverse cardiovascular (CV) events (MACEs), kidney failure requiring dialysis, and CKD etiology.
Participants ( = 5095, aged 18-74 years) of the ongoing multicenter German Chronic Kidney Disease (GCKD) cohort, enrolled on the basis of an estimated glomerular filtration rate (eGFR) of 30 to 60 ml/min (stages G3, A1-A3) or overt proteinuria (stages G1-G2, A3), were divided into 3 categories according to their educational attainment and were followed for 6.5 years.
Participants with low educational attainment (vs. high) had a higher risk for mortality (hazard ratio [HR] 1.48, 95% CI: 1.16-1.90), MACE (HR 1.37, 95% CI: 1.02-1.83), and kidney failure (HR 1.54, 95% CI: 1.15-2.05). Mediators between low educational attainment and mortality were smoking, CV disease (CVD) at baseline, low income, higher body mass index, and higher serum levels of CRP, high-density lipoprotein cholesterol, uric acid, NGAL, BAP, NT-proBNP, OPN, H-FABP, and urea. Low educational attainment was positively associated with diabetic nephropathy (odds ratio [OR] 1.65, 95% CI: 1.36-2.0) and CKD subsequent to acute kidney injury (OR 1.56, 95% CI: 1.03-2.35), but negatively associated with IgA nephropathy (OR 0.68, 95% CI: 0.52-0.90).
Low educational attainment is associated with adverse outcomes and CKD etiology. Lifestyle habits and biomarkers mediate associations between low educational attainment and mortality. Recognition of the role of educational attainment and the associated health-relevant risk factors is important to optimize the care of patients with CKD and improve prognosis.
关于教育程度对慢性肾脏病（CKD）患者预后影响的前瞻性数据匮乏。我们研究了教育程度与全因死亡率、主要不良心血管（CV）事件（MACE）、需要透析的肾衰竭以及CKD病因之间的关联。
正在进行的多中心德国慢性肾脏病（GCKD）队列研究的参与者（n = 5095，年龄18 - 74岁），根据估算肾小球滤过率（eGFR）为30至60 ml/min（G3期，A1 - A3）或显性蛋白尿（G1 - G2期，A3）入组，根据教育程度分为3类，并随访6.5年。
教育程度低的参与者（与高教育程度者相比）死亡率风险更高（风险比[HR] 1.48，95%置信区间：1.16 - 1.90）、MACE风险更高（HR 1.37，95%置信区间：1.02 - 1.83）以及肾衰竭风险更高（HR 1.54，95%置信区间：1.15 - 2.05）。教育程度低与死亡率之间的中介因素包括吸烟、基线时的心血管疾病（CVD）、低收入、较高的体重指数以及较高的血清CRP、高密度脂蛋白胆固醇、尿酸、中性粒细胞明胶酶相关脂质运载蛋白（NGAL）、骨桥蛋白（BAP）、N末端脑钠肽前体（NT - proBNP）、骨桥蛋白（OPN）、心脏型脂肪酸结合蛋白（H - FABP）和尿素水平。教育程度低与糖尿病肾病呈正相关（优势比[OR] 1.65，95%置信区间：1.36 - 2.0）以及急性肾损伤后CKD呈正相关（OR 1.56，95%置信区间：1.03 - 2.35），但与IgA肾病呈负相关（OR 0.68，95%置信区间：0.52 - 0.90）。
教育程度低与不良结局及CKD病因相关。生活方式习惯和生物标志物介导了教育程度低与死亡率之间的关联。认识到教育程度的作用以及相关的健康风险因素对于优化CKD患者的护理和改善预后很重要。
