Division of Public Health Research, Social & Scientific Systems, Inc., a DLH Holdings Corp Company, Atlanta, GA.
Division of Kidney, Urologic & Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.
Urology. 2024 Jan;183:185-191. doi: 10.1016/j.urology.2023.09.024. Epub 2023 Oct 5.
To describe sex- and diagnosis-specific comorbidities, outcomes, and secular trends associated with ureteropelvic junction obstruction (UPJO) in a large, real-world population diagnosed with hydronephrosis in infancy.
We identified all infants ≤1 year old with ≥1 claim in the Optum Clinformatics 2007-2020 nationwide population database and used univariable and multivariable Cox regression analyses to estimate associations of demographic and clinical characteristics of infants with a UPJO diagnosis with surgical status.
Of 22,349 infants with hydronephrosis (1.1% of infants; males-1.4%, females-0.7%), 1722 (7.7%; 7.9%-males, 7.2%-females) had UPJO. Follow-up was ≥1 year in 1198 (70%) and ≥3 years in 555 (32%) cases, and UPJO repair was performed in 542 children (31.5%; 32.3%-males, 29.5%-females); 77.7% within 1 year and 97.3% within 3 years. UPJO repair was associated with prior urinary tract infection (UTI) (hazard ratio (HR) 1.41, 95% confidence interval (CI) 1.12-1.76) and South (HR 1.42, 95% CI 1.14-1.78) or Midwest (HR 1.60, 95% CI 1.26-2.04) geographic region but did not change over time.
This population-based study provides a real-world view of postnatally diagnosed hydronephrosis, focusing on UPJO, for which 522 cases (∼1/3) had ≥3 years continuous coverage. UPJO-associated comorbidities were more common in females, and the frequencies of UPJO-associated surgery and comorbidities were higher than in other studies. Other than UTI, no other associated kidney or urinary tract diagnoses were associated with UPJO repair. We identified unique sex- and diagnosis-specific differences in associated comorbidities and interventions in children diagnosed with UPJO in the first year of life.
描述在大型真实人群中，与婴儿期肾盂积水相关的输尿管肾盂连接部梗阻（UPJO）的性别和诊断特异性合并症、结局和时间趋势。
我们在 Optum Clinformatics 2007-2020 年全国人群数据库中确定了所有≤1 岁且至少有 1 项索赔的婴儿，并使用单变量和多变量 Cox 回归分析来估计与 UPJO 诊断相关的婴儿人口统计学和临床特征与手术状态的关联。
在 22349 例肾盂积水（婴儿的 1.1%；男性 1.4%，女性 0.7%）中，有 1722 例（7.7%；男性为 7.9%，女性为 7.2%）存在 UPJO。1198 例（70%）的随访时间≥1 年，555 例（32%）的随访时间≥3 年，542 例（31.5%；男性为 32.3%，女性为 29.5%）接受了 UPJO 修复术；77.7%在 1 年内，97.3%在 3 年内。UPJO 修复与既往尿路感染（UTI）（风险比（HR）1.41，95%置信区间（CI）1.12-1.76）和南部（HR 1.42，95%CI 1.14-1.78）或中西部（HR 1.60，95%CI 1.26-2.04）地理区域相关，但随着时间的推移并未发生变化。
这项基于人群的研究提供了一个真实世界的观点，关注于 UPJO 相关的产后诊断肾盂积水，其中 522 例（约 1/3）有≥3 年的连续覆盖。与 UPJO 相关的合并症在女性中更为常见，且 UPJO 相关手术和合并症的频率高于其他研究。除 UTI 外，其他与肾脏或泌尿道相关的诊断与 UPJO 修复无关。我们在婴儿出生后的第一年就发现了与 UPJO 相关的独特的性别和诊断特异性合并症和干预措施差异。
