Al-Chalabi Saif, Parkinson Eleanor, Chinnadurai Rajkumar, Kalra Philip A, Sinha Smeeta
Department of Renal Medicine, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK.
Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
Clin Kidney J. 2024 Mar 27;17(7):sfae086. doi: 10.1093/ckj/sfae086. eCollection 2024 Jul.
Due to the high correlation of chronic kidney disease (CKD) with other comorbidities, the sole effect of CKD on deprived people is not clear. In addition, there is a paucity of evidence in the literature linking isolated domains of deprivation to outcomes. This study aimed to examine whether deprivation was associated with adverse outcomes in patients with CKD, independent of cardiometabolic morbidities. Individual domains of deprivation were also evaluated.
A retrospective study of patients with non-dialysis-dependent CKD (ND-CKD) in the Salford Kidney Study to investigate the association of deprivation with outcomes. The English Indices of Deprivation was used for the comparative analysis of the five quintiles of deprivation. Two propensity score methods were used to attenuate the confounding effect of cardiometabolic morbidities between the least and the most deprived groups.
People living in the least deprived areas ( = 319) had a lower risk of combined outcomes (all-cause mortality and renal replacement therapy) when compared with the most deprived group ( = 813) [hazard ratio (HR) 0.83; 95% confidence interval (CI) 0.71-0.98]. The negative association of deprivation remained after matching but with mixed statistical significance when using different propensity methods (HR 0.85; 95% CI 0.70-1.03 for propensity score matching and HR 0.77; 95% CI 0.61-0.98 for inverse probability weighting). The association of combined outcomes varied across component index of multiple deprivation domains with wide CIs. However, areas with lower scores for education, income and employment were significantly associated with a higher risk.
This study has identified that in people with ND-CKD, unemployment, poor educational attainment and lower household income were associated with poor outcomes. The association of deprivation with adverse outcomes persists despite adjustment for cardiometabolic morbidities.
由于慢性肾脏病（CKD）与其他合并症高度相关，CKD对贫困人群的单独影响尚不清楚。此外，文献中缺乏将孤立的贫困领域与结局联系起来的证据。本研究旨在探讨贫困是否与CKD患者的不良结局相关，而与心血管代谢合并症无关。还对贫困的各个领域进行了评估。
对索尔福德肾脏研究中不依赖透析的CKD（ND-CKD）患者进行回顾性研究，以调查贫困与结局之间的关联。使用英国贫困指数对贫困程度的五个五分位数进行比较分析。采用两种倾向评分方法来减弱最贫困组和最不贫困组之间心血管代谢合并症的混杂效应。
与最贫困组（n = 813）相比，生活在最不贫困地区的人群（n = 319）发生综合结局（全因死亡率和肾脏替代治疗）的风险较低[风险比（HR）0.83；95%置信区间（CI）0.71-0.98]。匹配后贫困的负相关仍然存在，但使用不同倾向方法时具有混合统计学意义（倾向评分匹配的HR为0.85；95%CI为0.70-1.03，逆概率加权的HR为0.77；95%CI为0.61-0.98）。综合结局的关联在多个贫困领域的组成指标中各不相同，置信区间较宽。然而，教育、收入和就业得分较低的地区与较高风险显著相关。
本研究发现，在ND-CKD患者中，失业、教育程度低和家庭收入低与不良结局相关。尽管对心血管代谢合并症进行了调整，但贫困与不良结局的关联仍然存在。
