Yoo Jung Eun, Kim Bongseong, Chang Won Hyuk, Lee Kyungho, Jang Hye Ryoun, Han Kyungdo, Shin Dong Wook
Department of Family Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul 06236, Republic of Korea.
Department of Family Medicine, Seoul National University College of Medicine, Seoul 03087, Republic of Korea.
Healthcare (Basel). 2025 Jan 4;13(1):80. doi: 10.3390/healthcare13010080.
Amputation confers disabilities upon patients and is associated with substantial cardiovascular and metabolic morbidity and mortality. We aimed to compare the incidence of end-stage kidney disease (ESKD) between individuals with amputation and the general population.
A population-based retrospective cohort study was performed using the Nationwide Health Insurance Service database for the period between 2010 and 2018. A total of 24,925 individuals with amputation were included with a ratio of 1:3 age- and sex-matched controls. A Cox proportional hazards regression analysis was used to calculate the risk of ESKD among amputees.
During a mean follow-up period of 4.3 years, there were 40 incident ESKD cases (0.4 per 1000 person-years) among individuals with amputation. Individuals with amputation showed a higher risk of ESKD (adjusted HR [aHR] of 1.75, 95% confidence interval [CI] of 1.20-2.54) compared with matched controls. The risk was further increased in those with mild disability (aHR of 1.41, 95% CI of 0.51-3.87) and severe disability (aHR of 8.22, 95% CI of 2.99-22.61). When considering the levels of amputation, the association was apparently more prominent in proximal than distal amputation, in particular for proximal upper limb amputation (aHR of 17.90, 95% CI of 4.37-73.40).
Individuals with amputation were at a significantly greater risk of ESKD than the general population, particularly subjects with severe disability and proximal amputation. Our data suggest that amputations should be added to the list of risk factors for the development of chronic kidney disease.
截肢会给患者带来残疾，并与大量心血管和代谢性疾病及死亡相关。我们旨在比较截肢个体与普通人群中终末期肾病（ESKD）的发病率。
利用2010年至2018年期间的全国健康保险服务数据库进行了一项基于人群的回顾性队列研究。共纳入24925例截肢个体，并按年龄和性别1:3匹配对照组。采用Cox比例风险回归分析计算截肢者发生ESKD的风险。
在平均4.3年的随访期内，截肢个体中有40例新发ESKD病例（每1000人年0.4例）。与匹配的对照组相比，截肢个体发生ESKD的风险更高（调整后风险比[aHR]为1.75，95%置信区间[CI]为1.20 - 2.54）。轻度残疾者（aHR为1.41，95%CI为0.51 - 3.87）和重度残疾者（aHR为8.22，95%CI为2.99 - 22.61）的风险进一步增加。考虑截肢水平时，这种关联在近端截肢比远端截肢中明显更突出，尤其是近端上肢截肢（aHR为17.90，95%CI为4.37 - 73.40）。
截肢个体发生ESKD的风险显著高于普通人群，尤其是重度残疾和近端截肢者。我们的数据表明，截肢应被列入慢性肾脏病发生的风险因素清单。
