男性的腎衰竭終生風險較高


  【24drs.com】根據線上發表於8月16日美國腎臟學會期刊的一篇研究,將近40分之一的中年男性和60分之一的中年女性,活到90歲時會發生末期腎臟病(ESRD),且腎功能降低者的此一風險更高。
  
  加拿大的研究者在1997-2008年間評估了沒有ESRD的2,895,521名Alberta住民,以更清楚了解中年成人終生發生腎衰竭的機率。
  
  Calgary大學的Tanvir Chowdhury Turin博士在媒體聲明中表示,因為腎衰竭發病率高且所費不貲,我們希望量化腎功能衰竭的疾病負擔,以更容易理解的指數讓病患、醫師與決策者溝通資訊。
  
  這篇分析在5年期間以「人-年」方法探討研究對象的血清肌酸酐,並計算年紀特定ESRD發生率;40歲時的ESRD特定終生風險,男性是2.66%,女性為1.76%。
  
  腎功能降低(估計腎絲球過濾速率[eGFR]44 - 59 mL/分鐘/1.73 m2)會增加男性的風險達7.51%,女性的風險達3.21%;而腎功能相對穩定(eGFR,60 - 89 mL/分鐘/1.73 m2)的研究對象,男性和女性風險則分別僅增加1.01%與0.63%。
  
  作者們指出,估計終生風險對於理解個人的風險程度相當重要,和代表社區疾病負擔的估計發生率及盛行率一樣重要。
  
  目前可估計終生風險的其他慢性疾病,包括冠心病、中風、高血壓、糖尿病、乳癌、骨折和失智,不過,還沒有關於ESRD的終生風險報告。
  
  作者們寫道,終生風險(表示個人在生活餘命發生某種疾病的可能性)可能是更適合一般大眾和決策者的資訊,因為它描繪出一個人生命中的整體風險負擔,因此可比較疾病的終生風險。一般認為,終生風險估計有助於大眾教育,因為它們比發生率、盛行率或相對風險更容易被理解。
  
  作者們指出,校正數據後可反映出Alberta目前實際生活餘命80歲的ESRD終生風險。
  
  同樣來自Calgary大學的Brenda Hemmelgarn博士在新聞稿中表示,觀察到的可能性指出,如果目前的估計不變,在加拿大Alberta,約有93分之一(或接近1%)中年男性、133分之一(或0.8%)女性,在其終生會發生腎衰竭。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=6913&x_classno=0&x_chkdelpoint=Y
  

Lifetime Risk for Kidney Failure Higher Among Men

By Nancy A. Melville
Medscape Medical News

August 16, 2012 — Approximately 1 in 40 men and 1 in 60 women of middle age who live into their 90s develop end-stage renal disease (ESRD), and the risk is higher among those with reduced kidney function, according to research published online August 16 in the Journal of the American Society of Nephrology.

Researchers in Alberta, Canada, evaluated a cohort of 2,895,521 Alberta residents free of ESRD from 1997 to 2008 in an effort to better clarify the chances that middle-aged adults have of developing kidney failure in their lifetime.

"Given the high morbidity and cost associated with kidney failure, we wanted to quantify the burden of disease for kidney failure in an easily understandable index to communicate information for patients, health practitioners, and policy makers," lead author Tanvir Chowdhury Turin, MD, PhD, from the University of Calgary, Alberta, said in a press statement.

The analysis looked at participants with serum creatinine measurement and calculated age-specific incidence rates of ESRD using the person-year method in 5-year bands.

The specific lifetime risk for ESRD at age 40 years was 2.66% for men and 1.76% for women.

Reduced kidney function (estimated glomerular filtration rate [eGFR], 44 - 59 mL/minute/1.73 m2) increased the risk by 7.51% among men and 3.21% among women compared with participants with relatively preserved kidney function (eGFR, 60 - 89 mL/minute/1.73 m2) who only experienced a 1.01% or 0.63% increased risk for men and women respectively.

The authors note that estimates of lifetime risk are important in conveying the level of risk at an individual level compared with estimates of incidence and prevalence, which represent the broader burden of disease in the community.

Estimates of lifetime risk are currently available for other chronic disease conditions, such as coronary heart disease, stroke, hypertension, diabetes, breast cancer, fractures, and dementia. However, reports on the lifetime risk for ESRD are lacking.

"Lifetime risk (which expresses the probability of an individual developing a disease condition during their remaining lifespan) may be more informative for both the general population and policy-makers since it portrays overall risk burden over the course of a person's life, thus allowing comparison of lifetime risks across diseases of interests," the authors write. "It has been suggested that lifetime risk estimates are useful for public education because they are easier to comprehend than measures such as incidence, prevalence, or relative risk."

The authors note that adjustment of figures to reflect the actual current life expectancy in Alberta of 80 years reduces the lifetime risk for ESRD.

"The observed probabilities indicate that, if the current estimates remains unchanged, approximately 1 in 93 (or approximately 1%) of men and 1 in 133 (or 0.8%) of women of middle age might develop kidney failure in their lifetime in Alberta, Canada," coauthor Brenda Hemmelgarn, MD, PhD, also from the University of Calgary, said in the news release.

Dr. Turin is supported by Fellowship Awards from the Canadian Institutes of Health Research, Canadian Diabetes Association, and Interdisciplinary Chronic Disease Collaboration team grant funded by Alberta Innovates–Health Solutions (AI-HS). Several coauthors are supported by AI-HS Salary Awards. One coauthor is supported by a salary award from the Canadian Institutes of Health Research. One coauthor is supported by the Roy and Vi Baay Chair in Kidney Research. One coauthor is supported by a Canada Research Chair.

J Am Soc Nephrol. Published online August 16, 2012.

    
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