澳大利亚悉尼大学Nicole L De La Mata团队研究了慢性肾病患者队列死亡率的性别差异。相关论文于2021年11月16日发表在《英国医学杂志》上。
Title: Sex differences in mortality among binational cohort of people with chronic kidney disease: population based data linkage study
Author: Nicole L De La Mata, Brenda Rosales, Grace MacLeod, Patrick J Kelly, Philip Masson, Rachael L Morton, Kate Wyburn, Angela C Webster
Objective To evaluate sex differences in mortality among people with kidney failure compared with the general population.
Design Population based cohort study using data linkage.
Setting The Australian and New Zealand Dialysis and Transplant Registry (ANZDATA), which includes all patients receiving kidney replacement therapy in Australia (1980-2019) and New Zealand (1988-2019). Data were linked to national death registers to determine deaths and their causes, with additional details obtained from ANZDATA.
Participants Of 82844 people with kidney failure, 33329 were female (40%) and 49555 were male (60%); 49376 deaths (20099 in female patients; 29277 in male patients) were recorded over a total of 536602 person years of follow-up.
Main outcome measures Relative measures of survival, including standardised mortality ratios, relative survival, and years of life lost, using general population data to account for background mortality (adjusting for country, age, sex, and year). Estimates were stratified by dialysis modality (haemodialysis or peritoneal dialysis) and for the subpopulation of kidney transplant recipients.
Results Few differences in outcomes were found between male and female patients with kidney failure. However, compared with the general population, female patients with kidney failure had greater excess all cause deaths than male patients (female patients: standardised mortality ratio 11.3, 95% confidence interval 11.2 to 11.5, expected deaths 1781, observed deaths 20099; male patients: 6.9, 6.8 to 6.9, expected deaths 4272, observed deaths 29 277). The greatest difference was observed among younger patients and those who died from cardiovascular disease. Relative survival was also consistently lower in female patients, with adjusted excess mortality 11% higher (95% confidence interval 8% to 13%). Average years of life lost was 3.6 years (95% confidence interval 3.6 to 3.7) greater in female patients with kidney failure compared with male patients across all ages. No major differences were found in mortality by sex for haemodialysis or peritoneal dialysis. Kidney transplantation reduced but did not entirely remove the sex difference in excess mortality, with similar relative survival (P=0.83) and years of life lost difference reduced to 2.3 years (95% confidence interval 2.2 to 2.3) between female and male patients.
Conclusions Compared with the general population, female patients had greater excess deaths, worse relative survival, and more years of life lost than male patients, however kidney transplantation reduced these differences. Future research should investigate whether systematic differences exist in access to care and possible strategies to mitigate excess mortality among female patients.