女性慢性肾病患者的全因死亡率显著高于男性患者
2021-11-22   阅读:446   来源:英国医学杂志

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。

为了评估肾衰竭患者与普通人群死亡率的性别差异,研究组使用数据链接进行了一项基于人群的队列研究,在澳大利亚和新西兰透析和移植登记处招募包括在澳大利亚(1980-2019年)和新西兰(1988-2019年)接受肾脏替代治疗的所有患者。将患者数据与国家死亡登记册相联系,以确定死亡及其原因,并从数据中获得更多细节。

82844例肾衰竭患者中,33329名为女性(40%),49555名为男性(60%);在536602人-年的随访中,共记录了49376例死亡,其中女性20099例,男性29277例。主要观察指标为生存率的相对评估,包括标准化死亡率、相对生存率和寿命损失年,使用一般人口数据说明背景死亡率(根据国家、年龄、性别和年份进行校正)。根据透析方式(血液透析或腹膜透析)和肾移植受者亚群对估计值进行分层。

男性和女性肾衰患者的预后差异不大。然而,与普通人群相比,肾功能衰竭女性患者的全因死亡率显著高于男性患者(标准化死亡率分别为11.3和6.9)。在年轻患者和死于心血管疾病的患者中观察到的差异最大。女性患者的相对生存率也一直较低,校正后的额外死亡率高11%。

肾衰竭女性患者的平均寿命损失年数比全年龄男性患者多3.6年。血液透析和腹膜透析的死亡率在性别上未发现显著差异。肾移植减少了但并没有完全消除额外死亡率的性别差异,女性和男性患者的相对生存率相似,寿命损失年数差异降低至2.3年。

研究结果表明,与普通人群相比,女性患者比男性患者有更多的额外死亡、更差的相对生存率和更多的寿命损失,然而肾移植减少了这些差异。未来研究应努力降低女性患者的额外死亡率。

附:英文原文

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

Issue&Volume: 2021/11/16

Abstract:

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.

DOI: 10.1136/BMJ-2021-068247

编辑:小柯机器人

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