心不全における人種と腎不全:白人と黒人の死亡率
Grace L Smith1, Michael G Shlipak, Edward P Havranek
1Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn 06520, USA.
Circulation
|March 17, 2005
まとめ
腎機能不全は,心不全 (HF) の患者の死亡リスクを増大させる. しかし,腎機能障害に関連する死亡リスクは,黒人患者と比較して白人患者においてより顕著である.
科学分野:
- 心臓病学 心臓病学
- ネフロロジーはネフロロジーを用います.
- 公衆衛生は公衆衛生である.
背景:
- 腎機能不全は,心不全 (HF) の予後要因としてますます認識されています.
- HFおよび腎疾患の進行において人種差異が存在します.
- 人種によるHF患者の予後に対する腎機能不全の差異的な影響は不明である.
研究 の 目的:
- HF患者において,クレアチニンの上昇と推定グローメルーラ濾過率 (eGFR) の低下に関連した1年間の死亡リスクを決定する.
- 腎機能不全のHF患者の死亡リスクにおける人種差異を定量化するために.
主な方法:
- 全国心臓ケアプロジェクト (National Heart Care Project) のコホートについて,遡及的に評価した結果.
- HFで入院した53640人のMedicare患者の分析.
- 黒と白の患者のサブグループにおけるクレアチニンレベルとeGFRの評価.
主要な成果:
- クレアチニン濃度の上昇は,死亡リスクの増加と関連しており,人種間では大きさが異なる (相互作用P=0.0001).
- クレアチニンの0.5 mg/dLの上昇は,黒人の死亡率>10%の増加と相関しており,白人の死亡率>15%でした.
- 死亡リスクにおける人種差異は,クレアチニンとeGFRの両方に一致する,より高いレベルの腎機能不全で最も顕著でした.
結論:
- 腎機能障害は,高齢のHF患者でより高い死亡率を予測し,白人の患者でより大きなリスクが観察されています.
- 黒人と白人のHF患者との間での罹病率と死亡率の負担の有意な差異は,リスクの階層化と標的治療の改善の必要性を強調しています.
- HFと腎不全の結果における観察された人種差異の生理学的根拠を探求するために,さらなる研究が不可欠です.
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