摘要
目的对维持性透析(maintenance dialysis,MD)患者的一级亲属和配偶中慢性肾脏病(chronic kidney disease,CKD)的流行情况和患病危险因素进行调查。方法将调查对象分为3组,一级亲属组(124例)、配偶组(95例)和对照组(823例)。比较3组的临床特征及CKD患病率,分析患病危险因素。结果一级亲属组和配偶组CKD的人数比例均高于对照组(23.4%比16.2%,χ~2=3.894,P=0.049;30.5%比16.2%,χ~2=11.916,P<0.001)。所有参与者进行CKD相关危险因素的多重逻辑回归分析发现,MD患者一级亲属的CKD患病风险是非一级亲属的1.86倍(OR=1.86,95%CI:1.12~3.11,P=0.004),MD患者配偶的CKD患病风险是非配偶的2.16倍(OR=2.16,95%CI:1.27~3.67,P=0.018),年龄增长、高血糖、高血压作为独立危险因素使CKD的风险增加2%(OR=1.02,95%CI:1.01~1.03,P=0.005)、21%(OR=1.21,95%CI:1.11~1.31,P<0.001)和112%(OR=2.12,95%CI:1.49~3.03,P<0.001)。结论 MD患者的一级亲属和配偶是CKD高发人群,高血糖、高血压和年龄增长是CKD患病的危险因素。
Objective The prevalence and risk factors for chronic kidney disease(CKD) among firstgrade relatives and spouses of maintenance dialysis(MD) patients were investigated. Methods The subjects were divided into three groups: first-degree relative group(124 cases), spouse group(95 cases) and control group(823 cases). Clinical characteristics and prevalence of CKD in the three groups were compared, and the risk factors were analyzed. Results The proportion of CKD in the first-degree relative group and spouse group was higher than that in the control group(23.4% vs. 16.2%, χ~2=3.894, P=0.049;30.5% vs. 16.2%, χ~2=11.916, P<0.001). Multiple logistic regression analysis for the risk factors for CKD in all participants found that the risk factor for CKD in first-degree relatives was 1.86 times higher than that in non first-degree relatives(OR=1.86, 95% CI: 1.12~3.11, P=0.004), the risk factor for CKD in spouses was 2.16 times higher than that in non-spouses(OR=2.16, 95% CI: 1.27~3.67, P=0.018), and older age, diabetes and hypertension were the independent risk factors for 2%, 21% and 112% increases of CKD risk respectively(OR=1.02, 95% CI: 1.01~1.03, P=0.005 for older age; OR=1.21, 95% CI: 1.11~1.31, P<0.001 for diabetes; OR=2.12, 95% CI : 1.49~3.03, P<0.001 for hypertension). Conclusion First-degree relatives and spouses of MD patients are at higher risk for CKD. Diabetes, hypertension and older age are the risk factors for CKD.
引文
[1] Freedman BI, Soucie JM, Kenderes B, et al. Family history of end-stage renal disease does not predict dialytic survival[J]. Am J Kidney Dis, 2001,38(3):547-552.
[2] Freedman BI, Volkova NV, Satko SG, et al. Populationbased screening for family history of end-stage renal disease among incident dialysis patients[J]. Am J Nephrol, 2005,25(6):529-535.
[3] Garg AX,Kiberd BA,Clark WF, et a1.Albuminuria and renal insufficiency prevalence guides population screening:results from the NHANES III[J].Kidney Int, 2002,61(6):2165-2175.
[4] O’Dea DF, Murphy SW, Hefferton D, et a1. Higher risk for renal failure in first-degree relatives of white patients with end-stage renal disease:a populationbased study[J]. Am J Kidney Dis, 1998,32(5):794–801.
[5] McClellan W, Speckman R, McClure L, et a1. Prevalence and characteristics of a family history of end-stage renal disease among adults in the United States population:Reasons for Geographic and Racial Differences in Stroke(REGARDS)renal cohort study[J]. J Am Soc Nephrol, 2007,18(4):1344-1352.
[6] Bello AK, Peters J, Wight J, et a1. A population-based screening for microalbuminuria among relatives of CKD patients:the Kidney Evaluation and Awareness Program in Sheffield(KEAPS)[J]. Am J Kidney Dis, 2008,52(3):434-443.
[7] Claudine Jurkovitz, Harold Franch, David Shoham, et a1. Family Members of Patients Treated for ESRD Have High Rates of Undetected Kidney Disease[J].Am J Kidney Dis,2002,40(6):1173-1178.
[8] Jurj AL, Wen W, Li HL. et al. Spousal correlations for lifestyle factors and selected diseases in Chinese couples[J]. Ann Epidemiol, 2006,16(4):285-291.
[9] Wei X, Li Z, Chen W,et al. Prevalence and risk factors of chronic kidney disease in first-degree relatives of chronic kidney disease patients in Southern China[J].Nephrology(Carlton), 2012,17(2):123-130.
[10] Tsai JC, Chen SC, Hwang SJ,et al.Prevalence and risk for CKD in Spouses and Relatives of Hemodialysis Patients[J]. Am J Kidney Dis, 2010,55(5):856-866.