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【medical-news】【资讯翻译】女性透析患者死亡率高于预期

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原文链接：http://www.medscape.com/viewarticle/805008

Mortality Rate Higher Than Expected for Women on Dialysis

ISTANBUL, Turkey — A worldwide analysis of patients on dialysis reveals that more women than men die during treatment. Researchers suggest that catheter use and control of secondary hyperparathyroidism underlie the surprising mortality rate.

"Men and women have a lot of differences genetically, and there are many studies out there suggesting that treatments should be personalized according to sex," said Manfred Hecking, MD, a resident in nephrology and dialysis at the Medical University of Vienna in Austria. He also works with the Arbor Research Collaborative for Health in Ann Arbor, Michigan, which is a nonprofit organization that conducts studies of epidemiology and public health.

Dr. Hecking presented the study results here at the European Renal Association-European Dialysis and Transplant Association 50th Congress

The researchers analyzed male and female participants in the international Dialysis Outcomes and Practice Patterns Study (DOPPS) for characteristics and mortality risk.

They used Cox regression models to evaluate mortality in the 36,216 patients. Because of regional variation in the differences between male and female participants, the researchers performed separate analyses for Japan and for North America, and combined analyses for Australia, Europe, New Zealand.

The researchers report that hypertension occurred less frequently in women than in men, diabetes occurred more frequently, and levels of serum phosphorous were similar.

There were significant regional mortality differences by sex. In principle, the mortality ratio of women to men should be 0.6, because that is the mortality ratio found in the general population, according to Dr. Hecking. However, in many countries, that ratio is closer to 1.0 in dialysis patients. "Women have a natural survival advantage over men, but it is almost completely eradicated in dialysis patients. That is striking," he said.

Table. Mean Characteristics of Male and Female Dialysis Patients

Characteristic	Females	Males	P value
Composition	43%	57%	<.001
Age	63.1 years	61.9 years	<.001
Length of time on dialysis	5.4 years	5.2 years	<.001
Body mass index	25.3 kg/m?	24.6 kg/m?	<.001
Obesity	21.2%	13.4%	<.001
Serum creatinine	8.4 mg/dL	10.0 mg/dL	<.001
Parathyroid hormone	302 pg/mL	285 pg/mL	<.001
Catheter use	18.5%	12.4%	<.001

A key issue is the underlying cause of that difference. "It could be that dialysis is a deadly process that affects men and women equally. Or it could be that care for women is different than care for men, and we might actually get closer to the 0.6 figure by improving care for women on dialysis," Dr. Hecking explained.

The data suggest a possible culprit. The frequency of catheter access use is significantly different in men and women; after adjustment for that, survival in women improved. "This could be an indication that catheters are a modifiable practice and women could be treated better," he noted.

The difference in parathyroid hormone suggests that control of secondary hyperparathyroidism is another factor.

"It's an interesting study," said Christoph Wanner, MD, from the University Clinic Würzburg in Germany. "This is the only dataset in which you can do this type of analysis, covering many parts of the world and different ethnicities. It's a huge database with a long time span," he noted.

"Because these survival differences are seen not in only 1 country, it would be interesting to compare" differences in dialysis treatment between men and women in different countries, Dr. Wanner told Medscape Medical News.

Dr. Hecking and Dr. Wanner have disclosed no relevant financial relationships.

European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) 50th Congress: Abstract MP563. Presented May 20, 2013.

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2013-06-09 23:00 浏览 : 686 回复 : 11

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女性透析患者死亡率高于预期

土耳其伊斯坦布尔- 一项全球性的关于透析患者的分析显示，在治疗过程中女性死亡人数比男性多。研究人员指出导管的使用和继发性甲旁亢可能是高死亡率的原因
“从遗传学的角度来说，男人和女人有很多差异，有许多研究表明应根据性别进行个性化治疗，”奥地利维也纳医科大学肾脏病与透析住院医师Manfred Hecking博士说。他也在密歇根州安阿伯的Arbor Research Collaborative for Health里工作，这是一个非营利性组织，它做了很多流行病学和公共卫生健康的研究。Hecking博士在欧洲肾脏协会 - 欧洲透析和移植协会第50届代表大会上介绍了研究结果。

研究人员分析了在国际透析预后与实践模式研究（DOPPS）的参与者中，男性和女性的特点和及其死亡风险。他们用Cox回归模型来评估36,216名患者的死亡率。由于男性和女性参加者之间的差异也存在区域差异，研究人员单独分析了日本和北美（参与者的情况），组合分析了澳大利亚，新西兰和欧洲（参与者的情况）。

研究人员报告说，与男性相比，女性高血压的发生率较低，糖尿病的发生率高，血清磷水平相似。根据Hecking博士的说法：区域死亡率在性别上有明显的差异。一般而言，女性和男性的死亡率比应该是0.6，因为那是在一般人群中发现的死亡率比。然而，在许多国家中，透析病人的死亡率之比接近1.0。他说，“女性相对于男性来说有一种天然的生存优势，但这优势在血液透析患者中几乎被完全消除了，这是惊人的。”

男性和女性透析患者的平均特征表

特征	女性	男性	P值
构成	43%	57%	<.001
年龄	63.1岁	61.9岁	<.001
透析时长	5.4年	5.2年	<.001
体重指数	25.3 kg/m?	24.6 kg/m?	<.001
肥胖	21.2%	13.4%	<.001
血清肌酸酐浓度	8.4 mg/dL	10.0 mg/dL	<.001
甲状旁腺素（浓度）	302 pg/mL	285 pg/mL	<.001
导管使用情况	18.5%	12.4%	<.001

Hecking博士解释道：“一个关键问题是这种差异的根本原因。这可能是由于透析是一种致命的、同等影响男性和女性的过程，或者可能是因为对男性和女性的照顾不同 --- 实际上，通过改善对透析妇女的呵护，我们可能得到接近0.6的比值。”““研究结果提示了可能的罪魁祸首，男，女间导管使用频率明显不同，经过调整这个因素之后，女性的生存得到改善，”他说，“这可能提示，通过调整导管这个可改变的因素，女性可以得到更好的治疗。”甲状旁腺激素的差异表明，继发性甲状旁腺功能亢进的控制程度是另一个因素。”

“这是一项有趣的研究，”来自德国维尔茨堡大学诊所的Christoph Wanner博士说，“这是唯一的数据集 --- 您可以在其中做这种类型的、涵盖了世界上的许多地方和不同种族的分析。他说：“这是一个巨大的、时间跨度长的数据库。”Wanner告诉Medscape Medical News：“因为不仅仅在1个国家看到这些生存差异，所以，比较在不同国家的男性和女性透析治疗之间的差异令人感兴趣。”

Hecking 博士和Wanner博士宣称他们之间没有经济关系。

欧洲肾脏协会 - 欧洲透析和移植协会（ERA-EDTA）第50次大会：摘要MP563。 2013年5月20日发表。

2013-06-10 10:53

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cyf923945 编辑于 2013-06-10 21:01

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Mortality Rate Higher Than Expected for Women on Dialysis
女性透析患者死亡率高于预期

1、ISTANBUL, Turkey — A worldwide analysis of patients on dialysis reveals that more women than men die during treatment. Researchers suggest that catheter use and control of secondary hyperparathyroidism underlie the surprising mortality rate.
土耳其伊斯坦布尔- 一项全球性的关于透析患者的分析显示，在治疗过程中女性死亡人数比男性多。研究人员指出导管的使用和继发性甲旁亢可能是高死亡率的原因
2、"Men and women have a lot of differences genetically, and there are many studies out there suggesting that treatments should be personalized according to sex," said Manfred Hecking, MD, a resident in nephrology and dialysis at the Medical University of Vienna in Austria. He also works with the Arbor Research Collaborative for Health in Ann Arbor, Michigan, which is a nonprofit organization that conducts studies of epidemiology and public health.
“从遗传学的角度来说，男人和女人有很多差异，有许多研究表明应根据性别进行个性化治疗，”奥地利维也纳医科大学肾脏病与透析住院医师Manfred Hecking博士说。他也在密歇根州安阿伯Arbor Research Collaborative for Health里工作，这是一个非营利性组织，它做了很多流行病学和公共卫生健康的研究。

3、Dr. Hecking presented the study results here at the European Renal Association-European Dialysis and Transplant Association 50th Congress
Hecking博士在欧洲肾脏协会 - 欧洲透析和移植协会第50届代表大会上介绍了研究结果。

4、The researchers analyzed male and female participants in the international Dialysis Outcomes and Practice Patterns Study (DOPPS) for characteristics and mortality risk.
研究人员分析了在国际透析预后与实践模式研究（DOPPS）的参与者中，男性和女性的特点和及其死亡风险。

5、They used Cox regression models to evaluate mortality in the 36,216 patients. Because of regional variation in the differences between male and female participants, the researchers performed separate analyses for Japan and for North America, and combined analyses for Australia, Europe, New Zealand.
他们用Cox回归模型来评估36,216名患者的死亡率。由于男性和女性参加者之间的差异也存在区域差异，研究人员单独分析了日本和北美（参与者的情况），组合分析了澳大利亚，新西兰和欧洲（参与者的情况）。

6、The researchers report that hypertension occurred less frequently in women than in men, diabetes occurred more frequently, and levels of serum phosphorous were similar.
研究人员报告说，与男性相比，女性高血压的发生率较低，糖尿病的发生率高，血清磷水平相似。

7、There were significant regional mortality differences by sex. In principle, the mortality ratio of women to men should be 0.6, because that is the mortality ratio found in the general population, according to Dr. Hecking. However, in many countries, that ratio is closer to 1.0 in dialysis patients. "Women have a natural survival advantage over men, but it is almost completely eradicated in dialysis patients. That is striking," he said. 根据Hecking博士的说法：区域死亡率在性别上有明显的差异。一般而言，女性和男性的死亡率比应该是0.6，因为那是在一般人群中发现的死亡率比。然而，在许多国家中，透析病人的死亡率之比接近1.0。他说，“女性相对于男性来说有一种天然的生存优势，但这优势在血液透析患者中几乎被完全消除了，这是惊人的。”

8、Table. Mean Characteristics of Male and Female Dialysis Patients
男性和女性透析患者的平均特征表

Characteristic 特征	Females 女性	Males 男性	P value P值
Composition 构成	43%	57%	<.001
Age 年龄	63.1 years 63.1岁	61.9 years 61.9岁	<.001
Length of time on dialysis 透析时长	5.4 years 5.4年	5.2 years 5.2年	<.001
Body mass index 体重指数	25.3 kg/m?	24.6 kg/m?	<.001
Obesity 肥胖	21.2%	13.4%	<.001
Serum creatinine 血清肌酸酐浓度	8.4 mg/dL	10.0 mg/dL	<.001
Parathyroid hormone 甲状旁腺素（浓度）	302 pg/mL	285 pg/mL	<.001
Catheter use 导管使用情况	18.5%	12.4%	<.001

9、A key issue is the underlying cause of that difference. "It could be that dialysis is a deadly process that affects men and women equally. Or it could be that care for women is different than care for men, and we might actually get closer to the 0.6 figure by improving care for women on dialysis," Dr. Hecking explained.
Hecking博士解释道：“一个关键问题是这种差异的根本原因。这可能是由于透析是一种致命的、同等影响男性和女性的过程，或者可能是因为对男性和女性的照顾不同 --- 实际上，通过改善对透析妇女的呵护，我们可能得到接近0.6的比值。”

10、The data suggest a possible culprit. The frequency of catheter access use is significantly different in men and women; after adjustment for that, survival in women improved. "This could be an indication that catheters are a modifiable practice and women could be treated better," he noted.
“研究结果提示了可能的罪魁祸首，男，女间导管使用频率明显不同，经过调整这个因素之后，女性的生存得到改善，”他说，“这可能提示，通过调整导管这个可改变的因素，女性可以得到更好的治疗。”
11、The difference in parathyroid hormone suggests that control of secondary hyperparathyroidism is another factor.
甲状旁腺激素的差异表明，继发性甲状旁腺功能亢进的控制程度是另一个因素。

12、"It's an interesting study," said Christoph Wanner, MD, from the University Clinic Würzburg in Germany. "This is the only dataset in which you can do this type of analysis, covering many parts of the world and different ethnicities. It's a huge database with a long time span," he noted.
“这是一项有趣的研究，”来自德国维尔茨堡大学诊所的Christoph Wanner博士说，“这是唯一的数据集，您可以在其中做这种类型的、涵盖了世界上的许多地方和不同种族的分析。他说：“这是一个巨大的、时间跨度长的数据库。”

13、"Because these survival differences are seen not in only 1 country, it would be interesting to compare" differences in dialysis treatment between men and women in different countries, Dr. Wanner told Medscape Medical News .
Wanner告诉Medscape Medical News：“因为不仅仅在1个国家看到这些生存差异，所以，比较在不同国家的男性和女性透析治疗之间的差异令人感兴趣。”

14、Dr. Hecking and Dr. Wanner have disclosed no relevant financial relationships.
Hecking 博士和Wanner博士宣称他们之间没有经济关系。

15、European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) 50th Congress: Abstract MP563 . Presented May 20, 2013.
欧洲肾脏协会 - 欧洲透析和移植协会（ERA-EDTA）第50次大会：摘要MP563。 2013年5月20日发表。

2013-06-10 10:52

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cyf923945 编辑于 2013-06-10 21:00

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