RESUMO
Over the past two decades, live kidney donation by older individuals (≥55 years) has become more common. Given the strong associations of older age with cardiovascular disease (CVD), nephrectomy could make older donors vulnerable to death and cardiovascular events. We performed a cohort study among older live kidney donors who were matched to healthy older individuals in the Health and Retirement Study. The primary outcome was mortality ascertained through national death registries. Secondary outcomes ascertained among pairs with Medicare coverage included death or CVD ascertained through Medicare claims data. During the period from 1996 to 2006, there were 5717 older donors in the United States. We matched 3368 donors 1:1 to older healthy nondonors. Among donors and matched pairs, the mean age was 59 years; 41% were male and 7% were black race. In median follow-up of 7.8 years, mortality was not different between donors and matched pairs (p = 0.21). Among donors with Medicare, the combined outcome of death/CVD (p = 0.70) was also not different between donors and nondonors. In summary, carefully selected older kidney donors do not face a higher risk of death or CVD. These findings should be provided to older individuals considering live kidney donation.
Assuntos
Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/mortalidade , Transplante de Rim , Doadores Vivos , Insuficiência Renal/cirurgia , Fatores Etários , Idoso , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Medicare , Pessoa de Meia-Idade , Nefrectomia , Qualidade de Vida , Fatores de Tempo , Resultado do Tratamento , Estados UnidosRESUMO
OBJECTIVE: To evaluate published pediatric dual-energy x-ray absorptiometry bone mineral density (BMD) reference data by comparing the diagnostic classification of measured BMD in children at risk for osteopenia as healthy or osteopenic according to reference source. STUDY DESIGN: Spine BMD was measured in 95 children, ages 9 to 15 years, at risk for osteopenia because of childhood disease. The BMD results were converted to age-specific z scores for each of the 5 reference data sets, and the z -score distributions were compared. RESULTS: Between 11% and 30% of children were classified as osteopenic (z score < -2.0) depending on the reference data set. The 2 sex-specific reference data sets yielded similar diagnostic classification of boys and girls: 10% of boys and 11% to 16% of girls were osteopenic (P =.4). The 3 sex-nonspecific reference data sets classified 9% to 13% of girls and 24% to 44% of boys as osteopenic; the diagnosis of osteopenia was significantly greater in boys (P <.01). CONCLUSIONS: The use of different published reference data for the assessment of children at risk for osteopenia results in inconsistent diagnostic classification of BMD results. These inconsistencies can be partially attributed to sex-nonspecific reference data that result in misclassification of boys as osteopenic.
Assuntos
Absorciometria de Fóton , Densidade Óssea/fisiologia , Doenças Ósseas Metabólicas/diagnóstico , Adolescente , Doenças Ósseas Metabólicas/epidemiologia , Criança , Feminino , Humanos , Vértebras Lombares/fisiologia , Masculino , Valores de Referência , Análise de Regressão , Estados Unidos/epidemiologiaRESUMO
This study examined epidemiologic patterns and time trends among male patients with Hispanic surnames in the Medicare End-Stage Renal Disease Program and compared US Hispanics with non-Hispanic Blacks and Whites. Male Hispanics had substantially higher proportions of end-stage renal disease attributed to diabetes than did Blacks and Whites. There were notable regional differences among Hispanics. Between 1980 and 1990, the incidence of treated renal failure among Hispanics increased more than that among Blacks or Whites. The increasing number of Hispanics in the United States with end-stage renal disease emphasizes the importance of explicit health evaluations and prevention strategies for Hispanic populations.