The changing trends and outcomes in renal replacement therapy: data from the ERA-EDTA Registry
The changing trends and outcomes in renal replacement therapy: data from the ERA-EDTA Registry
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DOI：
10.1093/ndt/gfv327
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发表时间：
2016-05-01
影响因子：
6.1
通讯作者：
Stel, Vianda S.
中科院分区：
文献类型：
--
作者：
Pippias, Maria;Jager, Kitty J.;Stel, Vianda S.
本研究调查了欧洲接受肾替代治疗（RRT）患者的发病率、患病率、患者和肾移植存活和死亡原因（COD）的时间趋势。18个国家或地区的肾脏登记处在1998年至2011年间向欧洲肾脏协会-欧洲透析和移植协会登记处提供了数据。采用关节点回归和泊松回归研究2001 - 2011年发病率和流行时间变化趋势。采用Kaplan-Meier法、竞争风险法和Cox回归分析1998 - 2011年患者和同种异体肾移植的生存和COD。从2001年到2008年，调整后的RRT发病率每年上升1.1% (95% CI: 0.6, 1.7)，达到每百万人131例（pmp）。在2008-2011年期间，调整后的发病率每年下降2.2% （95% CI: -4.2, -0.2）至125pmp。这种下降主要发生在45-64岁、65-74岁以及原发性肾病1型和2型糖尿病、肾血管疾病和肾小球肾炎患者中。2001年至2011年间，调整后的总体患病率从724 pmp增加到1032 pmp（每年增加3.3%,95% CI: 2.8, 3.8）。1998-2002年和2003-2007年RRT的校正5年患者生存率有所提高[校正风险比（HRa） 0.85, 95% CI: 0.84, 0.86]。比较这些时间段，心血管死亡的风险下降了25% （HRa 0.75, 95% CI: 0.74, 0.77）。然而，在每千分之一日元65岁的患者中，恶性死亡的风险增加了9% （HRa 1.09, 95% CI: 1.03, 1.16）。这项欧洲研究显示，RRT发病率下降，特别是在45-64岁、65-74岁和继发于糖尿病肾病的患者中。令人鼓舞的是，调整后的RRT患者生存率继续提高。尽管老年人口因恶性肿瘤死亡的风险有所增加，但因心血管疾病死亡的风险有所下降。
This study examines the time trends in incidence, prevalence, patient and kidney allograft survival and causes of death (COD) in patients receiving renal replacement therapy (RRT) in Europe.Eighteen national or regional renal registries providing data to the European Renal Association-European Dialysis and Transplant Association Registry between 1998 and 2011 were included. Incidence and prevalence time trends between 2001 and 2011 were studied with Joinpoint and Poisson regression. Patient and kidney allograft survival and COD between 1998 and 2011 were analysed using Kaplan-Meier and competing risk methods and Cox regression.From 2001 to 2008, the adjusted incidence of RRT rose by 1.1% (95% CI: 0.6, 1.7) annually to 131 per million population (pmp). During 2008-2011, the adjusted incidence fell by 2.2% (95% CI: -4.2, -0.2) annually to 125 pmp. This decline occurred predominantly in patients aged 45-64 years, 65-74 years and in the primary renal diseases diabetes mellitus type 1 and 2, renovascular disease and glomerulonephritis. Between 2001 and 2011, the overall adjusted prevalence increased from 724 to 1032 pmp (+3.3% annually, 95% CI: 2.8, 3.8). The adjusted 5-year patient survival on RRT improved between 1998-2002 and 2003-2007 [adjusted hazard ratio (HRa) 0.85, 95% CI: 0.84, 0.86]. Comparing these time periods, the risk of cardiovascular deaths fell by 25% (HRa 0.75, 95% CI: 0.74, 0.77). However the risk of malignant death rose by 9% (HRa 1.09, 95% CI: 1.03, 1.16) in patients a parts per thousand yen65 years.This European study shows a declining RRT incidence, particularly in patients aged 45-64 years, 65-74 years and secondary to diabetic nephropathy. Encouragingly, the adjusted RRT patient survival continues to improve. The risk of cardiovascular death has decreased, though the risk of death from malignancy has increased in the older population.