End-stage renal disease in the United States: An update from the United States renal data system
End-stage renal disease in the United States: An update from the United States renal data system
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DOI：
10.1681/asn.2007020220
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发表时间：
2007-10-01
影响因子：
13.6
通讯作者：
Collins, Allan J.
中科院分区：
文献类型：
--
作者：
Foley, Robert N.;Collins, Allan J.
终末期肾病患者消耗了大量不成比例的财政和人力资源。大约0.03%的美国人口在2004年开始肾脏替代治疗，调整后的发病率为339/百万。观察到ESRD的大多数主要原因和大多数主要人口统计学类别的发病率下降;令人担忧的是，糖尿病ESRD的发病率在年轻的黑人成年人中继续上升。虽然糖尿病和高血压仍然是最常见的终末期肾病的原因，终末期动脉粥样硬化性肾血管疾病的发生率似乎在老年患者中呈上升趋势。虽然临床护理指标，如使用瘘管的血液透析患者比例，继续逐步改善，但在依泊苷治疗下超过目标血红蛋白水平的患者比例可能是一个令人担忧的问题。自20世纪80年代末以来，美国ESRD人群的生存概率稳步提高，当考虑到事件患者中不断扩大的合并症负担时，这是值得注意的。然而，尽管第一年透析死亡率自1987年以来明显改善，但自1993年以来似乎没有取得有意义的改善，与第2年至第5年的稳定年度改善相反。尽管这些发现中的大多数都是谨慎乐观的理由，但成本问题却不能这么说;反映了ESRD人口规模的增长，相关成本在1999年至2004年期间增长了57%，目前占医疗保险总支出的6.7%。
Patients with ESRD consume a vastly disproportionate amount of financial and human resources. Approximately 0.03% of the US population began renal replacement therapy in 2004, an adjusted incidence rate of 339 per million. Declining incidence rates were observed for most primary causes of ESRD and in most major demographic categories; the worry is that rates of diabetic ESRD continue to rise in younger black adults. Although diabetes and hypertension remain the most commonly reported cause of ESRD, rates of end-stage atherosclerotic renovascular disease seem to be on the rise in older patients. Although clinical care indicators, such as the proportion of hemodialysis patients using fistulas, continue to improve gradually, the proportion of patients overshooting target hemoglobin levels under epoetin therapy may be a source of concern. Survival probabilities have improved steadily in the US ESRD population since the late 1980s, which is remarkable when one considers the ever-expanding burden of comorbidity in incident patients. However, although first-year dialysis mortality rates have clearly improved since 1987, meaningful improvements do not seem to have accrued since 1993, in contrast to steady annual improvements in years 2 through 5. Although most of these findings are grounds for cautious optimism, the same cannot be said for issues of cost; reflecting the growth in the size of the ESRD population, associated costs grew by 57% between 1999 and 2004 and now account for 6.7% of total Medicare expenditures.