Incidence of ESRD and survival after renal replacement therapy in patients with type 1 diabetes: A report from the Allegheny County Registry
Incidence of ESRD and survival after renal replacement therapy in patients with type 1 diabetes: A report from the Allegheny County Registry
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DOI：
10.1016/s0272-6386(03)00414-1
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发表时间：
2003-07-01
影响因子：
13.2
通讯作者：
Orchard, TJ
中科院分区：
文献类型：
--
作者：
Nishimura, R;Dorman, JS;Orchard, TJ
背景：关于 I 型糖尿病患者引入肾脏替代疗法 (RRT) 后终末期肾病 (ESRD) 的长期发病率和生存率的信息很少。方法：我们研究了 1,075 名 1965 年至 1979 年间诊断的 1 型糖尿病患者（发病年龄 < 18 岁），这些患者包括阿勒格尼县人口登记处。 ESRD 的发生被定义为 RRT（透析或移植）的引入。结果 截至1999年1月1日，在1,075名登记者中，确定了975名患者（90.7%）的生活状况和798名患者（74.2%）的并发症状况。观察期间，104名患者（113.0%）发生ESRD，发病率为521/100,000人年（95%置信区间， 424 至 629）。糖尿病患者 25 岁时，ESRD 累积发病率为 11.3%。 1965年至1969年、1970年至1974年、1975年至1979年诊断的患者的ESRD 20年累积发病率显着下降（分别为9.1%、4.7%和3.6%；P = 0.006）。在 104 名 ESRD 患者中，29 名患者（28%）接受单独透析，44 名患者（42%）接受透析后肾移植，26 名患者（25%）接受单独移植成功，5 名患者（5%）接受失败肾移植后接受透析治疗。引入RRT后10年的累积生存率为51.2%。透析治疗后肾移植的累积生存率显着高于单独透析治疗（P < 0.001）。胰肾移植受者与单纯肾移植受者之间的生存率没有差异（P = 0.7）。结论 在该队列中观察到的 ESRD 发生率有所下降，这可能反映了自 20 世纪 80 年代初以来血糖和血压控制得更好。 (C) 2003 年，国家肾脏基金会 (National Kidney Foundation, Inc.)
Background: Little information is available regarding the long-term incidence of end-stage renal disease (ESRD) and survival after the introduction of renal replacement therapy (RRT) in patients with type I diabetes. Methods: We studied 1,075 patients with type 1 diabetes (onset age < 18 years) diagnosed between 1965 and 1979, who comprise the Allegheny County population-based registry. Onset of ESRD was defined as the introduction of RRT (dialysis or transplantation). Results Of 1,075 registrants, the living status of 975 patients (90.7%) and complication status of 798 patients (74.2%) were ascertained as of, January 1, 1999. During the observation period, 104 patients (113.0%) developed ESRD, for an incidence rate of 521/100,000 person-years (95% confidence interval, 424 to 629). The cumulative incidence of ESRD was 11.3% at 25 years of diabetes. A significant decline was observed in 20-year cumulative incidence rates of ESRD for patients diagnosed between 1965 and 1969,1970 and 1974, and 1975 and 1979 (9.1%, 4.7%, and 3.6%, respectively; P = 0.006). Of 104 patients with ESRD, 29 patients (28%) received dialysis alone, 44 patients (42%) received dialysis followed by kidney transplantation, 26 patients (25%) underwent successful transplantation alone, and 5 patients (5%) underwent a failed kidney transplantation followed by dialysis therapy. The cumulative survival rate 10 years after the introduction of RRT was 51.2%. The cumulative survival rate of dialysis therapy followed by kidney transplantation was significantly greater than that of dialysis therapy alone (P < 0.001). No difference was detected in survival between pancreas-kidney transplant recipients and kidney-alone transplant recipients (P = 0.7). Conclusion The incidence of ESRD observed in this cohort has declined, probably reflecting the better glycemic and blood pressure control available since the early 1980s. (C) 2003 by the National Kidney Foundation, Inc.