Renal replacement therapy in rural and urban Australia
Renal replacement therapy in rural and urban Australia
复制标题
DOI：
10.1093/ndt/gfr584
复制
发表时间：
2012-05-01
影响因子：
6.1
通讯作者：
McDonald, Stephen P.
中科院分区：
文献类型：
--
作者：
Gray, Nicholas A.;Dent, Hannah;McDonald, Stephen P.
背景生活在农村地区的澳大利亚人的健康状况比城市居民差。本研究比较了澳大利亚农村和城市患者接受肾脏替代治疗（RRT）的情况和结局。纳入了1996年至2009年期间开始透析或接受肾移植的年龄≥ 16岁的非土著澳大利亚人，并在澳大利亚和新西兰透析和移植登记处进行了登记。根据偏远地区指数将每个患者的位置分为主要城市（MC）、内部区域（IR）、外部区域（OR）或偏远/非常偏远（REM）。在研究期间，共有24068人开始透析，5399人接受了肾移植。透析和移植患者按偏远地区指数的患者分布分别为71.3%和70.8% MC，19.1%和18.6% IR，8.4%和9.1% OR以及1.1%和1.5% REM。校正年龄和性别后，每百万人群的RRT发生率为124 [95%置信区间（CI）：122-126] MC、106（95% CI：103-110）IR、100（95% CI：96-105）OR和96（95% CI：84-109）REM。在控制人口统计学变量、合并症和其他协变量后，与MC相比，透析生存的风险比为1.08（95% CI：1.03-1.14）IR、1.19（95% CI：1.11-1.28）OR和1.03（95% CI：0.84-1.25）REM。移植患者的存活率在偏远地区没有统计学差异。澳大利亚农村地区的RRT发生率较低。目前尚不清楚RRT较低的原因是否反映了较低的疾病发生率或不同的治疗途径。透析的结果存在差异，但移植无差异。
Background. Australians living in rural regions have poorer health outcomes than city residents. This study compares rural and city patient access to and outcomes of renal replacement therapy (RRT) in Australia.Methods. Non-indigenous Australians aged >= 16 years who commenced dialysis or underwent renal transplantation between 1996 and 2009 and were registered with the Australia and New Zealand Dialysis and Transplant Registry were included. Each patient's location was classified according to a remote area index as major city (MC), inner regional (IR), outer regional (OR) or remote/very remote (REM).Results. A total of 24 068 commenced dialysis and 5399 received a renal transplant during the study period. Patient distribution by remote area index was 71.3 and 70.8% MC, 19.1 and 18.6% IR, 8.4 and 9.1% OR and 1.1 and 1.5% REM for dialysis and transplant patients, respectively. RRT incidence per million population after adjusting for age and gender was 124 [95% confidence interval (CI): 122-126] MC, 106 (95% CI: 103-110) IR, 100 (95% CI: 96-105) OR and 96 (95% CI: 84-109) REM. After controlling for demographic variables, comorbidities and other covariates, hazard ratios for dialysis survival compared to MC were 1.08 (95% CI: 1.03-1.14) IR, 1.19 (95% CI: 1.11-1.28) OR and 1.03 (95% CI: 0.84-1.25) REM. Transplant patient survival was not statistically different by remoteness.Conclusions. Rural Australians have lower incidence of RRT. Whether the causes of the lower RRT reflect lower disease rates or differential treatment access is not known. Differences in outcomes were seen for dialysis but not transplantation.