Epidemic of end-stage renal disease in people with diabetes in the United States population: Do we know the cause?
Epidemic of end-stage renal disease in people with diabetes in the United States population: Do we know the cause?
复制标题
DOI：
10.1111/j.1523-1755.2005.00265.x
复制
发表时间：
2005-05-01
影响因子：
19.6
通讯作者：
Warram, JH
中科院分区：
文献类型：
--
作者：
Jones, CA;Krolewski, AS;Warram, JH
背景在过去的二十年里，美国人群中开始肾脏替代治疗的人数呈指数级增长。糖尿病引起的终末期肾病病例占这一增加的大部分。在这份报告中，我们研究了可能导致这种增加的因素，以确定它是否真正代表了糖尿病所致ESRD的流行。我们回顾了美国肾脏数据系统、美国疾病控制和预防中心糖尿病监测项目和糖尿病文献的时间趋势数据。糖尿病患者数量的近期增长占糖尿病相关ESRD数量增长的不到10%。相反，其中大部分是由于糖尿病患者的ESRD风险增加了三倍，因此有资格成为流行病。奇怪的是，尽管有效的肾脏保护疗法得到了广泛的应用，这种流行病还是发生了。2型糖尿病患者，无论性别，年龄或种族，都经历了最大的风险增加。没有证据表明糖尿病患者的生存时间更长，因此风险增加并不归因于与长期糖尿病相关的高风险。我们假设，在过去的二十年里，在美国人群中糖尿病患者中发生了ESRD的流行。导致这种流行病的因素的性质以及它特别影响2型糖尿病患者的原因尚不清楚。确定推定因素的研究工作值得高度重视，为不断增加的ESRD和2型糖尿病患者提供护理的资源承诺也值得高度重视。
Background. The number of individuals initiating renal replacement therapy in the United States population grew exponentially over the past two decades. Cases of end-stage renal diseae (ESRD) attributed to diabetes accounted for most of this increase. In this report we examined factors that may account for the increase to determine whether it truly represents an epidemic of ESRD due to diabetes.Methods. We reviewed time trends in data of the United States Renal Data system, the Diabetes Surveillance Program of the Centers for Disease Control and Prevention, and diabetes literature.Results. Recent growth of the number of individuals with diabetes accounted for less than 10% of the increase in the number of diabetes-related ESRD. Instead, most of it was due to a threefold increase in risk of ESRD in people with diabetes and, therefore, qualifies as an epidemic. Curiously, this epidemic occurred despite widening implementation of effective renoprotective therapies. Individuals with type 2 diabetes, regardless of gender, age, or race, experienced the greatest increase in risk. There is no evidence that diabetic patients have been surviving longer, so the increased risk was not attributable to the high risk associated with long duration diabetes.Conclusion. We hypothesize that an epidemic of ESRD has occurred in people with diabetes in the United States population over the last two decades. The nature of the factor responsible for the epidemic and the reasons it affects patients with type 2 diabetes particularly are unknown. Research efforts to identify the putative factor deserve high priority, as does a commitment of resources to provide care for the burgeoning number of patients with ESRD and type 2 diabetes.