Simulation model of renal replacement therapy: predicting future demand in England
Simulation model of renal replacement therapy: predicting future demand in England
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DOI：
10.1093/ndt/gfg591
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发表时间：
2004-03-01
影响因子：
6.1
通讯作者：
Farrington, K
中科院分区：
文献类型：
--
作者：
Roderick, P;Davies, R;Farrington, K
背景。英国对肾脏替代疗法（RRT）的需求稳步上升，尽管其基础低于许多其他发达国家。需要预测 RRT 的未来需求以及接受率、移植供应和患者生存等因素的影响，以便为此类服务的规划提供信息。方法。离散事件模拟模型估计了 2010 年英国在一系列情景下对 RRT 的未来需求。该模型使用当前的患病率以及当前和预计的未来接受率、生存率以及模式之间的转换来预测未来的患者数量。全国人口和死亡率数据、已发表的文献以及来自英国肾脏登记处和英国移植局的数据，用于估计未满足的 RRT 需求、人口结构变化的影响和 2 型糖尿病发病率、患者血液透析 (HD) 存活率和移植供应。结果。到 2010 年，预计患病人数将从 2000 年的约 30 000 人增加到 42 至 51 000 人（下午 900 点至 1000 点），年均增长率为 4.5-6%。改变移植物供应对总体数量影响不大，但使移植物功能正常的患者比例发生高达 8% 的变化。即使移植供应乐观增加（5 年每年 11%），HD 患者数量仍将继续大幅增加，尤其是老年人。最影响未来患者数量的因素是接受率和透析存活率。结论。该模型预测，到 2010 年，RRT 人群将大幅增长，达到接近 1000 p.m.p. 的速度，特别是老年人和 HD 患者，并且至少在 25 年内无法达到稳定状态。
Background. The demand for renal replacement therapy (RRT) in England has risen steadily, although from a lower base than many other developed countries. Predicting the future demand for RRT and the impact of factors such as the acceptance rate, transplant supply and patient survival, is required in order to inform the planning of such services.Methods. A discrete event simulation model estimates the future demand for RRT in England in 2010 for a range of scenarios. The model uses current prevalence and current and projected future acceptance rates, survival rates and the transitions between modalities to predict future patient numbers. National population and mortality data, published literature and data from the UK Renal Registry and UK Transplant, are used to estimate unmet need for RRT, the impact of changing demography and incidence of Type 2 diabetes, patient haemodialysis (HD) survival and transplant supply.Results. By 2010 the predicted prevalence will have increased from about 30 000 in 2000 to between 42 and 51000 (900-1000 p.m.p.), an average annual growth of 4.5-6%. Changing transplant supply has a small effect on overall numbers but changes the proportion of patients with functioning graft by up to 8%. Even with an optimistic increase in transplant supply (11% p.a. for 5 years), numbers on HD will continue to rise substantially, especially in the elderly. The factors most influencing future patient numbers are the acceptance rate and dialysis survival.Conclusion. This model predicts a substantial growth in the RRT population to 2010 to a rate approaching 1000 p.m.p., particularly in the elderly and those on HD, with a steady state not being reached for at least 25 years.