The State of Chronic Kidney Disease, ESRD, and Morbidity and Mortality in the First Year of Dialysis
The State of Chronic Kidney Disease, ESRD, and Morbidity and Mortality in the First Year of Dialysis
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DOI：
10.2215/cjn.05980809
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发表时间：
2009-12-01
影响因子：
9.8
通讯作者：
Chen, Shu-Chen
中科院分区：
文献类型：
--
作者：
Collins, Allan J.;Foley, Robert N.;Chen, Shu-Chen
本综述研究了终末期肾病项目的趋势，评估了自1989年达拉斯发病率和死亡率会议以来在预防保健、住院和死亡率方面的进展。透析患者的人数几乎增加了两倍，从1989年的123，000人增加到2007年的366，000人。流行人群死亡率在20世纪80年代中期下降，但在20世纪90年代总体上没有变化;透析时间少于5年的患者死亡率下降，但透析时间超过5年的患者死亡率增加。自2000年以来，总人口的死亡率有所下降。在事件透析人群中，第一年后的死亡率有所下降，但自1996年以来，第一年的死亡率保持平稳;死亡率在第2和第3个月达到峰值，然后在1.2个月时下降到第一个月的水平。在过去的10年中，流行人群中的感染性住院率增加了40%。对于事件患者，10年内感染性住院治疗增加了近100%，血管通路住院治疗增加了200%，心血管住院治疗增加了30%。透析导管的使用率很高; 82%的患者使用导管开始透析。透析启动计划不佳可能导致导管使用和相关的高感染住院率，限制了第一年内改善患者生存率的可能性。公共卫生计划，包括新的医疗保险慢性肾脏疾病教育福利，需要促进更好地照顾可能需要透析的患者，以降低第一年的高发病率和死亡率。Clin J Am Soc Nephrol 4：S5-S11，2009。doi：10.2215/CJN.05980809
This review examines trends in the ESRD program, assessing progress in preventive care, hospitalizations, and mortality since 1989, the year of the Dallas Morbidity and Mortality Conference. The number of prevalent dialysis patients nearly tripled, to 366,000 in 2007 from 123,000 in 1989. Prevalent population mortality rates declined in the mid-1980s but did not change overall through the 1990s; rates declined for patients on dialysis for less than 5 yr but increased for patients on dialysis for longer than 5 yr. Death rates throughout the prevalent population have subsequently declined since 2000. In the incident dialysis population, death rates after the first year have declined, but first-year rates have remained flat since 1996; rates peak in months 2 and 3, then decline to the level of the first month by 1.2 mo. Infectious hospitalization rates in the prevalent population increased 40% in the last 10 yr. For incident patients, infectious hospitalizations increased almost 100% over 10 yr, vascular access hospitalizations by 200%, and cardiovascular hospitalizations by 30%. Use of dialysis catheters is high; 82% of patients start dialysis with a catheter. Poor planning for dialysis initiation may contribute to catheter use and the associated high infectious hospitalization rate, limiting potential for improved patient survival during the first year. Public health programs, including the new Medicare chronic kidney disease education benefit, are needed to promote better care of patients who may need dialysis to reduce the high morbidity and mortality in the first year. Clin J Am Soc Nephrol 4: S5-S11, 2009. doi: 10.2215/CJN.05980809