Trends in the incidence of kidney replacement therapy: comparisons of ERA, USRDS, and Japan registries.
Trends in the incidence of kidney replacement therapy: comparisons of ERA, USRDS, and Japan registries.
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肾脏替代治疗发生率的趋势：ERA、USRDS 和日本登记处的比较。
DOI：
10.1093/ndt/gfac312
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Yamagata Kunihiro
中科院分区：
文献类型：
--
作者：
Inoue T;Nakamura Y;Tanaka S;Kohro T;Li LX;Huang L;Yao J;Kawamura S;Inoue R;Nishi H;Fukaya D;Uni R;Hasegawa S;Inagi R;Umene R;Wu CH;Ye H;Bajwa A;Rosin DL;Ishihara K;Nangaku M;Wada Y;Okusa MD;Yamagata Kunihiro
需要肾脏替代治疗（KRT）的患者数量在全球范围内不断增加[1]。全球慢性肾脏病（CKD）对策的目标是防止CKD患者的肾功能恶化，不仅减轻与终末期肾脏病（ESKD）和心血管疾病（CVD）相关的身体负担，还减轻因接受KRT的患者数量增加而造成的社会负担。因此，促进了CKD的早期发现以及有效治疗方法的开发和研究。CKD对策的稳步实施有望减少未来ESKD患者的数量。具体而言，能够显示国家和地区基础上新发ESKD患者数量的年度趋势和减少，对于证明在对抗CKD方面实现重要目标至关重要。或者，可以根据CKD各阶段（G1至G5）患者数量的年度变化，特别是CKD G5患者，评估ESKD发生率的差异。尽管一些国家的既往研究准确显示了CKD G5患者的数量[2]，但在大多数国家和地区，难以正确评估这些数字[3]。虽然基于ESKD确切发生率的国际比较是理想的，但KRT的发生率被视为ESKD的发生率。然而，在每个国家和地区，KRT的发病率和患病率与CKD的发病率和患病率明显不同。在比较欧洲肾脏协会（ERA）、美国肾脏数据系统（USRDS）和日本登记研究（包括超过20年的KRT登记）之间的KRT发生率时，2019年美国每百万人群的KRT发生率为411.7，日本为327.5，ERA为145，低50%以上。这些发现归因于不同国家和种族ESKD的发病率、ESKD以外疾病的预期寿命、国家医疗保险系统对KRT的覆盖率以及KRT的接受率的差异。其中，社会因素对大多数国家和地区ESKD的发病率有明显影响。在美国、日本和欧洲对KRT发生率趋势的系列观察被认为反映了ESKD发生率的长期变化，因为这些国家的社会因素长期稳定。在欧洲，1990年至1999年期间，新发KRT患者的数量以每年4.8%（95% CI 4.5%至5.0%）的速度增加，但在2000年后逐渐下降，2008年至2011年期间新发患者显著减少-2.2%（95% CI-4.2%至0.2%）[4]。CKD对策的实施预计将减少新发KRT患者的数量。在本月的NDT中，报告了自2008年以来欧洲新KRT患者的进一步趋势、欧洲KRT患者的患病率和生存率[5]。Huijben等人的研究表明，2008年至2011年，8个欧洲国家的KRT发生率下降[-1.48%（-3.15%至0.21%）]，但2011年至2017年显著增加[1.01%（0.43%至1.60%）][5]。因此，观察到KRT发生率一过性降低。在这一下降之前，在尿毒症症状发作之前早期开始KRT被认为是一种生存优势，因此，尝试早期开始KRT [4]。然而，在临床研究中，无创早期透析的结果是否定的[6]，这表明引入无创早期透析的临床意义。
The number of patients requiring kidney replacement therapy (KRT) is increasing worldwide [1]. The objectives of global chronic kidney disease (CKD) countermeasures are to prevent the deterioration of renal function in CKD patients and reduce not only the physical burden associated with end-stage kidney disease (ESKD) and cardiovascular disease (CVD), but also the social burden caused by an increase in the number of patients receiving KRT. Therefore, the early detection of CKD as well as the development of and investigations on effective treatment methods have been promoted. The steady implementation of CKD countermeasures is expected to reduce the number of patients with ESKD in the future. Specifically, the ability to show annual trends and decreases in the number of new ESKD patients on a national and regional basis will be important for demonstrating the achievement of important goals in the fight against CKD. Alternatively, differences in the incidence of ESKD may be assessed based on annual transitions in the number of patients at each stage of CKD (G1 to G5), particularly CKD G5 patients. Although previous studies in some countries accurately showed the number of CKD G5 patients [2], difficulties are associated with correctly assessing these numbers in most countries and regions [3]. While international comparisons based on the exact incidence of ESKD would be ideal, the incidence of KRT is regarded as the incidence of ESKD instead. However, the incidence and prevalence of KRT markedly differ from those of CKD in each country and region. In comparisons of the incidence of KRT among the European Renal Association (ERA), United States Renal Data System (USRDS) and Japan registries, which included more than 20 years of KRT registration, the incidence of KRT per million population in 2019 was 411.7 in the USA, 327.5 in Japan and> 50% lower at 145 in the ERA. These findings were attributed to differences in the incidence of ESKD among countries and races, life expectancy due to diseases other than ESKD, coverage by national medical insurance systems for KRT and the acceptance rate of KRT. Among these, social factors had a marked effect on the incidence of ESKD in most countries and regions. Serial observations of trends in the incidence of KRT in the USA, Japan and Europe are considered to reflect secular changes in the incidence of ESKD because of the long-term stability of social factors in these countries. In Europe, the number of new KRT patients increased at an annual rate of 4.8%(95% CI 4.5% to 5.0%) between 1990 and 1999, but gradually declined after 2000, with a marked reduction of–2.2% in new patients between 2008 and 2011 (95% CI–4.2% to–0.2%)[4]. The implementation of CKD countermeasures was expected to decrease the number of new KRT patients. In this month of NDT, follow-ups on this report by further trends in new KRT patients in Europe since 2008, prevalence and survival of patients on KRT across Europe were reported [5]. Huijben et al. showed that the incidence of KRT in eight European countries decreased between 2008 and 2011 [–1.48%(–3.15% to 0.21%)], but significantly increased between 2011 and 2017 [1.01%(0.43% to 1.60%)][5]. Therefore, a transient decrease was noted in the incidence of KRT. Prior to this decrease, the early initiation of KRT before the onset of uremic symptoms was considered to be a survival advantage, and, thus, the early initiation of KRT was attempted [4]. However, negative findings were obtained in clinical studies on the symptom-free early initiation of dialysis [6], which suggested that the clinical significance of the introduction of …
日本肾脏替代治疗的年龄和性别发病率：国际比较
影响因子：
1.2
作者：
M. Wakasugi;J. Kazama;I. Narita
通讯作者：
I. Narita
影响因子：
6.1
作者：
Pippias, Maria;Jager, Kitty J.;Stel, Vianda S.
通讯作者：
Stel, Vianda S.