Global, regional, and national burden of chronic kidney disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017
Global, regional, and national burden of chronic kidney disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017
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DOI：
10.1016/s0140-6736(20)30045-3
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发表时间：
2020-02-29
期刊：
影响因子：
168.9
通讯作者：
Vos, Theo
中科院分区：
文献类型：
--
作者：
Bikbov, Boris;Purcell, Carrie;Vos, Theo
卫生系统规划需要对慢性肾脏病（CKD）流行病学进行仔细评估，但在许多国家，这种疾病的发病率和死亡率数据很少或根本不存在。我们在2017年全球疾病、损伤和风险因素负担研究中估计了全球、区域和国家CKD负担，以及肾功能受损导致的心血管疾病和痛风负担。我们使用术语“慢性肾脏病”来指可直接归因于慢性肾脏病各个阶段的发病率和死亡率，我们使用术语“肾功能受损”来指心血管疾病和痛风导致慢性肾脏病的额外风险。方法我们使用的主要数据来源是已发表的文献、生命登记系统、终末期肾病登记和家庭调查。CKD负担的估计值是使用死因推断模型和贝叶斯元回归分析工具得出的，包括发病率、患病率、残疾生存年、死亡率、寿命损失年和残疾调整生命年（DADs）。结果：2017年，全球有120万人（95%不确定区间[UI] 1.2 ~ 1.3）死于CKD。1990年至2017年，全球所有年龄段CKD死亡率增加了41.5%（95% UI 35.2至46.5），尽管年龄标准化死亡率没有显著变化（2.8%，-1.5至6.3）。2017年，记录了6.975亿例（95% UI 649.2至752.0）全期CKD病例，全球患病率为9.1%（8.5至9.8）。自1990年以来，全球所有年龄段CKD患病率增加了29.3%（95% UI 26.4至32.6），而年龄标准化患病率保持稳定（1.2%，-1.1至3.5）。2017年，CKD导致了3580万（95%UI 33.7至38.0）糖尿病患者，其中糖尿病肾病几乎占糖尿病患者的三分之一。CKD的大部分负担集中在社会人口指数（SDI）最低的三个五分之一。在一些地区，特别是大洋洲、撒哈拉以南非洲和拉丁美洲，CKD的负担远高于发展水平的预期，而撒哈拉以南非洲西部、东部和中部、东亚、南亚、中欧和东欧、澳大拉西亚和西欧的疾病负担低于预期。1.4 100万（95%UI 1.2至1.6）心血管疾病相关死亡和2530万（22.2至28.9）心血管疾病DRDs可归因于肾功能受损。解释肾脏疾病对全球健康有重大影响，既是全球发病率和死亡率的直接原因，也是心血管疾病的重要风险因素。CKD在很大程度上是可以预防和治疗的，在全球卫生政策决策中值得更多关注，特别是在低和中等SDI的地区。版权所有（C）2020作者。爱思唯尔有限公司出版
Background Health system planning requires careful assessment of chronic kidney disease (CKD) epidemiology, but data for morbidity and mortality of this disease are scarce or non-existent in many countries. We estimated the global, regional, and national burden of CKD, as well as the burden of cardiovascular disease and gout attributable to impaired kidney function, for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017. We use the term CKD to refer to the morbidity and mortality that can be directly attributed to all stages of CKD, and we use the term impaired kidney function to refer to the additional risk of CKD from cardiovascular disease and gout.Methods The main data sources we used were published literature, vital registration systems, end-stage kidney disease registries, and household surveys. Estimates of CKD burden were produced using a Cause of Death Ensemble model and a Bayesian meta-regression analytical tool, and induded incidence, prevalence, years lived with disability, mortality, years of life lost, and disability-adjusted life-years (DALYs). A comparative risk assessment approach was used to estimate the proportion of cardiovascular diseases and gout burden attributable to impaired kidney function.Findings Globally, in 2017,1.2 million (95% uncertainty interval [UI] 1.2 to 1.3) people died from CKD. The global all-age mortality rate from CKD increased 41.5% (95% UI 35.2 to 46.5) between 1990 and 2017, although there was no significant change in the age-standardised mortality rate (2.8%, -1.5 to 6.3). In 2017,697.5 million (95% UI 649.2 to 752.0) cases of all-stage CKD were recorded, for a global prevalence of 9.1% (8.5 to 9.8). The global all-age prevalence of CKD increased 29.3% (95% UI 26.4 to 32.6) since 1990, whereas the age-standardised prevalence remained stable (1.2%, -1.1 to 3.5). CKD resulted in 35.8 million (95% UI 33.7 to 38.0) DALYs in 2017, with diabetic nephropathy accounting for almost a third of DALYs. Most of the burden of CKD was concentrated in the three lowest quintiles of Socio-demographic Index (SDI). In several regions, particularly Oceania, sub-Saharan Africa, and Latin America, the burden of CKD was much higher than expected for the level of development, whereas the disease burden in western, eastern, and central sub-Saharan Africa, east Asia, south Asia, central and eastern Europe, Australasia, and western Europe was lower than expected. 1.4 million (95% UI 1.2 to 1.6) cardiovascular disease-related deaths and 25.3 million (22.2 to 28.9) cardiovascular disease DALYs were attributable to impaired kidney function.Interpretation Kidney disease has a major effect on global health, both as a direct cause of global morbidity and mortality and as an important risk factor for cardiovascular disease. CKD is largely preventable and treatable and deserves greater attention in global health policy decision making, particularly in locations with low and middle SDI. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd.