Pérez García R, Rodríguez Benítez P, Dall'Anesse C, Gómez Campderá F, Valderrábano F
Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid.
An Med Interna. 2001 Apr;18(4):175-80.
To study the incidence, prevalence, treatment modalities and prognosis of diabetic patients on renal replacement therapy.
We studied all end-stage renal failure (ESRF) diabetic patients on renal replacement therapy in "Area Sanitaria 1" in Madrid from 1978 to 1998.
Diabetes mellitus has become the leading cause of ESRF in our health area of Madrid, 30% of all causes of ESRF. Incidence of diabetics beginning RRT was 33.3 per million population (pmp) in 1998, while in 1993-94 diabetes was 15% and 21 pmp, respectively, table 1. The proportion of diabetics on RRT has increased from 7.4% 1986 to 12.7% 1998. The prevalence of diabetics on RRT in 1998 was 135 pmp, with an overall prevalence of 1054 pmp. At the mean time, the proportion between incident diabetics type 2/diabetics on RRT has increased from 15% in 1987-88, to 54% in 1993-94 and to 81% in 1997-98, consequently, mean age of diabetic patients at beginning RRT has increased from 47 years before 1988, 58 in 1989-90, 61 in 1993-94, 62 in 1995-96 and 63 in 1997-98 (Table I). We studied 182 diabetics admitted for renal replacement therapy, 106 males and 76 females, 105 were diabetics type 1 and 77 type 2. Their mean age at RRT beginning was 57.12 years (SD). Hemodialysis (HD) was the first modality of treatment for 128 (70%) diabetics and CAPD for 54. Seventy out of 128 patients on HD were dialyzed in the Hospital Unit, 40% on AFB (acetate free biofiltration) and 58 in two Satellite Units, that means a higher proportion of diabetics on CAPD and on HD in Hospital Unit. Diabetics allocated to CAPD were 5 years, as mean, younger than patients allocated to HD (p < 0.01) and the proportion of diabetes type 1 was higher in CAPD (72%) than in HD (51%), p 0.05. During the mean follow-up period (51.45 months) 79 patients changed their treatment modality and 45 of them received a kidney allogral. Relative risk of drop-out was higher in CAPD technique when compared to HD. Clinical complications were frequently observed: ocular (77%), cardiovascular (Myocardial infarction 1.7%), acute cerebrovascular disease (21%) and distal angiopathy (35%), 10% amputee. At December of 1998, 89 patients were dead. Cardiovascular and cerebrovascular diseases (29%) and Infections (27%) were the two most frequent causes of death. Unknown-origin deaths represent 19% of all deaths. The overall survival (Kaplan Meier) was 92%, 80%, 72%, 61% and 54% at 1, 2, 3, 4 and 5 years, respectively (57 patients completed last period). Survival was better on HD than on CAPD, but without statistical significance, although the significant difference in age and in proportion of diabetes type 2 between both groups. Data analysis estimated by Cox proportional hazards regression shows that younger age and ki,r transplantation had a positive independent effect on survival, whik clinical distal angiopathy had important negative effect on survival.
Diabetes mellitus has become the leading case of ESRF in our health area of Madrid. Young age and kidney transplantation had a positive independent effect on survival, while clinical distal angiopathy had important negative effect.
研究接受肾脏替代治疗的糖尿病患者的发病率、患病率、治疗方式及预后。
我们研究了1978年至1998年在马德里“第一卫生区”接受肾脏替代治疗的所有终末期肾衰竭（ESRF）糖尿病患者。
在我们马德里的卫生区域，糖尿病已成为ESRF的主要病因，占所有ESRF病因的30%。1998年开始接受肾脏替代治疗的糖尿病患者发病率为每百万人口33.3例（pmp），而在1993 - 1994年，糖尿病患者发病率分别为15%和每百万人口21例，表1。接受肾脏替代治疗的糖尿病患者比例从1986年的7.4%增至1998年的12.7%。1998年接受肾脏替代治疗的糖尿病患者患病率为每百万人口135例，总体患病率为每百万人口1054例。同时，2型糖尿病新发病例/接受肾脏替代治疗的糖尿病患者的比例从1987 - 1988年的15%增至1993 - 1994年的54%以及1997 - 1998年的81%，因此，开始接受肾脏替代治疗的糖尿病患者的平均年龄从1988年前的47岁，1989 - 1990年的58岁，1993 - 1994年的61岁，1995 - 1996年的62岁增至1997 - 1998年的63岁（表I）。我们研究了182例因肾脏替代治疗入院的糖尿病患者，其中男性106例，女性76例，1型糖尿病患者105例，2型糖尿病患者77例。他们开始接受肾脏替代治疗时的平均年龄为57.12岁（标准差）。血液透析（HD）是128例（70%）糖尿病患者的首选治疗方式，持续性不卧床腹膜透析（CAPD）用于54例患者。128例接受HD治疗的患者中，70例在医院科室进行透析，40%采用无醋酸盐生物滤过（AFB），58例在两个卫星科室透析，这意味着在医院科室接受CAPD和HD治疗的糖尿病患者比例更高。分配接受CAPD治疗的糖尿病患者平均年龄比接受HD治疗的患者小5岁（p < 0.01），且CAPD治疗中1型糖尿病的比例（72%）高于HD治疗（51%），p < 0.05。在平均随访期（51.45个月）内，79例患者改变了治疗方式，其中45例接受了肾移植。与HD相比，CAPD技术的退出相对风险更高。临床并发症常见：眼部并发症（77%）、心血管并发症（心肌梗死1.7%）、急性脑血管疾病（21%）和远端血管病变（35%），10%患者截肢。至1998年12月，89例患者死亡。心血管和脑血管疾病（29%）及感染（27%）是最常见的两个死亡原因。不明原因死亡占所有死亡的19%。总体生存率（Kaplan - Meier法）在1年、2年、3年、4年和5年时分别为92%、80%、72%、61%和54%（57例患者完成最后阶段）。HD治疗的生存率优于CAPD，但无统计学意义，尽管两组在年龄和2型糖尿病比例上存在显著差异。通过Cox比例风险回归估计的数据分析表明，年龄较小和肾移植对生存有积极的独立影响，而临床远端血管病变对生存有重要的负面影响。
在我们马德里的卫生区域，糖尿病已成为ESRF的主要病因。年龄较小和肾移植对生存有积极的独立影响，而临床远端血管病变有重要的负面影响。
