Nishimura Rimei, Dorman Janice S, Bosnyak Zsolt, Tajima Naoko, Becker Dorothy J, Orchard Trevor J
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
Am J Kidney Dis. 2003 Jul;42(1):117-24. doi: 10.1016/s0272-6386(03)00414-1.
Little information is available regarding the long-term incidence of end-stage renal disease (ESRD) and survival after the introduction of renal replacement therapy (RRT) in patients with type 1 diabetes.
We studied 1,075 patients with type 1 diabetes (onset age < 18 years) diagnosed between 1965 and 1979, who comprise the Allegheny County population-based registry. Onset of ESRD was defined as the introduction of RRT (dialysis or transplantation).
Of 1,075 registrants, the living status of 975 patients (90.7%) and complication status of 798 patients (74.2%) were ascertained as of January 1, 1999. During the observation period, 104 patients (13.0%) developed ESRD, for an incidence rate of 521/100,000 person-years (95% confidence interval, 424 to 629). The cumulative incidence of ESRD was 11.3% at 25 years of diabetes. A significant decline was observed in 20-year cumulative incidence rates of ESRD for patients diagnosed between 1965 and 1969, 1970 and 1974, and 1975 and 1979 (9.1%, 4.7%, and 3.6%, respectively; P = 0.006). Of 104 patients with ESRD, 29 patients (28%) received dialysis alone, 44 patients (42%) received dialysis followed by kidney transplantation, 26 patients (25%) underwent successful transplantation alone, and 5 patients (5%) underwent a failed kidney transplantation followed by dialysis therapy. The cumulative survival rate 10 years after the introduction of RRT was 51.2%. The cumulative survival rate of dialysis therapy followed by kidney transplantation was significantly greater than that of dialysis therapy alone (P < 0.001). No difference was detected in survival between pancreas-kidney transplant recipients and kidney-alone transplant recipients (P = 0.7).
The incidence of ESRD observed in this cohort has declined, probably reflecting the better glycemic and blood pressure control available since the early 1980s.
关于1型糖尿病患者开始接受肾脏替代治疗（RRT）后终末期肾病（ESRD）的长期发病率及生存率的信息较少。
我们研究了1965年至1979年间诊断的1075例1型糖尿病患者（发病年龄<18岁），这些患者来自阿勒格尼县基于人群的登记处。ESRD的发病定义为开始接受RRT（透析或移植）。
截至1999年1月1日，在1075名登记患者中，确定了975例患者（90.7%）的生存状况和798例患者（74.2%）的并发症状况。在观察期内，104例患者（13.0%）发生了ESRD，发病率为521/100,000人年（95%置信区间，424至629）。糖尿病25年时ESRD的累积发病率为11.3%。在1965年至1969年、1970年至1974年以及1975年至1979年诊断的患者中，ESRD的20年累积发病率显著下降（分别为9.1%、4.7%和3.6%；P = 0.006）。在104例ESRD患者中，29例患者（28%）仅接受透析，44例患者（42%）接受透析后进行肾脏移植，26例患者（25%）仅成功进行了移植，5例患者（5%）肾脏移植失败后接受透析治疗。开始RRT后10年的累积生存率为51.2%。透析后进行肾脏移植的累积生存率显著高于单纯透析（P < 0.001）。胰肾移植受者和单纯肾移植受者的生存率未检测到差异（P = 0.7）。
该队列中观察到的ESRD发病率有所下降，这可能反映了自20世纪80年代初以来血糖和血压控制的改善。
