Stengel Bénédicte, Billon Solenne, Van Dijk Paul C W, Jager Kitty J, Dekker Friedo W, Simpson Keith, Briggs J Douglas
Institut National de la Santé et de la Recherche Médicale, INSERM Unité 258, Villejuif, France.
Nephrol Dial Transplant. 2003 Sep;18(9):1824-33. doi: 10.1093/ndt/gfg233.
The epidemiology of renal replacement therapy (RRT) for end-stage renal disease (ESRD) varies considerably worldwide, but we have lacked reliable quantitative estimates of trends in the incidence by age, sex and cause in Europe over the last decade.
We analysed data from nine countries participating in the ERA-EDTA registry: Austria, Belgium, Denmark, Finland, Greece, The Netherlands, Norway, Spain and UK (Scotland). Adjusted incidence rates for age and sex were studied for 2 year periods between 1990 and 1999. Average annual changes (%) were estimated by Poisson regression.
The adjusted incidence rate of RRT increased from 79.4 per million population (pmp) (range: 58.4-101.0) in 1990-1991 to 117.1 pmp (91.6-144.8) in 1998-1999, i.e. 4.8% (3.1-6.4%) each year. This increase did not flatten out at the end of the decade, except in The Netherlands, and was greater in men than women, 5.2 vs 4.0%/year. In most countries, the incidence rate remained stable for those younger than 45 years; it rose by 2.2%/year on average in the 45-64 year age group and by 7.0% among those 65-74 years; it tripled over the decade in those 75 years or older, and by 1998-1999 it ranged from 140.9 to 540.4 pmp between countries. The incidence of ESRD due to diabetes, hypertension and renal vascular disease nearly doubled over 10 years; in 1998-1999, it varied between countries from 10.2 to 39.3 pmp for diabetes, from 5.8 to 21.0 for hypertension, and from 1.0 to 15.5 for renal vascular disease.
RRT incidence continues to rise but at various rates in the European countries studied, tending to widen the gap between them. This mainly results from enlarging differences in incidence in the elderly and, to a lesser extent, in that due to diabetes, hypertension and renal vascular disease.
全球范围内，终末期肾病（ESRD）的肾脏替代治疗（RRT）流行病学存在很大差异，但过去十年间，我们一直缺乏欧洲地区按年龄、性别和病因划分的发病率趋势的可靠定量估计。
我们分析了参与欧洲肾脏协会 - 欧洲透析与移植协会（ERA - EDTA）注册研究的九个国家的数据：奥地利、比利时、丹麦、芬兰、希腊、荷兰、挪威、西班牙和英国（苏格兰）。研究了1990年至1999年期间每两年的年龄和性别调整发病率。通过泊松回归估计年均变化率（%）。
RRT的调整发病率从1990 - 1991年的每百万人口79.4例（范围：58.4 - 101.0）增加到1998 - 1999年的117.1例/百万人口（91.6 - 144.8），即每年增加4.8%（3.1 - 6.4%）。除荷兰外，这一增长在十年末并未趋于平稳，且男性的增长率高于女性，分别为每年5.2%和4.0%。在大多数国家，45岁以下人群的发病率保持稳定；45 - 64岁年龄组平均每年上升2.2%，65 - 74岁人群中上升7.0%；75岁及以上人群的发病率在十年间增长了两倍，到1998 - 1999年，各国之间的发病率范围为140.9至540.4例/百万人口。因糖尿病、高血压和肾血管疾病导致的ESRD发病率在十年间几乎翻了一番；1998 - 1999年，各国之间糖尿病的发病率从10.2至39.3例/百万人口不等，高血压为5.8至21.0例/百万人口，肾血管疾病为1.0至15.5例/百万人口。
在所研究的欧洲国家中，RRT发病率持续上升，但上升速度各异，这往往会扩大各国之间的差距。这主要是由于老年人发病率差异扩大，以及在较小程度上由于糖尿病、高血压和肾血管疾病导致的发病率差异。
