Vitullo Felice, Casino Francesco G, Di Matteo Antonella, Di Candia Vito D, Gaudiano Vito, Piras Valeria, Alfonso Luigi, Basile Carlo, Procaccini Deni A, Gesualdo Loreto
Laboratory of Epidemiology & Health Policy, Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, S. Maria Imbaro, Italy.
J Nephrol. 2003 Nov-Dec;16(6):813-21.
This report on the 1994-1998 Dialysis and Transplantation Registry (DTR) of Puglia and Basilicata provides the first epidemiological profile of ESRD in southern Italy.
Frequency measures of patients in renal replacement therapy (RRT) were computed for Puglia and Basilicata (inhabitants: 4,086,422 and 610,000 respectively). Hazard ratios (HR) of death in relation to sex, age, educational level, primary nephropathies, and modality of dialysis, were estimated by applying the Cox model to patients starting dialysis as first RRT in 1994-1998 in Puglia.
The prevalence of treated ESRD in Puglia was 881 per million population (p.m.p.) (dialysis: 721 p.m.p.) in 1998, 713 p.m.p. (dialysis: 617 p.m.p.) in 1994. In Basilicata the prevalence of ESRD was 795 p.m.p. (dialysis: 669 p.m.p.) in 1998, 636 p.m.p. (dialysis: 575 p.m.p.) in 1994. Mean age at start of dialysis of incident cases of Puglia was 60 yr (median: 64 yr). Figures of diabetes, vascular diseases, and glomerulonephritis, were: 16%, 21%, 17%. Out of 2,152 incident patients on dialysis for at least one month, 293 started with peritoneal dialysis (PD). A 60-70% higher risk of death was observed for diabetic nephropathy and PD. In the Puglia/Basilicata DTR pooled analysis, lower educational level was associated with a 60% increased mortality risk.
The associations of PD and low education with the risk of death are very likely to be due to comorbid conditions, unavailable in these databases as in most regional and national DTR. By looking at variations of rates and outcomes among areas, potential improvements of local DTR for planning and research uses are discussed.
这份关于普利亚大区和巴西利卡塔大区1994 - 1998年透析与移植登记处（DTR）的报告提供了意大利南部终末期肾病（ESRD）的首个流行病学概况。
计算了普利亚大区和巴西利卡塔大区（居民分别为4,086,422人和610,000人）接受肾脏替代治疗（RRT）患者的频率指标。通过将Cox模型应用于1994 - 1998年在普利亚大区开始透析作为首次RRT的患者，估计了与性别、年龄、教育水平、原发性肾病以及透析方式相关的死亡风险比（HR）。
1998年普利亚大区接受治疗的ESRD患病率为每百万人口881例（p.m.p.）（透析：每百万人口721例），1994年为每百万人口713例（透析：每百万人口617例）。1998年巴西利卡塔大区ESRD患病率为每百万人口795例（透析：每百万人口669例），1994年为每百万人口636例（透析：每百万人口575例）。普利亚大区新发病例开始透析的平均年龄为60岁（中位数：64岁）。糖尿病、血管疾病和肾小球肾炎的比例分别为：16%、21%、17%。在2152例接受透析至少一个月的新发病例中，293例开始采用腹膜透析（PD）。观察到糖尿病肾病和PD患者的死亡风险高出60 - 70%。在普利亚大区/巴西利卡塔大区DTR汇总分析中，较低的教育水平与死亡风险增加60%相关。
PD和低教育水平与死亡风险之间的关联很可能归因于合并症，这些数据库中未提供此类信息，大多数地区和国家的DTR也是如此。通过观察不同地区的发病率和结局差异，讨论了地方DTR在规划和研究用途方面的潜在改进。
