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美国的终末期肾病:来自美国肾脏数据系统的最新情况

End-stage renal disease in the United States: an update from the United States Renal Data System.

作者信息

Foley Robert N, Collins Allan J

机构信息

United States Renal Data System, 914 South 8th Street, Suite S-253, Minneapolis, MN 55404, USA.

出版信息

J Am Soc Nephrol. 2007 Oct;18(10):2644-8. doi: 10.1681/ASN.2007020220. Epub 2007 Jul 26.

Abstract

Patients with ESRD consume a vastly disproportionate amount of financial and human resources. Approximately 0.03% of the US population began renal replacement therapy in 2004, an adjusted incidence rate of 339 per million. Declining incidence rates were observed for most primary causes of ESRD and in most major demographic categories; the worry is that rates of diabetic ESRD continue to rise in younger black adults. Although diabetes and hypertension remain the most commonly reported cause of ESRD, rates of end-stage atherosclerotic renovascular disease seem to be on the rise in older patients. Although clinical care indicators, such as the proportion of hemodialysis patients using fistulas, continue to improve gradually, the proportion of patients overshooting target hemoglobin levels under epoetin therapy may be a source of concern. Survival probabilities have improved steadily in the US ESRD population since the late 1980s, which is remarkable when one considers the ever-expanding burden of comorbidity in incident patients. However, although first-year dialysis mortality rates have clearly improved since 1987, meaningful improvements do not seem to have accrued since 1993, in contrast to steady annual improvements in years 2 through 5. Although most of these findings are grounds for cautious optimism, the same cannot be said for issues of cost; reflecting the growth in the size of the ESRD population, associated costs grew by 57% between 1999 and 2004 and now account for 6.7% of total Medicare expenditures.

摘要

终末期肾病(ESRD)患者消耗了大量不成比例的财政和人力资源。2004年,约0.03%的美国人口开始接受肾脏替代治疗,调整后的发病率为每百万人口339例。ESRD的大多数主要病因以及大多数主要人口类别中的发病率均呈下降趋势;令人担忧的是,年轻黑人成年人中糖尿病性ESRD的发病率持续上升。尽管糖尿病和高血压仍然是ESRD最常见的报告病因,但老年患者中终末期动脉粥样硬化性肾血管疾病的发病率似乎在上升。尽管诸如使用动静脉内瘘的血液透析患者比例等临床护理指标持续逐渐改善,但在促红细胞生成素治疗下血红蛋白水平超过目标值的患者比例可能令人担忧。自20世纪80年代末以来,美国ESRD人群的生存概率稳步提高,考虑到新发病例中合并症负担不断加重,这一情况颇为显著。然而,尽管自1987年以来第一年透析死亡率明显改善,但自1993年以来似乎并未取得显著改善,而在第2至5年则实现了稳步逐年改善。尽管这些发现大多令人谨慎乐观,但成本问题并非如此;反映ESRD人群规模的增长,相关成本在1999年至2004年间增长了57%,目前占医疗保险总支出的6.7%。

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