Villar Emmanuel, Chang Sean Haw, McDonald Stephen Peter
Australia and New Zealand Dialysis and Transplant Registry, Woodville, South Australia, Australia.
Diabetes Care. 2007 Dec;30(12):3070-6. doi: 10.2337/dc07-0895. Epub 2007 Sep 11.
We aimed to update the epidemiology of type 1 and type 2 diabetic patients among the incident end-stage renal disease (ESRD) population in Australia and New Zealand (ANZ) and to determine whether outcome is worse for diabetic women, as described in the general population.
All resident adults of ANZ who began renal replacement therapy (RRT) from 1 April 1991 to 31 December 2005 were included using data from the ANZ Dialysis and Transplant Registry. Incidence rates, RRT, and survival were analyzed. Risk factors for death were assessed using Cox regression.
The study included 1,284 type 1 diabetic (4.5%), 8,560 type 2 diabetic (30.0%), and 18,704 nondiabetic (65.5%) patients. The incidence rate of ESRD with type 2 diabetes increased markedly over time (+10.2% annually, P < 0.0001). In patients aged <70 years, rates of renal transplantation in type 1 diabetic, type 2 diabetic, and nondiabetic patients were 41.8, 6.5 (P < 0.0001 vs. other patients), and 40.9% (P = 0.56 vs. type 1 diabetic patients), respectively. Compared with nondiabetic patients, the adjusted hazard ratio (HR) for death was 1.64 (P < 0.0001) in type 1 diabetes and 1.13 (P < 0.0001) in type 2 diabetes. Survival rates per 5-year period improved by 6% in type 1 diabetic patients (P = 0.36), by 9% in type 2 diabetic patients (P < 0.0001), and by 5% in nondiabetic patients (P = 0.001). In type 2 diabetic patients aged >or=60 years, the adjusted HR for death in women versus men was 1.19 (P = 0.0003).
The incidence of ESRD with type 2 diabetes increased markedly. Despite high access to renal transplants, type 1 diabetic patients had a poor prognosis after starting RRT. Survival improved significantly in type 2 diabetic patients during the study period. Older type 2 diabetic women had a worse prognosis than older type 2 diabetic men.
我们旨在更新澳大利亚和新西兰（澳新地区）终末期肾病（ESRD）患者中1型和2型糖尿病患者的流行病学情况，并确定糖尿病女性患者的预后是否如普通人群所述那样更差。
利用澳新透析与移植登记处的数据，纳入了1991年4月1日至2005年12月31日开始接受肾脏替代治疗（RRT）的澳新地区所有成年居民。分析发病率、RRT及生存率。采用Cox回归评估死亡的危险因素。
该研究纳入了1284例1型糖尿病患者（4.5%）、8560例2型糖尿病患者（30.0%）和18704例非糖尿病患者（65.5%）。2型糖尿病患者的ESRD发病率随时间显著增加（每年增加10.2%，P<0.0001）。在年龄<70岁的患者中，1型糖尿病、2型糖尿病和非糖尿病患者的肾移植率分别为41.8%、6.5%（与其他患者相比，P<0.0001）和40.9%（与1型糖尿病患者相比，P = 0.56）。与非糖尿病患者相比，1型糖尿病患者死亡的校正风险比（HR）为1.64（P<0.0001），2型糖尿病患者为1.13（P<0.0001）。1型糖尿病患者每5年的生存率提高了6%（P = 0.36），2型糖尿病患者提高了9%（P<0.0001），非糖尿病患者提高了5%（P = 0.001）。在年龄≥60岁的2型糖尿病患者中，女性与男性相比死亡的校正HR为1.19（P = 0.0003）。
2型糖尿病患者的ESRD发病率显著增加。尽管肾移植机会较高，但1型糖尿病患者开始RRT后的预后较差。在研究期间，2型糖尿病患者的生存率显著提高。年龄较大的2型糖尿病女性患者的预后比年龄较大的2型糖尿病男性患者更差。
