Thorp M L, Weinstein J R, Johnson E S, Yang X, Smith D H
Department of Nephrology, Kaiser Permanente Northwest, Lake Road Nephrology Center, Milwaukie, OR, USA.
Clin Nephrol. 2008 Sep;70(3):187-93. doi: 10.5414/cnp70187.
Little is known about trends in renal replacement therapy among patients with chronic kidney disease (CKD) or about changes in the incidence of CKD. We studied the incidence of renal replacement therapy within the population of a health maintenance organization (HMO) both among the entire HMO population and among those with CKD.
We calculated yearly incidence rates of renal replacement therapy for each year from 1998 to 2005. We defined CKD using the National Kidney Foundation definition of 2 estimated glomerular filtration rates below 60 ml/min/1.73 m2 90 or more days apart. Poisson regression assessed year-to-year differences.
The number of patients with CKD rose consistently from 3,861 in 1998 to 5,242 in 2005. The proportion of patients who had been diagnosed with hypertension rose from 86.7% (starting renal replacement therapy) or 34.5% (with CKD) to 99.1 and 46.9%. The proportion of patients with diabetes changed little throughout the years studied. The mean estimated glomerular filtration rate among CKD patients rose minimally from 38.4 ml/min/1.73 m2 in 1998 to 39.9 ml/min/1.73 m2 in 2005. Age- and sex-adjusted rates of RRT among patients with CKD varied (p=0.0034), but did not follow a consistent pattern over time.
Incidence of renal replacement therapy among patients with CKD changed little between 1998 and 2005, despite an increase in the number of patients diagnosed with CKD. The discrepancy may be due to increased laboratory identification of CKD.
关于慢性肾脏病（CKD）患者的肾脏替代治疗趋势以及CKD发病率的变化，我们了解得很少。我们研究了健康维护组织（HMO）人群中以及CKD患者中肾脏替代治疗的发病率。
我们计算了1998年至2005年每年的肾脏替代治疗年发病率。我们采用美国国家肾脏基金会的定义，即估算肾小球滤过率低于60 ml/min/1.73 m²且间隔90天或更长时间，以此来定义CKD。采用泊松回归评估逐年差异。
CKD患者数量从1998年的3861例持续上升至2005年的5242例。已诊断为高血压的患者比例从86.7%（开始肾脏替代治疗）或34.5%（患有CKD）升至99.1%和46.9%。在整个研究年份中，糖尿病患者比例变化不大。CKD患者的平均估算肾小球滤过率从1998年的38.4 ml/min/1.73 m²微升至2005年的39.9 ml/min/1.73 m²。CKD患者中经年龄和性别调整后的肾脏替代治疗率有所不同（p = 0.0034），但随时间未呈现一致模式。
1998年至2005年期间，尽管诊断为CKD的患者数量增加，但CKD患者的肾脏替代治疗发病率变化不大。这种差异可能是由于CKD的实验室诊断增加所致。
