UK Renal Registry, Southmead Hospital, Bristol, UK.
Nephron Clin Pract. 2011;119 Suppl 2:c107-34. doi: 10.1159/000331756. Epub 2011 Aug 26.
These analyses examine (a) survival from the start of renal replacement therapy (RRT), based on the total incident UK RRT population reported to the UK Renal Registry, including the 18% who started on PD and the 6% who received a pre-emptive transplant and (b) survival of prevalent patients. Changes in survival between 1997 and 2008 are also reported.
Survival was calculated for both incident and prevalent patients on RRT and compared between the UK countries after adjustment for age. Survival of incident patients (starting RRT during 2008) was calculated both from the start of RRT and amongst the cohort who survived at least 90 days after RRT, both with and without censoring at transplantation. Both Kaplan-Meier and Cox adjusted models were used to calculate survival. Causes of death were analysed for both groups. Relative risk of death was calculated compared with the general UK population.
The 2008 unadjusted 1 year after 90 day survival for patients starting RRT was 87.3%. In incident patients aged 18-64, the unadjusted 1 year survival had risen from 85.9% in 1997 to 91.9% in 2008 and for those aged ≥ 65 it had risen from 64.2% to 75.8%. The age-adjusted one year survival (adjusted to age 60) of prevalent dialysis patients rose from 85% in 2000 to 89% in 2009. Diabetic prevalent patient one year survival rose from 76.6% in 2000 to 83.6% in 2009. The age-standardised mortality ratio for prevalent RRT patients compared with the general population was 19 at age 30 years and 2.4 at age 85 years. In the prevalent RRT dialysis population, cardiovascular disease accounted for 24% of deaths, infection 19% and treatment withdrawal 14%; 22% were recorded as uncertain. Treatment withdrawal was a more frequent cause of death in patients aged ≥ 65 at start of RRT than in younger patients. The median life years remaining for a 25-29 year old on RRT was 20 years and 4 years for a 75+ year old.
Survival of patients starting RRT, has improved in the 2008 incident cohort. The relative risk of death on RRT compared with the general population has fallen since 2001. Death rates on dialysis in the UK remained lower than when compared with a similar aged population on dialysis in the USA.
这些分析考察了（a）根据向英国肾脏登记处报告的英国全部起始肾脏替代治疗（RRT）人群，包括开始接受 PD 治疗的 18%和接受预先移植的 6%患者的 RRT 起始时的生存率，以及（b）现患患者的生存率。还报告了 1997 年至 2008 年之间生存率的变化。
对 RRT 上的起始和现患患者的生存率进行了计算，并在调整年龄后对英国各地区之间的生存率进行了比较。对 2008 年开始 RRT 的起始患者的生存率进行了计算，既从 RRT 开始时进行了计算，也从至少存活 90 天的队列中进行了计算，这两种情况均未进行移植时进行了删失。使用 Kaplan-Meier 和 Cox 调整模型计算了生存率。对两组患者的死亡原因进行了分析。与英国一般人群相比，计算了死亡的相对风险。
2008 年，起始 RRT 后 90 天无生存的 1 年生存率为 87.3%。在年龄为 18-64 岁的起始患者中，未经调整的 1 年生存率从 1997 年的 85.9%上升至 2008 年的 91.9%，而年龄为≥65 岁的患者则从 64.2%上升至 75.8%。2000 年，接受透析治疗的现患患者的 1 年生存率从 85%上升至 2009 年的 89%。2000 年，糖尿病现患患者的 1 年生存率从 76.6%上升至 2009 年的 83.6%。与一般人群相比，年龄标准化的 RRT 患者的死亡率为 30 岁时为 19，85 岁时为 2.4。在现患 RRT 透析患者中，心血管疾病占死亡的 24%，感染占 19%，治疗停药占 14%；22%被记录为不确定。与年轻患者相比，开始 RRT 时年龄≥65 岁的患者的治疗停药是导致死亡的更常见原因。接受 RRT 治疗的 25-29 岁患者的预期剩余寿命为 20 年，而 75 岁以上患者的预期剩余寿命为 4 年。
2008 年起始队列中，开始接受 RRT 治疗的患者的生存率有所提高。与一般人群相比，RRT 治疗的死亡相对风险自 2001 年以来有所下降。与美国相似年龄组的透析患者相比，英国的透析患者死亡率仍然较低。
