Brunner F P, Selwood N H
EDTA Registry, St Thomas' Hospital, London, England.
Am J Kidney Dis. 1990 May;15(5):384-96. doi: 10.1016/s0272-6386(12)70355-4.
The characteristics of the patient populations accepted for and undergoing renal replacement therapy (RRT) in Europe in 1980 to 1987 are presented. Acceptance rates have increased in most countries reporting to the EDTA Registry and have reached from between 50 to over 80 per million population in the more affluent Western European countries in 1987. Increasing acceptance rates were due to the inclusion of patient groups at a higher risk of dying, such as the elderly and those with diabetic nephropathy. Despite the acceptance of a growing proportion of high-risk patients, no increase in overall mortality was apparent. Gross mortality (some 10% annually) changed little between 1980 and 1987 for patients on hemodialysis, decreased sharply from 1980 to 1984 for patients on continuous ambulatory peritoneal dialysis (CAPD), and improved continuously from 4.2% in 1980 to 2.4% in 1987 for patients with a functioning kidney graft. In order to determine mortality more accurately, actuarial survival rates and annual death rates per thousand patient years at risk were computed according to age groups and to primary renal disease groups, both for the total patient data file and for selected countries. Actuarial 5-year survival on hemodialysis for all patients starting treatment between 1982 and 1987 varied according to age, being 84% in patients age 15 to 24 years and 20% in those age 75 to 84 years. Patients with "standard" primary renal diseases had slightly better survival, while of the group with diabetic nephropathy only 51% age 25 to 34 and no more than 3% of those age 75 to 84 survived the 5-year mark. To recognize trends in the mortality between 1980 and 1987, annual death rates for all patients on record, age 45 to 54 and 55 to 64 at the beginning of 1980, 1983, 1985, and 1987 were computed both for the total Registry and for the FRG. Despite an increasing acceptance rate of patients with diabetic nephropathy, the annual death rates on hemodialysis decreased or remained stable both for the total Registry and for the FRG. Death rates in patients with a functioning graft decreased. It is concluded that, during the last decade, survival on RRT has continued to improve not only because of decreasing mortality after transplantation and on CAPD, but also due to improving survival on hemodialysis. The latter is not readily apparent because of the increasing acceptance rate in older patient groups and a rapidly rising proportion of patients with diabetic nephropathy in most European countries.
本文介绍了1980年至1987年期间欧洲接受并正在接受肾脏替代治疗（RRT）的患者群体特征。向欧洲透析移植协会（EDTA）登记处报告的大多数国家，患者接受率都有所上升，在较为富裕的西欧国家，1987年每百万人口的接受率已达到50至80以上。接受率上升的原因是纳入了死亡风险较高的患者群体，如老年人和糖尿病肾病患者。尽管接受的高风险患者比例不断增加，但总体死亡率并未明显上升。血液透析患者的总死亡率（每年约10%）在1980年至1987年间变化不大，持续性非卧床腹膜透析（CAPD）患者的死亡率在1980年至1984年急剧下降，而有功能肾移植患者的死亡率则从1980年的4.2%持续降至1987年的2.4%。为了更准确地确定死亡率，根据年龄组和原发性肾脏疾病组，对整个患者数据文件和选定国家计算了精算生存率和每千患者年的年死亡率。1982年至1987年开始治疗的所有患者血液透析的精算5年生存率因年龄而异，15至24岁患者为84%，75至84岁患者为20%。患有“标准”原发性肾脏疾病的患者生存率略高，而糖尿病肾病组中，25至34岁的患者只有51%存活至5年，75至84岁的患者存活至5年的比例不超过3%。为了了解1980年至1987年期间的死亡率趋势，计算了1980年、1983年、1985年和1987年初记录的所有45至54岁和55至64岁患者的总登记处和联邦德国（FRG）的年死亡率。尽管糖尿病肾病患者的接受率不断上升，但总登记处和联邦德国血液透析患者的年死亡率均下降或保持稳定。有功能移植患者的死亡率下降。得出的结论是，在过去十年中，RRT的生存率持续提高，这不仅是因为移植后和CAPD后的死亡率下降，还因为血液透析的生存率提高。由于老年患者群体的接受率增加以及大多数欧洲国家糖尿病肾病患者比例迅速上升，后者并不明显。
