Renal Unit, Royal Infirmary of Edinburgh, Little France, Edinburgh, EH16 4SA, UK.
QJM. 2013 Dec;106(12):1077-85. doi: 10.1093/qjmed/hct176. Epub 2013 Aug 22.
The incidence of patients starting renal replacement therapy (RRT) for established renal failure (ERF) in Scotland has fallen from 2005 to 2011 due to a reduction in older patients starting RRT; there are significant differences between NHS Health board areas.
To understand the apparent inequality in provision of RRT between NHS board areas in Scotland.
Retrospective population analysis of Scottish renal registry (SRR) data, population statistics and quality outcomes framework summary statistics.
The incidence of patients starting RRT for ERF in Scotland fell from 123 per million population (pmp) in 2005 to 96 pmp in 2011. The incidence of ≥75 year olds fell from 406 to 274 pmp. There are significant differences between NHS board areas when standardized for age and social deprivation. There is no relationship between the population prevalence of CKD as reported by QOF and the incidence of RRT for ERF. Those areas with high incidence rates of ≥75 year olds have higher 90-day [Spearman's rank correlation: coefficient = 0.662; P = 0.03] and 1-year [Spearman's rank correlation: coefficient = 0.776; P = 0.003] mortality rates.
The significant variation in provision of RRT for ERF between Scottish NHS Board areas is not explained by age or social deprivation. There is evidence of change in practice towards RRT for patients aged ≥75 years but variation between NHS Board areas. This disparity must be further investigated to ensure equity of access to RRT for those who will benefit from it, and to non-dialytic care for those who would not.
由于老年患者开始接受肾脏替代治疗（RRT）的人数减少，苏格兰因已确诊肾衰竭（ERF）而开始接受 RRT 的患者人数从 2005 年至 2011 年有所下降；不同的国民保健制度（NHS）健康委员会区域之间存在显著差异。
了解苏格兰 NHS 委员会区域之间 RRT 提供情况的明显不平等。
对苏格兰肾脏登记处（SRR）数据、人口统计数据和质量结果框架汇总统计数据进行回顾性人群分析。
苏格兰因 ERF 开始接受 RRT 的患者人数从 2005 年的每百万人 123 人降至 2011 年的每百万人 96 人。≥75 岁患者的发病率从每百万人 406 人降至 274 人。按年龄和社会贫困程度标准化后，NHS 委员会区域之间存在显著差异。QOF 报告的 CKD 人群患病率与 ERF 的 RRT 发病率之间没有关系。≥75 岁人群发病率较高的地区，90 天[Spearman 秩相关：系数=0.662；P=0.03]和 1 年[Spearman 秩相关：系数=0.776；P=0.003]死亡率较高。
苏格兰 NHS 委员会区域之间 ERF 的 RRT 提供情况存在显著差异，这不能用年龄或社会贫困程度来解释。≥75 岁患者接受 RRT 的做法有所改变，但 NHS 委员会区域之间存在差异。必须进一步调查这种差异，以确保那些将受益于 RRT 的人能够平等获得 RRT，并确保那些不会受益于 RRT 的人能够获得非透析治疗。
