Faculty of Medicine, University of Ottawa, Ottawa, Canada; Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada; ICES@uOttawa Health Services Research Facility, University of Ottawa, Ottawa, Canada.
Faculty of Medicine, University of Ottawa, Ottawa, Canada; Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada; ICES@uOttawa Health Services Research Facility, University of Ottawa, Ottawa, Canada.
Am J Kidney Dis. 2014 Mar;63(3):491-9. doi: 10.1053/j.ajkd.2013.09.011. Epub 2013 Nov 6.
Health care resources expended on patients with end-stage renal disease (ESRD) have increased extensively, with uncertain changes in outcomes. In this study, we examined survival trends in the United States in patients with ESRD receiving renal replacement therapy with long-term dialysis or transplantation relative to the general population.
Secondary analysis of records from the US Renal Data System.
SETTING & PARTICIPANTS: American adults receiving renal replacement therapy in 1977, 1987, 1997, and 2007.
Year.
1-year survival.
Abridged period life tables were created for each cross-sectional patient group and were compared with general US population life tables to measure relative survival, calculated as differences in average survival between the general US and the ESRD populations.
From 1977 to 2007, ESRD patient groups became significantly older (mean age increased from 47 to 58 years) and sicker (ESRD due to diabetes increased from 9.1% to 38.2%; patients with a high death risk increased from 36.8% to 50.7%). Unadjusted age-specific survival improved (for 50-year-olds, average life expectancy increased 8% from 7.3 years in 1977 to 7.9 years in 2007), but age-specific survival increased more extensively in the general US population (from 27.5 years in 1977 to 30.9 years in 2007; 12% improvement). Accounting for this, age-specific relative survival in patients with ESRD decreased (for 50-year-olds, 20.2 life-years lost in 1977 vs 23.0 life-years lost in 2007).
Our analysis controlled for neither patient comorbid conditions nor initial glomerular filtration rate at the start of renal replacement therapy.
Over the past 4 decades, age-specific survival in patients with ESRD has improved, but has not kept pace with that of the general US population. To be complete, future survival studies in patients with ESRD should focus on both temporal changes in survival within this group and changes relative to the general population.
接受肾脏替代治疗的终末期肾病（ESRD）患者所消耗的医疗资源大幅增加，但治疗效果的变化尚不确定。本研究旨在考察美国 ESRD 患者的生存趋势，这些患者接受长期透析或移植治疗，与普通人群相比。
对美国肾脏数据系统记录的二次分析。
1977 年、1987 年、1997 年和 2007 年接受肾脏替代治疗的美国成年人。
年份。
1 年生存率。
为每个横断面患者群体创建了简化时期生命表，并与美国普通人群生命表进行比较，以衡量相对生存率，该生存率计算为美国普通人群和 ESRD 人群之间平均生存率的差异。
1977 年至 2007 年，ESRD 患者群体的年龄明显增大（平均年龄从 47 岁增加到 58 岁），病情加重（由糖尿病引起的 ESRD 从 9.1%增加到 38.2%；高死亡风险患者从 36.8%增加到 50.7%）。未经调整的年龄特异性生存率提高（对于 50 岁的患者，平均预期寿命从 1977 年的 7.3 年增加到 2007 年的 7.9 年，增加了 8%），但美国普通人群的年龄特异性生存率提高幅度更大（从 1977 年的 27.5 年增加到 2007 年的 30.9 年，提高了 12%）。考虑到这一点，ESRD 患者的年龄特异性相对生存率下降（对于 50 岁的患者，1977 年损失 20.2 个生命年，2007 年损失 23.0 个生命年）。
我们的分析既没有控制患者的合并症，也没有控制开始肾脏替代治疗时的肾小球滤过率。
在过去的 40 年中，ESRD 患者的年龄特异性生存率有所提高，但并未与美国普通人群的生存率保持同步。为了全面起见，未来 ESRD 患者的生存研究应同时关注该群体中生存率的时间变化以及与普通人群的相对变化。
