台湾年轻人群中终末期肾病的发病率和肾脏存活率。
Incidence and renal survival of ESRD in the young Taiwanese population.
机构信息
Department of Medical Research and Education and , †Department of Pediatrics, National Yang-Ming University Hospital, I-Lan, Taiwan, ‡Department of Medicine and , §Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
出版信息
Clin J Am Soc Nephrol. 2014 Feb;9(2):302-9. doi: 10.2215/CJN.12761212. Epub 2013 Nov 21.
BACKGROUND AND OBJECTIVES
ESRD in the young represents a heavy burden to patients, families, and health care systems. This nationwide retrospective study characterized the incidence of ESRD and analyzed diagnoses associated with renal survival in the young population in Taiwan.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Through use of Taiwan's National Health Insurance Research Database, the population of young patients (age<30 years, including children and young adults) with ESRD between January 1998 and December 2009 were enrolled. The medical claims were used to derive the date when the cause of ESRD was first determined. The medical data were reviewed and the renal survival time (time from first diagnosis of the cause to the start of ESRD) was calculated by experts, including clinical physicians and a large-database specialist.
RESULTS
The incidence rate of ESRD in the young population was high compared with the worldwide rate at 21.1 per million person-years, whereas the incidence in the pediatric group was still similar to that in other countries at 10.3 per million person-years. A total of 2304 patients with new-onset ESRD and identified renal diseases during the study period were enrolled. All preschool-age patients (100%) began receiving peritoneal dialysis as their initial treatment for ESRD. The leading causes, which varied by sex and onset age, were glomerulonephropathy followed by hypertension for the young adult group and glomerulonephropathy followed by congenital anomalies of the kidney and urinary tract (CAKUT) for the pediatric group. Renal survival was cause-dependent. The median overall renal survival duration was 0.8 year (interquartile range [IQR], 0.7-3.5 years). CAKUT-related ESRD had the longest progression time (median renal survival, 16.0 years; IQR, 10.7-23.5 years); glomerulonephropathy progressed more rapidly into ESRD and had the shortest median renal survival of 0.5 year (IQR, 0.1-2.7 years).
CONCLUSIONS
The incidence and causes of ESRD greatly differ between pediatric patients and young adults. Moreover, renal survival in the young population markedly varies depending on the cause of renal disease.
背景和目的
年轻人中的终末期肾病（ESRD）给患者、家庭和医疗保健系统带来了沉重的负担。本项全国性回顾性研究对台湾年轻人中 ESRD 的发病率进行了特征描述，并对与肾脏存活率相关的诊断进行了分析。
方法
通过使用台湾全民健康保险研究数据库，纳入了 1998 年 1 月至 2009 年 12 月期间患有 ESRD 的年轻患者（年龄<30 岁，包括儿童和青年）。医疗索赔记录用于确定 ESRD 病因的首次确定日期。医疗数据经专家（包括临床医生和大型数据库专家）审查，计算肾脏存活率（从病因首次诊断到 ESRD 开始的时间）。
结果
与全球发病率 21.1/100 万人年相比，年轻人中 ESRD 的发病率较高，而儿科组的发病率仍与其他国家相似，为 10.3/100 万人年。研究期间共纳入了 2304 名新确诊 ESRD 并确定有肾脏疾病的患者。所有学龄前患者（100%）均开始接受腹膜透析作为 ESRD 的初始治疗。男女和发病年龄不同，主要病因分别为青年组的肾小球肾炎，随后是高血压，以及儿科组的肾小球肾炎，随后是先天性肾和尿路异常（CAKUT）。肾脏存活率与病因有关。总体肾脏中位存活率为 0.8 年（四分位间距[IQR]，0.7-3.5 年）。CAKUT 相关 ESRD 进展时间最长（中位肾脏存活率 16.0 年；IQR，10.7-23.5 年）；肾小球肾炎更快进展为 ESRD，中位肾脏存活率最短为 0.5 年（IQR，0.1-2.7 年）。
结论
儿科患者和青年成人的 ESRD 发病率和病因差异很大。此外，年轻人的肾脏存活率因肾脏疾病的病因而明显不同。
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