Foley Robert N, Sexton Donal J, Reule Scott, Solid Craig, Chen Shu-Cheng, Collins Allan J
Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, Minn., USA.
Am J Nephrol. 2015;41(1):1-6. doi: 10.1159/000369832. Epub 2015 Jan 23.
BACKGROUND/AIMS: Though end-stage renal disease (ESRD) is increasingly attributed to acute tubular necrosis (ATN), contemporary trends in the rates of incidence and recovery of renal function are poorly defined. Hence, we set out to describe the clinical epidemiology of ESRD due to ATN between 2001 and 2010.
We examined United States Renal Data System data (n = 1,070,490) for 2001 through 2010 to calculate the incidence rates and rates of renal recovery and death for patients with ESRD due to ATN treated with renal replacement therapy (RRT, n = 27,603).
Standardized incidence ratios increased between 2001-2002 and 2009-2010 in the overall population (ratio 2.14), having risen in all demographic subgroups examined. Recovery of renal function was more likely in patients with ATN than in matched controls (cumulative incidence 23% vs. 2% at 12 weeks, 34% vs. 4% at 1 year), as was death (cumulative incidence 38% vs. 27% at 1 year). Hazards ratios for renal recovery increased stepwise with year of RRT inception to 1.34 (95% confidence interval 1.24-1.45) for 2009-2010 (vs. 2001-2002). In contrast, hazards ratios for death declined stepwise to 0.83 (0.79-0.87) in 2009-2010.
While the incidence of ESRD attributed to ATN has increased, prospects of renal recovery and survival have also increased. Despite substantial mortality risk on RRT, renal recovery is not a rare occurrence.
背景/目的：尽管终末期肾病（ESRD）越来越多地归因于急性肾小管坏死（ATN），但目前肾功能发病率和恢复率的当代趋势仍不明确。因此，我们着手描述2001年至2010年间因ATN导致的ESRD的临床流行病学情况。
我们研究了2001年至2010年美国肾脏数据系统的数据（n = 1,070,490），以计算接受肾脏替代治疗（RRT，n = 27,603）的因ATN导致ESRD患者的发病率、肾功能恢复率和死亡率。
在整个人口中，标准化发病率在2001 - 2002年至2009 - 2010年间有所上升（比率为2.14），在所研究的所有人口亚组中均呈上升趋势。与匹配的对照组相比，ATN患者肾功能恢复的可能性更大（12周时累积发病率分别为23%和2%，1年时分别为34%和4%），死亡的可能性也是如此（1年时累积发病率分别为38%和27%）。肾功能恢复的风险比随着开始接受RRT的年份逐步增加，2009 - 2010年为1.34（95%置信区间1.24 - 1.45）（与2001 - 2002年相比）。相比之下，2009 - 2010年死亡的风险比逐步下降至0.83（0.79 - 0.87）。
虽然因ATN导致的ESRD发病率有所上升，但肾功能恢复和生存的前景也有所改善。尽管接受RRT存在很大的死亡风险，但肾功能恢复并非罕见。
