Prischl Friedrich C, Auinger Martin, Säemann Marcus, Mayer Gert, Rosenkranz Alexander R, Wallner Manfred, Kramar Reinhard
Division of Nephrology, 4th Department of Medicine, Klinikum Wels-Grieskirchen, Wels, Austria.
3rd Department of Internal Medicine, Hospital Hietzing, Vienna, Austria.
Nephrol Dial Transplant. 2015 Nov;30(11):1920-7. doi: 10.1093/ndt/gfv113. Epub 2015 May 13.
Diabetic kidney disease (DKD) is the leading cause of end-stage renal disease (ESRD) in Austria, accounting for a high burden of morbidity and mortality. In this nationwide study, we aimed to evaluate the incidence and fate of patients with DKD-ESRD over time.
Data (collected annually) from the Austrian Dialysis- and Transplant Registry were analysed for the development of ESRD due to DKD from 1965 to 2013.
Over 48 years, 8322 and 22 975 patients with ESRD due to diabetes and non-diabetes, respectively, entered dialysis. While DKD-ESRD-patients were not dialysed until 1974, in 1975 seven type 1- and one type 2-diabetics started dialysis (1.06 per million population-PMP). In the mid-eighties, DKD-ESRD-patients increasingly were accepted for dialysis (1986: 14.53 PMP, 1996: 31.16 PMP). After a peak incidence of 415 diabetic ESRD-patients in 2006 (50.19 PMP), numbers decreased continuously thereafter (2013: 299 patients, 35.73 PMP). Mean age at start of dialysis increased over time and was lower in type 1- and higher in type 2- compared with non-diabetic patients. Five-year-survival-probability in two diabetic ESRD-cohorts, starting in 2007/08 and 10 years earlier was calculated. Five-year-survival was 28% in 1997/98 and 37.5% in 2007/08. Adjusted relative risk reduction was 33% (HR 0.67, CI 95% 0.57-0.78; P < 0.001).
Despite a growing prevalence of diabetes, the incidence of diabetic ESRD has decreased after 2006. Five-year-survival-probability has improved over 10 years. Multifactorial therapeutic interventions may have resulted in this improvement.
糖尿病肾病（DKD）是奥地利终末期肾病（ESRD）的主要病因，造成了很高的发病和死亡负担。在这项全国性研究中，我们旨在评估DKD-ESRD患者随时间推移的发病率和转归情况。
分析了奥地利透析与移植登记处（每年收集的数据）中1965年至2013年因DKD导致的ESRD的发展情况。
在48年期间，分别有8322例和22975例因糖尿病和非糖尿病导致ESRD的患者开始透析。DKD-ESRD患者直到1974年才开始透析，1975年有7例1型糖尿病患者和1例2型糖尿病患者开始透析（每百万人口1.06例）。在80年代中期，DKD-ESRD患者越来越多地被接受透析（1986年：每百万人口14.53例，1996年：每百万人口31.16例）。在2006年糖尿病ESRD患者发病率达到峰值415例（每百万人口50.19例）后，此后数量持续下降（2013年：299例患者，每百万人口35.73例）。开始透析时的平均年龄随时间增加，与非糖尿病患者相比，1型糖尿病患者的平均年龄较低，2型糖尿病患者的平均年龄较高。计算了分别于2007/08年及10年前开始透析的两个糖尿病ESRD队列的5年生存率。1997/98年的5年生存率为28%，2007/08年为37.5%。调整后的相对风险降低率为33%（风险比0.67，95%置信区间0.57 - 0.78；P < 0.001）。
尽管糖尿病患病率不断上升，但2006年后糖尿病ESRD的发病率有所下降。5年生存率在10年中有所提高。多因素治疗干预可能导致了这种改善。
