Vijayakumar Pavithra, Hoyer Annika, Nelson Robert G, Brinks Ralph, Pavkov Meda E
National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona, United States of America.
Institute for Biometry and Epidemiology, German Diabetes Center Duesseldorf, Germany.
PLoS One. 2017 Feb 6;12(2):e0171027. doi: 10.1371/journal.pone.0171027. eCollection 2017.
The objective was to estimate chronic kidney disease (CKD) incidence rates from prevalence and mortality data, and compare the estimates with observed (true) incidence rates in a well-characterized population with diabetes. Pima Indians aged 20 years and older with type 2 diabetes were followed from 1982 through 2007. CKD was defined by estimated GFR (eGFR) <60 ml/min/1.72 m2 or albumin-to-creatinine ratio (ACR) ≥30 mg/g. True CKD incidence and mortality rates were computed for the whole study period, and prevalence for the intervals 1982-1994 and 1995-2007. Estimated age-sex stratified CKD incidence rates were computed using illness-death models of the observed prevalences, and of the whole-period mortality rate ratio of CKD to non-CKD persons. Among 1201 participants, 616 incident events of CKD occurred during a median follow-up of 5.6 years. Observed CKD prevalence was 56.9% (95%CI 53.7-60.0) and 48.0% (95%CI 45.2-50.8) in women; 54.0% (95%CI 49.9-58.1) and 49.6% (95%CI 46.0-53.3) in men, across the two periods. Mortality rate was 2.5 (95%CI 1.9-3.3) times as high in women with CKD and 1.6 (95%CI 1.3-2.1) times as high in men with CKD, compared to women or men without CKD. In women, estimated CKD incidence increased linearly from 25.6 (95%CI 4.2-53.0) to 128.6 (95%CI 77.1-196.6) with each 5-year age group up to 69 years, and to 99.8 (95%CI 38.7-204.7) at age ≥70. In men, estimated CKD incidence increased form 28.5 (95%CI 3.8-71.2) at age 20-24 years to 118.7 (95%CI 23.6-336.7) at age ≥70. Age-sex-stratified estimated incidence reflected the magnitude and directional trend of the true incidence and were similar to the true incidence rates (p>0.05 for difference) except for age 20-24 in women (p = 0.008) and age 25-29 in men (p = 0.002). In conclusion, the estimated and observed incidence rates of CKD agree well over 25 years of observation in this well characterized population with type 2 diabetes.
目的是根据患病率和死亡率数据估算慢性肾脏病（CKD）发病率，并将估算值与有详细特征的糖尿病患者群体中的观察到的（真实）发病率进行比较。1982年至2007年对年龄在20岁及以上的2型糖尿病皮马印第安人进行了随访。CKD的定义为估计肾小球滤过率（eGFR）<60 ml/（min·1.72 m²）或白蛋白与肌酐比值（ACR）≥30 mg/g。计算了整个研究期间的真实CKD发病率和死亡率，以及1982 - 1994年和1995 - 2007年期间的患病率。使用观察到的患病率以及CKD与非CKD人群的全期死亡率比值的疾病死亡模型，计算了按年龄和性别分层的估计CKD发病率。在1201名参与者中，在中位随访5.6年期间发生了616例CKD事件。在两个时间段中，女性观察到的CKD患病率分别为56.9%（95%CI 53.7 - 60.0）和48.0%（95%CI 45.2 - 50.8）；男性分别为54.0%（95%CI 49.9 - 58.1）和49.6%（95%CI 46.0 - 53.3）。与无CKD的女性或男性相比，患有CKD的女性死亡率高2.5倍（95%CI 1.9 - 3.3），患有CKD的男性死亡率高1.6倍（95%CI 1.3 - 2.1）。在女性中，估计的CKD发病率随着年龄每增加5岁组（直至69岁）从25.6（95%CI 4.2 - 53.0）线性增加至128.6（95%CI 77.1 - 196.6），在≥70岁时为99.8（95%CI 38.7 - 204.7）。在男性中，估计的CKD发病率从20 - 24岁时的28.5（95%CI 3.8 - 71.2）增加至≥70岁时的118.7（95%CI 23.6 - 336.7）。按年龄和性别分层的估计发病率反映了真实发病率的大小和趋势，并且与真实发病率相似（差异p>0.05），但女性20 - 24岁年龄组（p = 0.008）和男性25 - 29岁年龄组（p = 0.002）除外。总之，在这个有详细特征的2型糖尿病患者群体中，25年的观察期间，CKD的估计发病率和观察到的发病率吻合良好。
