UK Renal Registry, Bristol BS10 5NB, UK.
School of Social and Community Medicine, University of Bristol, Room 1.13/1.14, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK.
Nephrol Dial Transplant. 2018 Feb 1;33(2):356-364. doi: 10.1093/ndt/gfw444.
Clinical epidemiology data for young adults on renal replacement therapy (RRT) are lacking. While mostly transplanted, they have an increased risk of graft loss during young adulthood.
We combined the UK Renal Registry paediatric and adult databases to describe patient characteristics, transplantation and survival for young adults. We grouped patients 11-30 years of age starting RRT from 1999 to 2008 by age band and examined their course during 5 years of follow-up.
The cohort (n = 3370) was 58% male, 79% white and 29% had glomerulonephritis. Half (52%) started RRT on haemodialysis (HD). Most (78%) were transplanted (18% pre-emptive, 61% as second modality); 11% were not listed for transplant. Transplant timing varied by age group. The deceased:living donor kidney transplant ratio was 2:1 for 11-<16 year olds and 1:1 otherwise. Median deceased donor transplant waiting times ranged from 6 months if <16 years of age to 17 months if ≥21 years. Overall 8% died, with being on dialysis and not transplant listed versus transplanted {hazard ratio [HR] 16.6 [95% confidence interval (CI) 10.8-25.4], P < 0.0001} and diabetes versus glomerulonephritis [HR 4.03 (95% CI 2.71-6.01), P < 0.0001] increasing mortality risk.
This study highlights the frequent use of HD and the importance of transplant listing and diabetes for young adults. More than half the young adults in our cohort started renal replacement therapy on HD. One in 10 young adults were not listed for transplant by 5 years and were ∼20 times more likely to die than those who were transplanted. Diabetes as a primary renal disease was common among young adults and associated with increased mortality. Overall, almost 1 in 10 young adults had died by 5 years from the start of RRT.
关于接受肾脏替代治疗（RRT）的年轻成年人的临床流行病学数据尚缺乏。尽管大多数患者接受了移植，但他们在年轻成年期间有更高的移植物丢失风险。
我们结合了英国肾脏注册处的儿科和成人数据库，以描述年轻成年人的患者特征、移植和生存情况。我们根据年龄组将 1999 年至 2008 年开始接受 RRT 的 11-30 岁患者分为不同年龄组，并在 5 年随访期间检查他们的治疗过程。
该队列（n=3370）中，58%为男性，79%为白人，29%患有肾小球肾炎。一半（52%）的患者开始接受血液透析（HD）治疗。大多数（78%）接受了移植（18%为抢先移植，61%为第二种方式）；11%未被列入移植名单。移植时间因年龄组而异。11-<16 岁的患者，死亡：活体供肾移植比例为 2:1，而其他患者为 1:1。如果患者年龄<16 岁，等待死亡供体移植的中位数时间为 6 个月，如果患者年龄≥21 岁，则为 17 个月。总体而言，有 8%的患者死亡，与接受透析治疗且未被列入移植名单和已接受移植的患者相比，未被列入移植名单的患者死亡风险更高[风险比（HR）16.6（95%置信区间（CI）10.8-25.4），P<0.0001]，患有糖尿病的患者比患有肾小球肾炎的患者死亡风险更高[HR 4.03（95%CI 2.71-6.01），P<0.0001]。
本研究强调了 HD 的广泛应用以及移植列入名单和糖尿病对年轻成年人的重要性。我们队列中的一半以上的年轻成年人开始接受 HD 治疗。在 5 年内，有 10%的年轻成年人未被列入移植名单，其死亡风险比接受移植的患者高 20 倍。年轻成年人中常见的原发性肾脏疾病是糖尿病，且与死亡率升高有关。总体而言，从开始接受 RRT 到 5 年时，近 10%的年轻成年人已经死亡。
