Lu Yimin, Stamm Christina, Nobre Dina, Pruijm Menno, Teta Daniel, Cherpillod Anne, Halabi Georges, Phan Olivier, Fumeaux Zina, Bullani Roberto, Gauthier Thierry, Mathieu Claudine, Burnier Michel, Zanchi Anne
Service of Nephrology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
Haemodialysis Unit, Cecil Clinic, Lausanne, Switzerland.
Swiss Med Wkly. 2017 Jul 6;147:w14458. doi: 10.4414/smw.2017.14458. eCollection 2017.
Worldwide, diabetes has become the most common cause of end-stage renal disease (ESRD), yet Swiss data are largely lacking.
This observational study examined ESRD patients with diabetes mellitus (ESRD-DM) at end of 2009 and 2014. The prevalence and characteristics of ESRD-DM patients were collected in all dialysis facilities in the Canton of Vaud of Switzerland in 2009 and in 2014, and the 5-year mortality rate was assessed.
A total of 107 and 140 ESRD-DM patients underwent dialysis at end of 2009 and 2014, respectively. Within the 5-year period a total of 167 incidental ESRD-DM patients required dialysis, corresponding to an estimated incidental rate of 0.84/1000 person-years in the diabetic population. In 2009, all patients with ESRD-DM underwent haemodialysis, decreasing to 96.2% in 2014, with 3.8% on peritoneal dialysis. Age, sex, body mass index, type of diabetes, duration of diabetes, cause of ESRD, dialysis duration, dialysis frequency, vascular access, and glycosylated haemoglobin levels did not differ between 2009 and 2014. In 2014, macrovascular comorbidity was reported more often than in 2009, but not amputations. Haemoglobin level decreased significantly from 117.9 g/l to 112.3 g/l. Calcium-containing phosphate binder and angiotensin-converting enzyme inhibitor use significantly decreased, whereas iron therapy significantly increased with time. The 5-year mortality rate was 61.7%. Five-year survivors were significantly younger and had a higher body mass index.
The growing prevalence of ESRD-DM emphasises that prevention of chronic kidney disease and its progression should be a public health priority in Switzerland.
在全球范围内，糖尿病已成为终末期肾病（ESRD）最常见的病因，但瑞士的相关数据十分匮乏。
这项观察性研究对2009年末和2014年末的糖尿病终末期肾病（ESRD-DM）患者进行了检查。收集了2009年和2014年瑞士沃州所有透析机构中ESRD-DM患者的患病率及特征，并评估了5年死亡率。
2009年末和2014年末分别有107例和140例ESRD-DM患者接受透析。在这5年期间，共有167例偶发性ESRD-DM患者需要透析，糖尿病患者人群中估计的偶发率为0.84/1000人年。2009年，所有ESRD-DM患者均接受血液透析，这一比例在2014年降至96.2%，3.8%接受腹膜透析。2009年和2014年之间，患者的年龄、性别、体重指数、糖尿病类型、糖尿病病程、ESRD病因、透析时间、透析频率、血管通路以及糖化血红蛋白水平并无差异。2014年，大血管合并症的报告比2009年更为常见，但截肢情况并非如此。血红蛋白水平从117.9 g/l显著降至112.3 g/l。含钙磷结合剂和血管紧张素转换酶抑制剂的使用显著减少，而铁剂治疗随时间显著增加。5年死亡率为61.7%。5年幸存者明显更年轻，体重指数更高。
ESRD-DM患病率的上升强调，预防慢性肾病及其进展应成为瑞士公共卫生的优先事项。
