Department of Medicine, Colonial War Memorial Hospital, Suva, Fiji.
Department of Medicine, Lautoka Hospital, Lautoka, Fiji.
Intern Med J. 2019 Apr;49(4):461-466. doi: 10.1111/imj.14108.
Chronic kidney disease is now a leading cause of death in Fiji. The country lacks even basic statistics about the incidence of end-stage kidney disease (ESKD) and presents significant challenges to conducting clinical research.
To estimate the incidence and characteristics of ESKD in Fijian adults.
A retrospective cohort study was conducted of patients admitted to Colonial War Memorial Hospital in Suva, Fiji, in 2012. Suspected ESKD cases were identified from laboratory registers of renal function tests and confirmed through medical record review. Population data were from the Fijian Bureau of Statistics.
Screening identified 1474 suspected ESKD cases. Following removal of 763 duplicates and cases with discrepant identifiers, 711 unique cases remained. An additional 552 cases met exclusion criteria, including acute kidney injury (247), failure to be admitted (131) and pre-existing ESKD diagnosis (103), leaving 159 cases of confirmed ESKD. Median age was 57 years (interquartile range 47-65). Crude and age-adjusted ESKD incidence rates were 753 per million population (pmp) (95% confidence interval (CI) 636-870) and 793 pmp (95% CI 669-916), respectively, rising to 938 pmp (95% CI 804-1072) if African-American correction was removed. Diabetic nephropathy was the most common cause of ESKD (65.4%).
The incidence of ESKD in Fiji is high. This is a substantial public health problem that is likely impacting life expectancy and quality of life. Improving screening, detection and management of kidney disease should be given more prominence in programmes to address non-communicable diseases in Fiji and the Western Pacific.
慢性肾脏病现已成为斐济的主要致死病因。该国甚至缺乏关于终末期肾病（ESKD）发病率的基本统计数据，这给开展临床研究带来了巨大挑战。
估算斐济成年人群 ESKD 的发病率和特征。
对 2012 年在斐济苏瓦的殖民战争纪念医院住院的患者进行了一项回顾性队列研究。通过肾功能检测的实验室登记册识别疑似 ESKD 病例，并通过病历审查进行确认。人口数据来自斐济统计局。
筛查出 1474 例疑似 ESKD 病例。剔除 763 例重复病例和身份标识不一致的病例后，余下 711 例为唯一病例。另外有 552 例符合排除标准，包括急性肾损伤（247 例）、未入院（131 例）和预先存在的 ESKD 诊断（103 例），因此确诊的 ESKD 病例为 159 例。中位年龄为 57 岁（四分位间距 47-65）。未经年龄调整的 ESKD 发病率为 753/100 万人口（95%置信区间 636-870），经年龄调整的 ESKD 发病率为 793/100 万人口（95%置信区间 669-916），如果去除非裔美国人校正值，发病率则上升至 938/100 万人口（95%置信区间 804-1072）。ESKD 的最常见病因是糖尿病肾病（65.4%）。
斐济的 ESKD 发病率较高。这是一个严重的公共卫生问题，可能对预期寿命和生活质量产生影响。在斐济和西太平洋地区解决非传染性疾病的方案中，应更加重视加强肾病的筛查、检测和管理。
