Department of Clinical Diabetes and Epidemiology, Baker Heart and Diabetes Institute, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
Department of Clinical Diabetes and Epidemiology, Baker Heart and Diabetes Institute, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
Am J Kidney Dis. 2019 Mar;73(3):300-308. doi: 10.1053/j.ajkd.2018.10.005. Epub 2018 Dec 19.
RATIONALE & OBJECTIVE: The number of people with diabetes and end-stage kidney disease (ESKD) is increasing worldwide, but it is unknown whether this indicates an increasing risk for ESKD in people with diabetes. We examined temporal trends in the incidence of ESKD within the Australian population with diabetes from 2002 to 2013.
Follow-up study using a national health care services registry.
SETTING & PARTICIPANTS: Registrants with type 1 or type 2 diabetes in Australia's National Diabetes Services Scheme (NDSS).
Age, sex, indigenous status, diabetes type, and calendar year.
Incidence of ESKD (dialysis or kidney transplantation) or death ascertained using the Australian and New Zealand Dialysis and Transplant Registry and the Australian national death index.
NDSS registrants were followed up from 2002 or date of registration until onset of ESKD, death, or December 31, 2013. The incidence of ESKD in type 1 diabetes was calculated only in those younger than 55 years.
Among 1,375,877 registrants between 2002 and 2013, a total of 9,977 experienced incident ESKD, representing an overall incidence of ESKD in people with diabetes of 10.0 (95% CI, 9.8-10.2) per 10,000 person-years. Among those with type 1 diabetes, the age-standardized annual incidence was stable during the study period. Among those with type 2 diabetes, the incidence increased in nonindigenous people (annual percentage change, 2.2%; 95% CI, 0.4%-4.1%) with the greatest increases in those younger than 50 and those older than 80 years. No significant change over time was observed in indigenous people, although the adjusted incident rate ratio for indigenous versus nonindigenous was 4.03 (95% CI, 3.68-4.41).
Lack of covariates such as comorbid conditions, medication use, measures of quality of care, and baseline kidney function.
The age-standardized annual incidence of ESKD increased in Australia from 2002 to 2013 for nonindigenous people with type 2 diabetes but was stable for people with type 1 diabetes. Efforts to prevent the development of ESKD, especially among indigenous Australians and those with early-onset type 2 diabetes, are warranted.
全球范围内，糖尿病患者和终末期肾病（ESKD）患者的数量都在增加，但尚不清楚这是否表明糖尿病患者发生 ESKD 的风险增加。我们研究了澳大利亚糖尿病患者人群中 2002 年至 2013 年 ESKD 的发病率的时间趋势。
使用国家卫生保健服务登记处进行随访研究。
澳大利亚国家糖尿病服务计划（NDSS）中的 1 型或 2 型糖尿病注册患者。
年龄、性别、土著地位、糖尿病类型和日历年份。
使用澳大利亚和新西兰透析和移植登记处及澳大利亚国家死亡索引确定 ESKD（透析或肾移植）或死亡的发生率。
从 2002 年或登记日期起对 NDSS 注册患者进行随访，直至发生 ESKD、死亡或 2013 年 12 月 31 日。仅在年龄小于 55 岁的 1 型糖尿病患者中计算 1 型糖尿病患者的 ESKD 发生率。
在 2002 年至 2013 年期间，1375877 名登记患者中共有 9977 人发生了新发 ESKD，糖尿病患者的 ESKD 总发病率为每 10000 人年 10.0（95%CI，9.8-10.2）。在 1 型糖尿病患者中，研究期间年龄标准化的年发病率保持稳定。在 2 型糖尿病患者中，发病率在非土著人群中增加（年百分比变化，2.2%；95%CI，0.4%-4.1%），发病率增加最大的是年龄小于 50 岁和大于 80 岁的人群。在土著人群中未观察到随时间的变化，但土著与非土著的调整后发病率比值比为 4.03（95%CI，3.68-4.41）。
缺乏合并症、药物使用、护理质量措施和基线肾功能等协变量。
澳大利亚非土著 2 型糖尿病患者的 ESKD 年龄标准化年发病率从 2002 年到 2013 年增加，但 1 型糖尿病患者的发病率保持稳定。需要努力预防 ESKD 的发生，特别是在澳大利亚土著人群和早发 2 型糖尿病患者中。
