Division of Comprehensive Geriatrics in Community, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
Department of Nephrology and Hypertension, Fukushima Medical University, Fukushima, Japan.
Nephrology (Carlton). 2020 Feb;25(2):172-178. doi: 10.1111/nep.13595. Epub 2019 May 1.
We aimed to describe secular trends in the incidence of end-stage kidney disease (ESKD) requiring renal replacement therapy (RRT) in Japan, and to assess the effect of population aging on the incidence of ESKD.
The national incidence of ESKD requiring RRT was calculated using published data and Japan's population statistics. Age-standardized incidence was calculated by direct standardization using the World Standard Population. The average annual percentage of change (APC) in rates and corresponding 95% confidence interval (CI) were computed for trends by joinpoint regression analysis. To assess the effect of population aging on the incidence of ESKD requiring RRT, we used the method proposed by Bashir and Estève, which splits the crude incidence into three components: population structure, population size, and age-independent risk.
Age-standardized incidence trends (1983-1996) increased significantly in both men (APC 6.33, 95% CI: 5.39-7.29) and women (APC 5.25, 95% CI: 4.26-6.24). With a significant inflection point in 1996, the trend was stable for men (APC -0.16, 95% CI: -0.48 to 0.17) but significantly decreased for women (APC -1.98, 95% CI: -2.38 to -1.59) from 1996 to 2016. The main reason for the increase in those with ESKD requiring RRT has changed; before 1996, the change in age-independent risk was the main contributor, but after 1996, the change in age structure with a higher proportion of older individuals was the main contributor.
The increase in number of ESKD patients requiring RRT dramatically changed in Japan during the 1983 to 2016 period.
本研究旨在描述日本终末期肾病（ESKD）患者接受肾脏替代治疗（RRT）的发病率的长期变化趋势，并评估人口老龄化对 ESKD 发病率的影响。
利用已发表的数据和日本人口统计资料计算接受 RRT 的 ESKD 的全国发病率。采用世界标准人口直接标准化法计算年龄标准化发病率。通过 Joinpoint 回归分析计算发病率变化的平均年百分比（APC）及其 95%置信区间（CI）。为了评估人口老龄化对 RRT 治疗的 ESKD 发病率的影响，我们采用了 Bashir 和 Estève 提出的方法，该方法将粗发病率分为三个组成部分：人口结构、人口规模和与年龄无关的风险。
1983 年至 1996 年，男性（APC6.33，95%CI：5.39-7.29）和女性（APC5.25，95%CI：4.26-6.24）的年龄标准化发病率呈显著上升趋势。1996 年出现显著拐点后，男性的趋势保持稳定（APC-0.16，95%CI：-0.48 至 0.17），而女性的趋势则明显下降（APC-1.98，95%CI：-2.38 至-1.59），从 1996 年到 2016 年。需要 RRT 的 ESKD 患者数量增加的主要原因已经发生了变化；1996 年之前，与年龄无关的风险变化是主要原因，而 1996 年之后，年龄结构的变化（即老年人口比例更高）是主要原因。
1983 年至 2016 年期间，日本需要接受 RRT 的 ESKD 患者数量急剧增加。
