Brunner F P, Fassbinder W, Broyer M, Oulès R, Brynger H, Rizzoni G, Challah S, Selwood N H, Dykes S R, Wing A J
Department für Innere Medizin, Universität Basel, Switzerland.
Nephrol Dial Transplant. 1988;3(2):109-22.
Extensive survival data are presented from the EDTA Registry's files for patients who started renal replacement therapy in 1970-1974 compared to 1980-1984. The contribution of the different treatment modalities (haemodialysis, continuous peritoneal dialysis, and transplantation) to the survival of patients according to geographical region is also shown. Survival on renal replacement therapy, irrespective of treatment modality and of primary renal disease, was best in the 10-14-year-old patients, with 58% at 10 years and 52% at 15 years, and decreased with rising age to 28% at 10 years and 16% at 15 years in patients aged 45-54 when they commenced therapy in 1970-1974. When comparing the 0-4-year-old with the 10-14-year-old cohort of the paediatric patients, 5-year survival rates for patients starting renal replacement therapy in the early eighties declined from 85% to 70% with decreasing age. Treatment policy, as reflected by the proportion of patients on different modes of therapy, varied markedly between European regions but affected survival to a small extent only. The large population with diabetic nephropathy incurred annual mortality rates 2-3 times greater than those observed in patients with 'standard' primary renal diseases. Haemodialysis and continuous peritoneal dialysis, although not comparable because of important differences in selection policy, yielded similar survival rates. Patients and graft survival rates have improved markedly when comparing patients starting renal replacement therapy in the early seventies with the eighties; particularly for cadaveric transplantation. Patient survival after second grafting was similar to that after first grafting, with 83% at 5 years after second cadaveric grafting in the 15-44-year-old cohort, vs 85% after first cadaver transplantation in 1980-1984. Second cadaveric graft survival was superior to average first-graft survival for those recipients whose first graft had been functioning for more than 1 year. However, second-graft survival in rapid rejectors of a first graft as well as third cadaveric graft survival were curtailed by the large number of early losses, with only 52% of third grafts functioning at 1 year. For living related donor transplantation, parents were mostly used in children whilst identical siblings predominated in adults older than 45. In the early eighties, patient survival was 92% at 5 years for recipients younger than 15, 87% for the 15-45 year old cohort and 72% for those aged 45 or older.(ABSTRACT TRUNCATED AT 400 WORDS)
与1980 - 1984年开始肾脏替代治疗的患者相比，呈现了来自EDTA注册中心1970 - 1974年开始肾脏替代治疗患者的大量生存数据。还展示了不同治疗方式（血液透析、持续性腹膜透析和移植）对不同地理区域患者生存的贡献。无论治疗方式和原发性肾脏疾病如何，肾脏替代治疗的生存率在10 - 14岁患者中最佳，10年生存率为58%，15年生存率为52%；在1970 - 1974年开始治疗的45 - 54岁患者中，随着年龄增长，10年生存率降至28%，15年生存率降至16%。在比较0 - 4岁与10 - 14岁儿科患者队列时，80年代初开始肾脏替代治疗的患者5年生存率随着年龄降低从85%降至70%。不同治疗方式患者比例所反映的治疗策略在欧洲各地区差异显著，但对生存率影响较小。大量糖尿病肾病患者的年死亡率比“标准”原发性肾脏疾病患者高2 - 3倍。血液透析和持续性腹膜透析，由于选择策略存在重要差异不可比，但生存率相似。将70年代初与80年代开始肾脏替代治疗的患者进行比较时，患者和移植物生存率有显著提高；特别是尸体肾移植。第二次移植后的患者生存率与第一次移植后相似，15 - 44岁队列中第二次尸体肾移植后5年生存率为83%，而1980 - 1984年第一次尸体肾移植后为85%。对于第一次移植物已存活超过1年的受者，第二次尸体肾移植物生存率优于平均第一次移植物生存率。然而，第一次移植物快速排斥者的第二次移植物生存率以及第三次尸体肾移植物生存率因早期大量失功而降低，第三次移植物1年时仅有52%仍在发挥功能。对于亲属活体供肾移植，儿童大多使用父母的供肾，而45岁以上成人则以同卵兄弟姐妹的供肾为主。80年代初，15岁以下受者5年生存率为92%，15 - 45岁队列中为87%，45岁及以上为72%。（摘要截选至400字）
