Brunner F P, Brynger H, Challah S, Fassbinder W, Geerlings W, Selwood N H, Tufveson G, Wing A J
European Dialysis and Transplant Association Registry, St Thomas's Hospital London, UK.
Nephrol Dial Transplant. 1988;3(5):585-95. doi: 10.1093/oxfordjournals.ndt.a091710.
Diabetic nephropathy, a rarely listed cause of end-stage renal failure (ESRF) among patients starting renal replacement therapy (RRT) in the early seventies, has progressively gained in importance and become one of the major reasons for the continuous growth of the patient population on RRT in most European countries. Amongst new patients commencing RRT in 1985, the acceptance rate varied between 3 and 12 per million population for type I diabetes mellitus and between one and four per million population for type II diabetes mellitus. Nordic countries, particularly Sweden and Finland, had the highest acceptance rate of young patients with type I diabetes mellitus whose median ages were 38-42 years. In most central and southern European countries the median age of patients with type I diabetes mellitus varied between 50 and 58 years. The high number of young patients with type I diabetes mellitus and ESRF in Nordic countries point to a different natural history of this disease. It cannot be excluded, however, that the higher median age in other countries might result from doctors mistakenly diagnosing type I disease in patients with type II disease who need insulin treatment. Patients with type II diabetes mellitus had a similar age distribution at start of RRT throughout Europe and their median ages clustered around 60 years in most countries. The contribution of haemodialysis, peritoneal dialysis and renal transplantation was analysed for diabetic compared to non-diabetic ESRF. Despite large geographical differences in the proportional use of methods of treatment, a general trend to apply CAPD more frequently in diabetic as compared to non-diabetic patients was observed, and this was true for countries with both predominant haemodialysis and predominant transplant programmes. Transplantation without prior dialysis was performed in 17% of Swedish and 30% of Norwegian patients with type I diabetes mellitus. In order to better explain the mortality of patients with diabetic ESRF, the proportional distribution of causes of death was analysed. Myocardial ischaemia and infarction was confirmed to be the leading cause of death in patients with diabetes mellitus on RRT. The coronary death rate was estimated to be 10 times greater in young patients with type I diabetes mellitus as compared to their non-diabetic counterparts. Other cardiovascular as well as infectious causes were recorded in a similar proportion of deaths in diabetics as in non-diabetics. Cancer deaths, however, appeared to be definitely less frequent in patients on RRT due to diabetic nephropathy.
糖尿病肾病在20世纪70年代初开始接受肾脏替代治疗（RRT）的患者中是终末期肾衰竭（ESRF）较少被提及的病因，但它的重要性已逐渐增加，并成为大多数欧洲国家接受RRT患者人数持续增长的主要原因之一。在1985年开始接受RRT的新患者中，1型糖尿病的接受率在每百万人口3至12例之间，2型糖尿病在每百万人口1至4例之间。北欧国家，尤其是瑞典和芬兰，1型糖尿病年轻患者的接受率最高，其年龄中位数为38 - 42岁。在大多数中欧和南欧国家，1型糖尿病患者的年龄中位数在50至58岁之间。北欧国家1型糖尿病合并ESRF的年轻患者数量众多，表明这种疾病有不同的自然病程。然而，不能排除其他国家较高的年龄中位数可能是由于医生将需要胰岛素治疗的2型疾病患者误诊为1型疾病所致。在整个欧洲，2型糖尿病患者开始接受RRT时的年龄分布相似，大多数国家的年龄中位数集中在60岁左右。分析了糖尿病与非糖尿病ESRF患者中血液透析、腹膜透析和肾移植的贡献。尽管治疗方法的使用比例存在很大的地域差异，但观察到与非糖尿病患者相比，糖尿病患者更频繁应用持续性非卧床腹膜透析（CAPD）的总体趋势，在以血液透析为主和以移植项目为主的国家都是如此。17%的瑞典1型糖尿病患者和30%的挪威1型糖尿病患者在未进行透析前就接受了肾移植。为了更好地解释糖尿病ESRF患者的死亡率，分析了死亡原因的比例分布。心肌缺血和梗死被确认为接受RRT的糖尿病患者的主要死亡原因。据估计，1型糖尿病年轻患者的冠状动脉死亡率比非糖尿病同龄人高10倍。糖尿病患者中其他心血管疾病以及感染性病因导致的死亡比例与非糖尿病患者相似。然而，因糖尿病肾病接受RRT的患者中癌症死亡似乎确实较少。
