Nordio M, Limido A, Postorino M
Unit of Nephrology, General Hospital, Piazzale Ospedale, 23, 31100, Treviso, Italy.
Unit of Nephrology and Dialysis, ASST Fatebenefratelli Sacco, Milan, Italy.
J Nephrol. 2020 Dec;33(6):1195-1200. doi: 10.1007/s40620-020-00750-z. Epub 2020 May 22.
Incidence of kidney replacement therapy (KRT) stabilizes or declines both in Europe and in the US; however, it is predictable that global prevalence of KRT will double by 2030. In this paper, we focus on the patterns of incidence, mortality, and prevalence of KRT in Italy, and we compare, when possible, the findings with other countries. The Italian Dialysis and Transplantation Registry (IDTR) currently collects aggregate data from regional registries. In Italy, KRT yearly incidence is around 160 patients per million population (pmp). This incidence showed an increasing trend up until 2011 with an average annual percentage change (AAPC) of 1.8%, after which it stabilized. Older age is an important determinant for KRT incidence, and it is strongly associated with the variability between Italian regions. Incidence is very stable within patients less than 50 years old; however, it greatly differs between regions for patients over 75 years old, ranging from 400 to 900 pmp. Moreover, the incidence for patients over 50 years old declined from 366 pmp in 2011 to 285 in 2017. An age-period-cohort (APC) model showed a very strong cohort effect, which shows the decline in incidence seems mainly due to the better health conditions of people born after 1940. Mortality rate in KRT patients was 109 per 1000 patient-year (py) between 2011 and 2017 with great differences among treatment modalities: 162 per 1000 py in haemodialysis, 117 per 1000 py in peritoneal dialysis, and 16 per 1000 py in kidney transplantation. Premature death is better detected by the standard expected years of life lost (YLL). The distribution of YLL rate per age shows a sharp increase between 40 and 70 years old both in haemodialysis and peritoneal dialysis patients with an AAPC of 5.2% and 4.1% respectively. Transplanted patients experience a very low YLL rate at any age. KRT prevalence was 1118 pmp in 2017 and it should be close to 1175 pmp by 2025 with a projected increase of transplanted patients' prevalence to 500 pmp, and a decrease of dialysis patients from 714 to 680 pmp. The proportion of patients treated with one of the three modalities strictly depends on age, with a sharp increase of haemodialysis after the age of 50. All data suggests the necessity to improve the care of middle and older age patients who experience the higher incidence of disease and mortality.
在欧洲和美国，肾脏替代疗法（KRT）的发病率趋于稳定或有所下降；然而，可以预见，到2030年全球KRT的患病率将翻番。在本文中，我们重点关注意大利KRT的发病率、死亡率和患病率模式，并尽可能将研究结果与其他国家进行比较。意大利透析和移植登记处（IDTR）目前从各地区登记处收集汇总数据。在意大利，KRT的年发病率约为每百万人口160例（pmp）。在2011年之前，这一发病率呈上升趋势，年均变化率（AAPC）为1.8%，之后趋于稳定。高龄是KRT发病率的一个重要决定因素，并且与意大利各地区之间的差异密切相关。50岁以下患者的发病率非常稳定；然而，75岁以上患者的发病率在各地区之间差异很大，从400到900 pmp不等。此外，50岁以上患者的发病率从2011年的366 pmp降至2017年的285 pmp。年龄-时期-队列（APC）模型显示出很强的队列效应，这表明发病率的下降似乎主要归因于1940年后出生人群更好的健康状况。2011年至2017年期间，KRT患者的死亡率为每1000患者年109例（py），不同治疗方式之间差异很大：血液透析为每1000 py 162例，腹膜透析为每1000 py 117例，肾移植为每1000 py 16例。过早死亡通过标准预期寿命损失年数（YLL）能得到更好的体现。按年龄划分的YLL率分布显示，血液透析和腹膜透析患者在40至70岁之间急剧上升，AAPC分别为5.2%和4.1%。移植患者在任何年龄的YLL率都非常低。2017年KRT患病率为1118 pmp，到2025年预计将接近1175 pmp，预计移植患者的患病率将增至500 pmp，透析患者的患病率将从714降至680 pmp。采用三种治疗方式之一进行治疗的患者比例严格取决于年龄，50岁以后血液透析的比例急剧上升。所有数据都表明有必要改善对疾病和死亡率较高的中老年患者的护理。
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