Cirillo Massimo, Palladino Raffaele, Ciacci Carolina, Atripaldi Lidia, Fumo Maria Grazia, Giordana Roberta, Triassi Maria
Department of Public Health, University "Federico II" of Naples, 80131 Naples, Italy.
Interdepartmental Center for Research in Healthcare Management and Innovation in Healthcare (CIRMIS), University "Federico II" of Naples, 80131 Naples, Italy.
J Clin Med. 2021 Jan 24;10(3):449. doi: 10.3390/jcm10030449.
The aim of this study was to investigate the epidemiology of kidney replacement treatment (KRT) in Italy with a focus on gender and residence. As a population-based study using administrative databases from the Campania region of Italy between 2015 and 2018, the study outcomes included diagnoses of haemodialysis, peritoneal dialysis, kidney transplant, and mortality. A total of 11,713 residents in Campania were on KRT from 2015 to 2018. The annual prevalence ranged between 1000 and 1015 patients per million population (pmp) for haemodialysis, between 115 and 133 pmp for peritoneal dialysis, and between 2081 and 2245 pmp for kidney transplant. The annual incidence ranged between 160 and 185 pmp for de novo haemodialysis and between 59 and 191 pmp for kidney transplant. Annual mortality ranged between 12.8% and 14.2% in haemodialysis, between 5.2% and 13.8% in peritoneal dialysis, and between 2.4% and 3.3% in kidney transplant. In Cox regression targeting mortality, significant HRs were found for age (95%CI = 1.05/1.05), kidney transplant (compared to haemodialysis: 0.37/0.47), residence in suburban areas (1.03/1.24), and de novo dialysis incidence in years 2015-2018 (1.01/1.17). The annual rate of kidney transplant was 2.6%. In regression targeting kidney transplant rate, significant HRs were found for female gender (0.67/0.92), age (0.93/0.94), residence in suburban areas (0.65/0.98), and de novo incidence of dialysis in 2015-2018 (0.49/0.71). The existence of socioeconomic inequities in KRT is suggested by the evidence that gender and suburban residence predicted mortality and/or access to kidney transplant.
本研究旨在调查意大利肾脏替代治疗（KRT）的流行病学情况，重点关注性别和居住地区。作为一项基于意大利坎帕尼亚地区2015年至2018年行政数据库的人群研究，研究结果包括血液透析、腹膜透析、肾移植的诊断以及死亡率。2015年至2018年期间，坎帕尼亚共有11713名居民接受KRT治疗。血液透析的年患病率为每百万人口（pmp）1000至1015例患者，腹膜透析为115至133 pmp，肾移植为2081至2245 pmp。新发血液透析的年发病率为160至185 pmp，肾移植为59至191 pmp。血液透析的年死亡率为12.8%至14.2%，腹膜透析为5.2%至13.8%，肾移植为2.4%至3.3%。在以死亡率为目标的Cox回归分析中，发现年龄（95%置信区间=1.05/1.05）、肾移植（与血液透析相比：0.37/0.47）、郊区居住（1.03/1.24）以及2015年至2018年新发透析发病率（1.01/1.17）的风险比具有统计学意义。肾移植的年发生率为2.6%。在以肾移植率为目标的回归分析中，发现女性性别（0.67/0.92）、年龄（0.93/0.94）、郊区居住（0.65/0.98）以及2015年至2018年透析的新发发病率（0.49/0.71）的风险比具有统计学意义。性别和郊区居住情况可预测死亡率和/或肾移植可及性，这一证据表明KRT存在社会经济不平等现象。
