Department of Neuromotor and Biomedical Sciences, Unit of Hygiene and Public Health, University of Bologna, Bologna, Italy.
Department of Primary Care, Bologna Healthcare Authority, Bologna, Italy.
J Nephrol. 2022 Jan;35(1):179-190. doi: 10.1007/s40620-021-00984-5. Epub 2021 Feb 17.
In recent decades, high income countries (HIC) have been exposed to huge human migratory flows. Consistent with this influx, there has been a dramatic increase in the number of chronic kidney disease (CKD) patients in the immigrant population. In Italy, comparisons between Italian and immigrant CKD patients are still lacking, thus we aimed to describe the baseline clinical characteristics and the main outcomes of CKD patients who immigrated to Italy and reside in the Emilia Romagna region.
This is a retrospective cohort study based on CKD patients from the Prevenzione Insufficienza Renale Progressiva (PIRP) project, which included 963 (3.1%) immigrants among the 30,702 patients seen by nephrologists between April 1st, 2004 and June 30th, 2020. We sub-divided the immigrants into seven groups based on their area of origin, and compared their baseline characteristics, CKD progression and time to end-stage kidney disease (ESKD) to those of Italian CKD patients.
At presentation, Italian subjects were on average older (73.1 years) and had less preserved kidney function (eGFR 34.3 ml/min), while South and East Asians had the highest proportion of diabetes and obesity (approximately 45% and 30%, respectively). At 4-year follow-up, about 20% of patients from South Asia, Eastern Europe and Arab Countries were diagnosed with ESKD, compared to only 11% of Italians and Latin Americans.
We found important differences between Italian and immigrant CKD patients, as well as among immigrant subgroups. First clinical encounters with nephrologists revealed that immigrants had varied patterns of clinical presentation and of nephropathy. During follow-up, immigrants showed faster kidney function decline which led to a higher risk of disease evolution and progression towards ESKD.
近几十年来，高收入国家（HIC）面临着大规模的人口迁移。与此涌入相对应的是，移民人口中的慢性肾脏病（CKD）患者数量急剧增加。在意大利，意大利人和移民 CKD 患者之间的比较仍然缺乏，因此我们旨在描述移民到意大利并居住在艾米利亚-罗马涅地区的 CKD 患者的基线临床特征和主要结局。
这是一项基于 Prevenzione Insufficienza Renale Progressiva（PIRP）项目的 CKD 患者的回顾性队列研究，该项目纳入了 2004 年 4 月 1 日至 2020 年 6 月 30 日期间由肾病医生诊治的 30702 名患者中的 963 名（3.1%）移民。我们根据原籍地区将移民分为七组，并将他们的基线特征、CKD 进展和终末期肾病（ESKD）时间与意大利 CKD 患者进行了比较。
在就诊时，意大利患者的年龄平均较大（73.1 岁），肾功能保存较差（eGFR 34.3ml/min），而南亚和东亚患者的糖尿病和肥胖比例最高（分别约为 45%和 30%）。在 4 年的随访中，南亚、东欧和阿拉伯国家的约 20%的患者被诊断为 ESKD，而意大利和拉丁美洲患者的这一比例仅为 11%。
我们发现意大利人和移民 CKD 患者之间以及移民亚组之间存在重要差异。首次与肾病医生就诊时，移民患者的临床表现和肾病类型各不相同。在随访期间，移民患者的肾功能下降速度更快，导致疾病进展和向 ESKD 进展的风险更高。
