全球、区域和国家 1990 年至 2019 年与糖尿病相关的慢性肾脏病负担。
Global, Regional, and National Burden of Diabetes-Related Chronic Kidney Disease From 1990 to 2019.
机构信息
Department of Nephrology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
出版信息
Front Endocrinol (Lausanne). 2021 Jul 1;12:672350. doi: 10.3389/fendo.2021.672350. eCollection 2021.
BACKGROUND
Chronic kidney disease (CKD) is a public health problem largely caused by diabetes. The epidemiology of diabetes mellitus-related CKD (CKD-DM) could provide specific support to lessen global, regional, and national CKD burden.
METHODS
Data were derived from the GBD 2019 study, including four measures and age-standardized rates (ASRs). Estimated annual percentage changes and 95% CIs were calculated to evaluate the variation trend of ASRs.
RESULTS
Diabetes caused the majority of new cases and patients with CKD in all regions. All ASRs for type 2 diabetes-related CKD increased over 30 years. Asia and Middle socio-demographic index (SDI) quintile always carried the heaviest burden of CKD-DM. Diabetes type 2 became the second leading cause of CKD and CKD-related death and the third leading cause of CKD-related DALYs in 2019. Type 2 diabetes-related CKD accounted for most of the CKD-DM disease burden. There were 2.62 million incident cases, 134.58 million patients, 405.99 thousand deaths, and 13.09 million disability-adjusted life-years (DALYs) of CKD-DM worldwide in 2019. Age-standardized incidence (ASIR) and prevalence rate (ASPR) of type 1 diabetes-related CKD increased, whereas age-standardized death rate (ASDR) and DALY rate decreased for females and increased for males. In high SDI quintile, ASIR and ASPR of type 1 diabetes-related CKD remained the highest, with the slowest increase, whereas the ASDR and age-standardized DALY rate remained the lowest there. In high SDI quintile, ASIR of type 2 diabetes-related CKD was the highest, with the lowest increasing rate. In addition, type 2 diabetes-related CKD occurred most in people aged 80-plus years worldwide. The main age of type 2 diabetes-related CKD patients was 55-64 years in Asia and Africa. The prevalence, mortality, and DALY rate of type 2 diabetes-related CKD increased with age. As for incidence, there was a peak at 80 years, and after age of 80, the incidence declined. CKD-DM-related anemia was mainly in mild to moderate grade.
CONCLUSIONS
Increasing burden of CKD-DM varied among regions and countries. Prevention and treatment measures should be strengthened according to CKD-DM epidemiology, especially in middle SDI quintile and Asia.
背景
慢性肾脏病（CKD）是一个主要由糖尿病引起的公共卫生问题。糖尿病相关 CKD（CKD-DM）的流行病学可以为减轻全球、区域和国家 CKD 负担提供具体支持。
方法
数据来源于 GBD 2019 研究，包括四项措施和年龄标准化率（ASR）。计算估计的年变化百分比和 95%置信区间，以评估 ASR 的变化趋势。
结果
糖尿病导致所有地区新发病例和 CKD 患者的大部分。30 多年来，所有 2 型糖尿病相关 CKD 的 ASR 均呈上升趋势。亚洲和中等社会人口指数（SDI）五分位数地区始终承担着 CKD-DM 最重的负担。2019 年，2 型糖尿病成为 CKD 和 CKD 相关死亡的第二大病因，也是 CKD 相关残疾调整生命年（DALY）的第三大病因。2 型糖尿病相关 CKD 占 CKD-DM 疾病负担的大部分。2019 年，全球有 262 万例新发病例、1.3458 亿例患者、40.59 万例死亡和 1309 万残疾调整生命年（DALY）的 CKD-DM。全世界女性的 1 型糖尿病相关 CKD 的年龄标准化发病率（ASIR）和患病率（ASPR）增加，而年龄标准化死亡率（ASDR）和 DALY 率下降，男性则相反。在高 SDI 五分位数中，1 型糖尿病相关 CKD 的 ASIR 和 ASPR 仍然最高，增长最慢，而 ASDR 和年龄标准化 DALY 率仍然最低。在高 SDI 五分位数中，2 型糖尿病相关 CKD 的 ASIR 最高，增长率最低。此外，全世界 80 岁以上人群中 2 型糖尿病相关 CKD 最为常见。亚洲和非洲 2 型糖尿病相关 CKD 患者的主要年龄为 55-64 岁。2 型糖尿病相关 CKD 的患病率、死亡率和 DALY 率随年龄增长而增加。至于发病率，在 80 岁时达到峰值，80 岁以后，发病率下降。CKD-DM 相关贫血主要为轻至中度。
结论
CKD-DM 的负担增加在不同地区和国家之间存在差异。应根据 CKD-DM 的流行病学情况加强预防和治疗措施，特别是在中 SDI 五分位数和亚洲地区。
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