Wu Hongjiang, Lau Eric S H, Yang Aimin, Szeto Cheuk-Chun, Ma Ronald C W, Kong Alice P S, Chow Elaine, So Wing-Yee, Chan Juliana C N, Luk Andrea O Y
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.
Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.
Lancet Reg Health West Pac. 2021 Jun 9;11:100165. doi: 10.1016/j.lanwpc.2021.100165. eCollection 2021 Jun.
There are limited population-wide trend data on kidney failure and kidney replacement therapy (KRT) in people with diabetes. We conducted a retrospective cohort study to report incidence trends of kidney failure and KRT and related mortality in people with diabetes in Hong Kong between 2002 and 2015.
We used territory-wide electronic medical records including laboratory, diagnostic and procedural data to identify people with kidney failure and KRT. We used Joinpoint regression models to estimate the average annual percent change (AAPC) of kidney failure and KRT incidence for entire study period, and annual percent change (APC) for each linear trend segment, along with 1-year and 5-year mortality rates.
During 4.9 million person-years of follow-up of 712,222 people with diabetes, 31,425 developed kidney failure, among whom 23.0% (n=7,233) received KRT. The incidence of kidney failure declined by 46.8% from 2002 to 2007 (APC: -11.6, 95% CI: -16.3, -6.7), then flattened from 2007 to 2015 (APC: -0.9, 95% CI: -3.1, 1.3). The incidence of KRT remained constant (AAPC: -1.6, 95% CI: -4.4, 1.2). The 1-year mortality rates declined statistically significantly after both kidney failure and KRT. The 5-year mortality rates declined after kidney failure but the decline was not statistically significant after KRT.
The findings of our study highlight the importance of developing new strategies to prevent a looming epidemic of kidney failure in people with diabetes in Hong Kong.
Asia Diabetes Foundation.
关于糖尿病患者肾衰竭及肾脏替代治疗（KRT）的全人群趋势数据有限。我们开展了一项回顾性队列研究，以报告2002年至2015年香港糖尿病患者肾衰竭、KRT的发病率趋势及相关死亡率。
我们使用涵盖实验室、诊断和诊疗数据的全港电子病历，来识别肾衰竭和接受KRT的患者。我们使用Joinpoint回归模型来估计整个研究期间肾衰竭和KRT发病率的平均年度变化百分比（AAPC），以及每个线性趋势段的年度变化百分比（APC），同时计算1年和5年死亡率。
在对712,222名糖尿病患者进行的490万人年的随访中，31,425人发生肾衰竭，其中23.0%（n = 7,233）接受了KRT。2002年至2007年，肾衰竭发病率下降了46.8%（APC：-11.6，95%CI：-16.3，-6.7），然后在2007年至2015年趋于平稳（APC：-0.9，95%CI：-3.1，1.3）。KRT的发病率保持稳定（AAPC：-1.6，95%CI：-4.4，1.2）。肾衰竭和KRT后1年死亡率均有统计学显著下降。肾衰竭后5年死亡率下降，但KRT后下降无统计学显著性。
我们的研究结果凸显了制定新策略以预防香港糖尿病患者中即将出现的肾衰竭流行的重要性。
亚洲糖尿病基金会。
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