de Almeida Edgar A F, Raimundo Mário, Coelho Anabela, Sá Helena
Department of Nephrology, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal.
Serviço de Nefrologia, Hospital Beatriz Ângelo, Loures, Portugal.
Clin Kidney J. 2020 Jun 24;14(3):869-875. doi: 10.1093/ckj/sfaa023. eCollection 2021 Mar.
The Portuguese Society of Nephrology (PSN) reported that Portugal has one of the highest incidences of dialysis in Europe. However, this claim was based on aggregated data supplied by dialysis providers, hampering comparisons between countries. In 2009, an individual registry of patients starting dialysis was set up by the Portuguese Ministry of Health. We analysed individual data of patients starting dialysis from January 2010 until December 2016.
Demography, starting treatment day, modality, regional distribution and outcomes, such as death, recovery of renal function, transfer to renal transplantation, peritoneal dialysis or conservative management, were extracted. Incidence, prevalence and survival analysis were calculated and compared with the PSN registry.
Out of 19 190 registrations, 16 775 were incident patients (61.8% men). Yearly incidence of renal replacement therapy was 250, 248, 229, 239, 230, 231 and 244 per million population (p.m.p.) for 2010 to 2016, compared with 235, 224, 218, 230, 234, 225 and 239 p.m.p. reported by the PSN registry. On the other hand, prevalence increased from 998 p.m.p. in 2010 to 1286 p.m.p. in 2016, compared with 1010 p.m.p. in 2010 increasing to 1203 p.m.p. in 2016 from the PSN registry. The regions of Alentejo (122.9 p.m.p.) and the the Centre (160.8 p.m.p.) had the lowest regional incidence, while Lisbon had the highest (386 p.m.p. in 2016). Unadjusted survival analysis revealed that 93.5% of the patients were alive on the 91st day, whereas 85.2 and 78.3% were alive at 1 and 2 years, respectively. Crude survival at 7 years was 40%.
For the first time, an individual registry of patients starting dialysis in Portugal was subject to analysis and added new information about long-term survival and regional differences in the incidence and prevalence of renal replacement therapy. We were able to confirm that Portugal has one of the world's highest incidences and prevalences of dialysis. We also demonstrate, for the first time, a striking regional difference in the incidence of dialysis and an excellent early and long-term survival of patients on dialysis. These results compare well with other European countries in terms of the dialysis efficiency.
葡萄牙肾脏病学会（PSN）报告称，葡萄牙是欧洲透析发病率最高的国家之一。然而，这一说法是基于透析服务提供商提供的汇总数据，不利于进行国家间的比较。2009年，葡萄牙卫生部建立了开始透析患者的个人登记册。我们分析了2010年1月至2016年12月开始透析患者的个人数据。
提取人口统计学信息、开始治疗日期、治疗方式、区域分布以及死亡、肾功能恢复、转至肾移植、腹膜透析或保守治疗等结局。计算发病率、患病率和生存分析，并与PSN登记册进行比较。
在19190例登记中，16775例为新发病例（男性占61.8%）。2010年至2016年，肾替代治疗的年发病率分别为每百万人口250例、248例、229例、239例、230例、231例和244例，而PSN登记册报告的为每百万人口235例、224例、218例、230例、234例、225例和239例。另一方面，患病率从2010年的每百万人口998例增加到2016年的每百万人口1286例，而PSN登记册显示从2010年的每百万人口1010例增加到2016年的每百万人口1203例。阿连特茹地区（每百万人口122.9例）和中部地区（每百万人口160.8例）的区域发病率最低，而里斯本的发病率最高（2016年为每百万人口386例）。未经调整的生存分析显示，93.5%的患者在第91天时存活，而在1年和2年时存活的患者分别为85.2%和78.3%。7年时的粗生存率为40%。
葡萄牙首次对开始透析患者的个人登记册进行了分析，并提供了有关肾替代治疗发病率、患病率的长期生存及区域差异的新信息。我们能够证实葡萄牙是世界上透析发病率和患病率最高的国家之一。我们还首次证明了透析发病率存在显著的区域差异，以及透析患者出色的早期和长期生存率。就透析效率而言，这些结果与其他欧洲国家相比情况良好。
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