儿童肾衰竭患者的生命损失年数：一项具有多国死亡和预期寿命多状态概率的跨国队列研究。
Life Years Lost in Children with Kidney Failure: A Binational Cohort Study with Multistate Probabilities of Death and Life Expectancy.
机构信息
Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia.
Department of Renal and Transplant Medicine, Westmead Hospital, Westmead, New South Wales, Australia.
出版信息
J Am Soc Nephrol. 2023 Jun 1;34(6):1057-1068. doi: 10.1681/ASN.0000000000000118. Epub 2023 Apr 7.
SIGNIFICANCE STATEMENT
In children with kidney failure, little is known about their treatment trajectories or the effects of kidney failure on lifetime survival and years of life lost, which are arguably more relevant measures for children. In this population-based cohort study of 2013 children who developed kidney failure in Australia and New Zealand, most children were either transplanted after initiating dialysis (74%) or had a preemptive kidney transplant (14%). Life expectancy increased with older age at kidney failure, but more life years were spent on dialysis than with a functioning transplant. The expected (compared with the general population) number of life years lost ranged from 16 to 32 years, with female patients and those who developed kidney failure at a younger age experiencing the greatest loss of life years.
BACKGROUND
Of the consequences of kidney failure in childhood, those rated as most important by children and their caregivers are its effects on long-term survival. From a life course perspective, little is known about the experience of kidney failure treatment or long-term survival.
METHODS
To determine expected years of life lost (YLL) and treatment trajectory for kidney failure in childhood, we conducted a population-based cohort study of all children aged 18 years or younger with treated kidney failure in Australia (1980-2019) and New Zealand (1988-2019).We used patient data from the CELESTIAL study, which linked the Australian and New Zealand Dialysis and Transplant registry with national death registers. We estimated standardized mortality ratios and used multistate modeling to understand treatment transitions and life expectancy.
RESULTS
A total of 394 (20%) of 2013 individuals died over 30,082 person-years of follow-up (median follow-up, 13.1 years). Most children (74%) were transplanted after initiating dialysis; 14% (18% of male patients and 10% of female patients) underwent preemptive kidney transplantation. Excess deaths (compared with the general population) decreased dramatically from 1980 to 1999 (from 41 to 22 times expected) and declined more modestly (to 17 times expected) by 2019. Life expectancy increased with older age at kidney failure, but more life years were spent on dialysis than with a functioning transplant. The number of YLL ranged from 16 to 32 years, with the greatest loss among female patients and those who developed kidney failure at a younger age.
CONCLUSIONS
Children with kidney failure lose a substantial number of their potential life years. Female patients and those who develop kidney failure at younger ages experience the greatest burden.
声明：在患有肾衰竭的儿童中，人们对其治疗轨迹或肾衰竭对终身生存和丧失的生命年数的影响知之甚少，而这些可能是更相关的儿童衡量指标。在这项针对澳大利亚和新西兰 2013 名儿童的基于人群的队列研究中，大多数儿童在开始透析后进行了移植（74%）或进行了预防性肾移植（14%）。肾衰竭时的年龄越大，预期寿命越长，但在透析上花费的生命年数多于功能移植。预期（与一般人群相比）丧失的生命年数范围为 16 至 32 年，女性患者和年龄较小的肾衰竭患者丧失的生命年数最多。
背景：在儿童肾衰竭的后果中，儿童及其照顾者认为最重要的是其对长期生存的影响。从生命历程的角度来看，人们对肾衰竭的治疗经验或长期生存情况知之甚少。
方法：为了确定儿童肾衰竭的预期寿命损失（YLL）和治疗轨迹，我们对澳大利亚（1980-2019 年）和新西兰（1988-2019 年）接受治疗的所有 18 岁或以下肾衰竭儿童进行了一项基于人群的队列研究。我们使用了来自 CELESTIAL 研究的数据，该研究将澳大利亚和新西兰透析和移植登记处与国家死亡登记处联系起来。我们估计了标准化死亡率比，并使用多状态建模来了解治疗的转变和预期寿命。
结果：在 30082 人年的随访中（中位随访时间为 13.1 年），共有 394 人（20%）死亡。大多数儿童（74%）在开始透析后进行了移植；14%（18%的男性患者和 10%的女性患者）进行了预防性肾移植。与一般人群相比，超额死亡人数从 1980 年到 1999 年急剧下降（从 41 倍降至 22 倍），到 2019 年略有下降（降至 17 倍）。预期寿命随着肾衰竭时年龄的增加而增加，但在透析上花费的生命年数多于功能移植。预期寿命损失年数范围为 16 至 32 年，女性患者和年轻患者的损失最大。
结论：患有肾衰竭的儿童会失去大量潜在的生命年数。女性患者和年龄较小的肾衰竭患者的负担最大。
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