Department of Inter-Organ Communication Research, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi, Chuo-Ku, Niigata, 951-8510, Japan.
Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
Clin Exp Nephrol. 2023 Aug;27(8):707-714. doi: 10.1007/s10157-023-02345-x. Epub 2023 Apr 4.
This study aimed to investigate the long-term trends of incident end-stage kidney disease (ESKD) requiring renal replacement therapy (RRT) in Japan using age-period-cohort analysis and evaluated birth cohort effects for incident ESKD requiring RRT.
The number of incident RRT patients aged between 20 and 84 years by sex from 1982 to 2021 was extracted from the Japanese Society of Dialysis Therapy registry data. Annual incidence rates of RRT were calculated using census population as denominators, and changes in the incidence rates were evaluated using an age-period-cohort model. The age and survey year period categories generated 20 birth cohorts with 5-year intervals (from 1902-1907 to 1997-2001).
The incidence rates of RRT in both sexes initially rose in the birth cohorts born in the early 1900s, and then decelerated and peaked during 1940-1960s in men and 1930-1940s in women, following a steady decline in both sexes. Compared with the reference 1947-1951 birth cohort, the highest cohort rate ratio was 1.14 (95% CI, 1.04-1.25) in the 1967-1971 birth cohort in men and 1.04 (95% CI, 0.98-1.10) in the 1937-1941 birth cohort in women.
Significant cohort effects were identified in both sexes, but the peak of RRT was different for each sex. Our findings suggest that men born between 1940 and 1960s and women born between 1930 and 40 s may be important target populations to consider when decreasing incidence rates of RRT among the general Japanese population.
本研究旨在使用年龄-时期-队列分析方法研究日本终末期肾病（ESKD）需要肾脏替代治疗（RRT）的长期发病趋势，并评估需要 RRT 的新发 ESKD 的出生队列效应。
从日本透析治疗学会登记处的数据中提取了 1982 年至 2021 年间年龄在 20 至 84 岁之间的新发 RRT 患者的人数，按性别划分。使用人口普查人口作为分母计算 RRT 的年发病率，并使用年龄-时期-队列模型评估发病率的变化。年龄和调查年份周期类别生成了 20 个出生队列，间隔 5 年（从 1902-1907 年到 1997-2001 年）。
男女两性的 RRT 发病率最初在 20 世纪初出生的队列中上升，然后在男性中于 1940-1960 年代和女性中于 1930-1940 年代减速并达到峰值，随后在两性中持续下降。与参考的 1947-1951 年出生队列相比，男性中最高队列的比率为 1.14（95%置信区间，1.04-1.25），女性中为 1.04（95%置信区间，0.98-1.10）。
在两性中都发现了显著的队列效应，但 RRT 的高峰期因性别而异。我们的研究结果表明，1940 年代至 60 年代出生的男性和 1930 年代至 40 年代出生的女性可能是降低日本普通人群 RRT 发病率的重要目标人群。
