van Oevelen Mathijs, Abrahams Alferso C, Hoekstra Tiny, Ten Dam Marc A G J, Kramer Anneke, Jager Kitty J, Ocak Gurbey, van Buren Marjolijn, Bos Willem Jan W
Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands.
Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands.
Clin Kidney J. 2023 Mar 14;16(7):1149-1159. doi: 10.1093/ckj/sfad048. eCollection 2023 Jul.
After decades of increasing dialysis incidence, we observed a decreasing trend in the Netherlands in the last decade. We compared this trend with trends in other European countries.
Aggregated data for calendar years 2001-2019 from the Dutch registries of kidney replacement therapy patients and the European Renal Association Registry were used. Dialysis incidence in the Netherlands was compared with that in 11 other European countries/regions using three age groups: 20-64, 65-74, and ≥75 years, taking into account pre-emptive kidney transplantation (PKT) incidence. Time trends were assessed as annual percentage change (APC) with 95% confidence intervals (CI) using joinpoint regression analysis.
Between 2001 and 2019 the Dutch dialysis incidence decreased slightly among patients aged 20-64 years (APC -0.9, 95% CI -1.4; -0.5). For patients 65-74 and ≥75 years old, a peak was seen in 2004 and 2009, respectively. Afterwards, the decrease was most marked in patients aged ≥75 years: APC -3.2 (-4.1; -2.3) versus APC -1.8 (-2.2; -1.3) for patients 65-74 years old. PKT incidence increased significantly during the study period but remained limited compared to the observed decrease in dialysis incidence, especially among older patients. Large differences in dialysis incidence were observed among European countries/regions. A decreasing dialysis incidence among older patients was also seen in Austria, Denmark, England/Wales, Finland, Scotland, and Sweden.
The Dutch dialysis incidence decreased most profoundly among older patients. This was also observed in several other European countries/regions. Although PKT incidence increased, it can only explain a minor part of the decrease in dialysis incidence.
在透析发病率数十年持续上升之后，我们观察到荷兰在过去十年中出现了下降趋势。我们将这一趋势与其他欧洲国家的趋势进行了比较。
使用了荷兰肾脏替代治疗患者登记处和欧洲肾脏协会登记处2001 - 2019历年的汇总数据。荷兰的透析发病率与其他11个欧洲国家/地区的发病率进行了比较，分为三个年龄组：20 - 64岁、65 - 74岁和≥75岁，并考虑了抢先肾移植（PKT）发病率。使用连接点回归分析将时间趋势评估为年度百分比变化（APC）及95%置信区间（CI）。
2001年至2019年间，20 - 64岁患者的荷兰透析发病率略有下降（APC -0.9，95% CI -1.4；-0.5）。65 - 74岁和≥75岁的患者分别在2004年和2009年出现了峰值。此后，≥75岁患者的下降最为明显：APC为-3.2（-4.1；-2.3），而65 - 74岁患者的APC为-1.8（-2.2；-1.3）。在研究期间，PKT发病率显著增加，但与观察到的透析发病率下降相比仍然有限，尤其是在老年患者中。欧洲国家/地区之间观察到透析发病率存在很大差异。奥地利、丹麦、英格兰/威尔士、芬兰、苏格兰和瑞典的老年患者透析发病率也呈下降趋势。
荷兰老年患者的透析发病率下降最为显著。其他几个欧洲国家/地区也观察到了这一现象。尽管PKT发病率有所增加，但它只能解释透析发病率下降的一小部分。
