Spencer J L, Silva D T, Snelling P, Hoy W E
Menzies School of Health Research, Casuarina, NT.
Med J Aust. 1998 Jun 1;168(11):537-41. doi: 10.5694/j.1326-5377.1998.tb139080.x.
To define recent trends (1993-1996) in incidence of endstage renal disease (ESRD) among Australian Aboriginal people in the Top End of the Northern Territory (NT).
Analysis of hospital and clinical records of the Darwin-based ESRD treatment program from 1993 to 1996 and comparison with data accumulated since 1978.
All people entering the ESRD treatment program from 1978 to 1996.
Number of patients treated for ESRD; their ethnicity, age and sex; comorbidities in Aboriginal patients; treatment methods and outcomes.
More Aboriginal people presented with ESRD between 1993 and 1996 (87) than in the previous 15 years of the program (68). The incidence of ESRD in Aboriginals reached 838 per million in 1996, and is doubling every 4 years. Aboriginal people presenting with ESRD are younger than non-Aboriginal people with ESRD, and, in contrast to non-Aboriginals, ESRD rates are higher in women than men. The numbers and proportions of Aboriginal ESRD patients who have hypertension, type 2 diabetes and cardiac disease are rising. Haemodialysis remains the most common form of treatment, and the number of dialysis treatments is doubling every 2.5 years. Only 9% of Aboriginal patients entering the program in 1993-1996 were treated with chronic ambulatory peritoneal dialysis and only 3% received transplants. Despite their younger age, survival of Aboriginal people on dialysis is low (median 3.3 years v. 6.5 years in non-Aboriginals), and graft survival after transplant is poor (37% at 5 years v. 88% in non-Aboriginals). Survival has not improved in the past 4 years, with fewer deaths from infection offset by more deaths from cardiovascular disease.
The predicted doubling of ESRD incidence among Aboriginal people by the year 2000 will add an enormous burden to limited resources. Risk factors for renal disease underlie all the excess morbidity and mortality in NT Aboriginal adults, and arise out of accelerated lifestyle changes and socioeconomic disadvantage. Better living conditions and education, robust and integrated primary healthcare programs, and systematic screening for early renal disease and treatment of those with established disease are all matters of urgency.
确定北领地顶端地区澳大利亚原住民终末期肾病（ESRD）的发病率近期（1993 - 1996年）趋势。
分析1993年至1996年达尔文市ESRD治疗项目的医院和临床记录，并与1978年以来积累的数据进行比较。
1978年至1996年所有进入ESRD治疗项目的患者。
接受ESRD治疗的患者数量；他们的种族、年龄和性别；原住民患者的合并症；治疗方法和结果。
1993年至1996年期间出现ESRD的原住民（87例）比该项目此前15年（68例）更多。1996年原住民ESRD发病率达每百万人口838例，且每4年翻一番。出现ESRD的原住民比非原住民患者更年轻，与非原住民不同的是，女性ESRD发病率高于男性。患有高血压、2型糖尿病和心脏病的原住民ESRD患者数量及比例在上升。血液透析仍是最常见的治疗方式，透析治疗次数每2.5年翻一番。1993 - 1996年进入该项目的原住民患者中，仅9%接受了持续性非卧床腹膜透析治疗，仅3%接受了移植手术。尽管原住民患者年龄较轻，但透析患者的生存率较低（中位数为3.3年，非原住民为6.5年），移植后的移植物存活率也较差（5年时为37%，非原住民为88%）。过去4年生存率并未改善，感染导致的死亡减少被心血管疾病导致的更多死亡所抵消。
预计到2000年原住民ESRD发病率将翻番，这将给有限的资源带来巨大负担。肾病的危险因素是北领地原住民成年人所有额外发病和死亡的根本原因，是生活方式加速改变和社会经济劣势导致的。改善生活条件和教育、建立健全综合的初级医疗保健项目，以及对早期肾病进行系统筛查和对已确诊疾病患者进行治疗都迫在眉睫。
