末期性腎臓病のために最初に透析治療を受けた子供の死亡リスク,1990-2010年
Mark M Mitsnefes1, Benjamin L Laskin, Mourad Dahhou
1Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
JAMA
|May 7, 2013
まとめ
透析中の末期腎疾患 (ESKD) の子供と青年の死亡率は1990年から2010年の間に著しく減少しました. この研究は,20年以上にわたる小児ESKDケアにおける改善を強調しています.
科学分野:
- 小児腎臓病理学について
- 腎臓置換療法とは,腎臓置換療法です.
- 慢性腎臓病の流行病学について
背景:
- 末期腎疾患 (ESKD) のほとんどの子供は,腎臓移植の前に透析を受けます.
- 透析を受けている小児ESKD患者の死亡率の最近の傾向は,十分に確立されていません.
研究 の 目的:
- 1990年から2010年の間にESKDのために透析を開始した子供と青年の全因,心血管,および感染症関連死亡率の変化を評価する.
- 小児透析患者の死亡リスクに対する治療開始年度の影響を評価する.
主な方法:
- 1990年から2010年にかけての米国腎臓データシステム (USRDS) を利用した遡及コホート研究.
- ESKDのために透析を開始した21歳未満の患者が含まれており,以前の移植を受けた患者は除外されています.
- コックス比例リスクモデルは,透析開始年度の5年増と関連した死亡リスクの分析に使用され,腎臓移植の検閲が行われました.
主要な成果:
- この研究では,ESKDのために透析を開始した23,401人の子供と青少年を分析しました.
- 透析中の死亡率は,1990-1994年から2005-2010年にかけて,5歳未満と5歳以上の年齢層において著しく減少しました.
- 透析開始年度の5年毎の増加は,死亡率の危険比率の低下と関連していました (HR 0.80 for <5年,HR 0.88 for ≥5年).
結論:
- 1990年から2010年の間に,ESKDのために透析を開始した米国の子供と若者の間で,死亡率の大幅な減少が観察されました.
- これらの発見は,研究期間中に透析を受けている小児ESKD患者の管理と結果の有意な改善を示しています.
- この観察された死亡率の減少に寄与する特定の要因を特定するために,さらなる研究が必要である.
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