超全!我国肾脏病流行病学大盘点,各种病因一网打尽丨CSN2019

2019-09-19 Fiona MedSci原创

2019年9月18-9月21日,中华医学会肾脏病学分会2019年学术年会(CSN2019)于美丽的杭州举行,梅斯小编也第一时间奔赴现场,与大家一起分享肾脏病学的最新进展。刘章锁教授在《我国肾脏病流行病学研究现状与展望》专题中,对我国肾脏病流行病学进行了详细介绍。 在我国,慢病已成为全球主要疾病负担,约占全球疾病总负担的69%,该病死亡率高,从06年到16年增加了16.1%。而慢性肾脏病是


2019年9月18-9月21日,中华医学会肾脏病学分会2019年学术年会(CSN2019)于美丽的杭州举行,梅斯小编也第一时间奔赴现场,与大家一起分享肾脏病学的最新进展。
刘章锁教授在《我国肾脏病流行病学研究现状与展望》专题中,对我国肾脏病流行病学进行了详细介绍。
 
在我国,慢病已成为全球主要疾病负担,约占全球疾病总负担的69%,该病死亡率高,从06年到16年增加了16.1%。而慢性肾脏病是我国常见慢病之一,其患者高达1.195亿,高于糖尿病患者(1.139亿),仅次于高血压患者(2.54亿)。

CKD所致的致残致死率增幅排在所有疾病之首,而CKD导致的伤残调整生命年,于1990年-2016年增加了63%。预计2040年,慢性肾病引起的早死所致寿命损失年将从2016年16位上升至5位。而1990年至2016年间,全球CKD导致的死亡增加了98%。

不仅如此,慢性肾病的医疗花费也非常高。我国2015年住院CKD患者费用为237.8亿元人民币,占总住院费用的6.3%。

我国CKD流行病学研究虽然起步晚,但发展迅速,仅2015年关于CKD流调的文章就超过100篇。而近年来发表于Lancet的研究表明,我国CKD总患病率为10.8%,预计有1.195亿患者。eGFR<60 ml/min和白蛋白尿发生率分别为1.7%和9.4%。

除此之外,肾脏病的病因多且变迁大,2016年发表于NEJM的研究表明,目前糖尿病肾病已经成为CKD首要病因。具体来说,2010年住院患者的糖尿病肾病比例低于肾小球肾炎所占比例,为0.82%vs1.01%;而2015年,住院患者的糖尿病肾病与肾小球肾炎所占百分比分别为1.10%vs0.75%。
 

住院患者与一般人群的患病率如下:
 

我国肾脏病流行病学研究现状还有一个特点就是病种全、特色鲜。不管是膜性肾病、IgA肾病、狼疮性肾炎、急性肾功能衰竭(AKI)还是终末期肾病(ESRD),均有详细的流行病学数据,具体为:

 

上海地区ESKD流行病学研究显示,2007-2014年ESKD发病率约为89.4~128.1人/百万人年,而ESKD的患病率则从2007年的409.8/百万人年上升到898.2/百万人年。

由北大医院肾内科发起,北京大学肾脏病系和北京大学健康医疗大数据国家研究院联合共建的中国肾脏疾病数据网络(CK-NET)是我国涵盖了超过千万人群的若干大型数据库,包括国家监管性数据、公共卫生信息平台数据、医保数据、流行病学研究数据等,代表着肾脏病大数据未来。

2019年,Kidney International 增刊发表了CK-NET2015年度数据报告,包括慢性肾脏病和终末期肾脏病两大部分,全面描述了中国肾脏疾病流行病学特征与肾脏疾病负担。
该报告指出,在1850万住院患者中,CKD近89万人,患病率为4.8%。CKD患病率随着年龄的增加而增加,60岁或以上患者可达6.2%。其中,CKD合并糖尿病的患者为13.9%,CKD合并高血压的患者为11.3%。

 

慢性肾脏病的病因在城市和农村有很大区别。在城市,超过一半的患者为DKD(32.73%)或高血压肾病(22.98%);在农村,最常见的原因为ON(21.41%),其次是GN(18.53%),DKD(17.36%)和HTN(17.3%)。在北方,常见的病因为糖尿病肾病,南方常见的为梗阻性肾病。

CK-NET数据显示,我国AKI患者患病率为0.30%,而在ICU中高达3.93%。在AKI患者中,常见并发症,有27.13%的患者合并CKD,16.67%的患者合并DM。而血液透析(HD)和腹膜透析(PD)患病率约为402.18/百万和39.95/百万,校正年龄后,透析发生率为122.19/百万。

在未来,希望有更多中心更长时间的队列随访数据,不仅有年度报告,还有疾病变迁。同时,期待更大数据更加智能的研究设计,借助AI与大数据,驱动肾脏病学流行病学研究,预估疾病风险、筛选肾脏病生物标志物辅助诊断、评估糖尿病肾病患者预后、预测肾脏病病例类型等,造福患者。


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    2019-09-21 xugumin
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    2019-09-20 zybear

    谢谢分享,继发性肾病越来越多,需要注意!

    0

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    2019-09-20 深海的鱼

    继续努力学习

    0

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    2019-09-20 飛歌

    厉害厉害,学习了

    0

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    2019-09-19 1209e435m98(暂无昵称)

    学习了,谢谢分享

    0

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