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1990-2017年全球国家和地区的慢性肾脏疾病负担的系统分析
作者:小柯机器人 发布时间:2020/2/21 16:12:56

GBD慢性肾脏病协作组近日取得一项新成果。经过不懈努力,他们对1990-2017年全球国家和地区的慢性肾脏疾病的负担进行了系统分析。相关论文于2020年2月13日发表在《柳叶刀》杂志上。

卫生系统规划需要对慢性肾脏病(CKD)流行病学进行仔细评估,但是在许多国家中,该疾病的发病率和死亡率数据很少或不存在。

研究组对已发表论文、生命登记系统、终末期肾病登记和家庭调查的数据进行整理,对CKD负担进行估计,包括发病率、流行率、残疾年数、死亡率、寿命损失年和伤残调整寿命年(DALYs)。

2017年全球有120万人死于CKD。1990年至2017年间,虽然年龄标准化死亡率(2.8%)没有显著变化,但CKD导致的全球全年龄死亡率增加了41.5%。2017年共有6.975亿例全期CKD,全球患病率为9.1%。自1990年以来,CKD的全年龄患病率增加了29.3%,而年龄标准化患病率保持稳定(1.2%)。

2017年,CKD导致3580万DALYs,其中糖尿病肾病几乎占三分之一。CKD的负担主要集中在三个社会人口指数(SDI)最低五分位数的地区。

在一些地区,特别是大洋洲、撒哈拉以南非洲和拉丁美洲,CKD的负担远远高于发展水平的预期,而在西撒哈拉以南非洲、东亚、南亚、中欧和东欧、澳大拉西亚和西欧,疾病负担则低于预期。肾功能损害可导致140万心血管疾病相关死亡和2530万心血管疾病DALYs。

总之,肾脏疾病对全球健康具有重大影响,既是全球发病率和死亡率的直接原因,也是心血管疾病的重要危险因素。CKD在很大程度上可防可治,在制定全球卫生政策中,应特别关注低SDI和中等SDI的地区。

附:英文原文

Title: Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Author: Boris Bikbov, Caroline A Purcell, Andrew S Levey, Mari Smith, Amir Abdoli, Molla Abebe, Oladimeji M Adebayo, Mohsen Afarideh, Sanjay Kumar Agarwal, Marcela Agudelo-Botero, Elham Ahmadian, Ziyad Al-Aly, Vahid Alipour, Amir Almasi-Hashiani, Rajaa M Al-Raddadi, Nelson Alvis-Guzman, Saeed Amini, Tudorel Andrei, Catalina Liliana Andrei, Zewudu Andualem, Mina Anjomshoa, Jalal Arabloo, Alebachew Fasil Ashagre, Daniel Asmelash, Zerihun Ataro, Maha Mohd Wahbi Atout, Martin Amogre Ayanore, Alaa Badawi, Ahad Bakhtiari, Shoshana H Ballew, Abbas Balouchi, Maciej Banach, Simon Barquera, Sanjay Basu, Mulat Tirfie Bayih, Neeraj Bedi, Aminu K Bello, Isabela M Bensenor, Ali Bijani, Archith Boloor, Antonio M Borzì, Luis Alberto Cámera, Juan J Carrero, Félix Carvalho, Franz Castro, Ferrán Catalá-López, Alex R Chang, Ken Lee Chin, Sheng-Chia Chung, Massimo Cirillo, Ewerton Cousin, Lalit Dandona, Rakhi Dandona, Ahmad Daryani, Rajat Das Gupta, Feleke Mekonnen Demeke, Gebre Teklemariam Demoz, Desilu Mahari Desta, Huyen Phuc Do, Bruce B Duncan, Aziz Eftekhari, Alireza Esteghamati, Syeda Sadia Fatima, Joo C Fernandes, Eduarda Fernandes, Florian Fischer, Marisa Freitas, Mohamed M Gad, Gebreamlak Gebremedhn Gebremeskel, Begashaw Melaku Gebresillassie, Birhanu Geta, Mansour Ghafourifard, Alireza Ghajar, Nermin Ghith, Paramjit Singh Gill, Ibrahim Abdelmageed Ginawi, Rajeev Gupta, Nima Hafezi-Nejad, Arvin Haj-Mirzaian, Arya Haj-Mirzaian, Ninuk Hariyani, Mehedi Hasan, Milad Hasankhani, Amir Hasanzadeh, Hamid Yimam Hassen, Simon I Hay, Behnam Heidari, Claudiu Herteliu, Chi Linh Hoang, Mostafa Hosseini, Mihaela Hostiuc, Seyed Sina Naghibi Irvani, Sheikh Mohammed Shariful Islam, Nader Jafari Balalami, Spencer L James, Simerjot K Jassal, Vivekanand Jha, Jost B Jonas, Farahnaz Joukar, Jacek Jerzy Jozwiak, Ali Kabir, Amaha Kahsay, Amir Kasaeian, Tesfaye Dessale Kassa, Hagazi Gebremedhin Kassaye, Yousef Saleh Khader, Rovshan Khalilov, Ejaz Ahmad Khan, Mohammad Saud Khan, Young-Ho Khang, Adnan Kisa, Csaba P Kovesdy, Barthelemy Kuate Defo, G Anil Kumar, Anders O Larsson, Lee-Ling Lim, Alan D Lopez, Paulo A Lotufo, Azeem Majeed, Reza Malekzadeh, Winfried Mrz, Anthony Masaka, Hailemariam Abiy Alemu Meheretu, Tomasz Miazgowski, Andreea Mirica, Erkin M Mirrakhimov, Prasanna Mithra, Babak Moazen, Dara K Mohammad, Reza Mohammadpourhodki, Shafiu Mohammed, Ali H Mokdad, Linda Morales, Ilais Moreno Velasquez, Seyyed Meysam Mousavi, Satinath Mukhopadhyay, Jean B Nachega, Girish N Nadkarni, Jobert Richie Nansseu, Gopalakrishnan Natarajan, Javad Nazari, Bruce Neal, Ruxandra Irina Negoi, Cuong Tat Nguyen, Rajan Nikbakhsh, Jean Jacques Noubiap, Christoph Nowak, Andrew T Olagunju, Alberto Ortiz

Issue&Volume: February 13, 2020

Abstract: 

Background
Health system planning requires careful assessment of chronic kidney disease (CKD) epidemiology, but data for morbidity and mortality of this disease are scarce or non-existent in many countries. We estimated the global, regional, and national burden of CKD, as well as the burden of cardiovascular disease and gout attributable to impaired kidney function, for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017. We use the term CKD to refer to the morbidity and mortality that can be directly attributed to all stages of CKD, and we use the term impaired kidney function to refer to the additional risk of CKD from cardiovascular disease and gout.
Methods
The main data sources we used were published literature, vital registration systems, end-stage kidney disease registries, and household surveys. Estimates of CKD burden were produced using a Cause of Death Ensemble model and a Bayesian meta-regression analytical tool, and included incidence, prevalence, years lived with disability, mortality, years of life lost, and disability-adjusted life-years (DALYs). A comparative risk assessment approach was used to estimate the proportion of cardiovascular diseases and gout burden attributable to impaired kidney function.
Findings
Globally, in 2017, 1·2 million (95% uncertainty interval [UI] 1·2 to 1·3) people died from CKD. The global all-age mortality rate from CKD increased 41·5% (95% UI 35·2 to 46·5) between 1990 and 2017, although there was no significant change in the age-standardised mortality rate (2·8%, −1·5 to 6·3). In 2017, 697·5 million (95% UI 649·2 to 752·0) cases of all-stage CKD were recorded, for a global prevalence of 9·1% (8·5 to 9·8). The global all-age prevalence of CKD increased 29·3% (95% UI 26·4 to 32·6) since 1990, whereas the age-standardised prevalence remained stable (1·2%, −1·1 to 3·5). CKD resulted in 35·8 million (95% UI 33·7 to 38·0) DALYs in 2017, with diabetic nephropathy accounting for almost a third of DALYs. Most of the burden of CKD was concentrated in the three lowest quintiles of Socio-demographic Index (SDI). In several regions, particularly Oceania, sub-Saharan Africa, and Latin America, the burden of CKD was much higher than expected for the level of development, whereas the disease burden in western, eastern, and central sub-Saharan Africa, east Asia, south Asia, central and eastern Europe, Australasia, and western Europe was lower than expected. 1·4 million (95% UI 1·2 to 1·6) cardiovascular disease-related deaths and 25·3 million (22·2 to 28·9) cardiovascular disease DALYs were attributable to impaired kidney function.
Interpretation
Kidney disease has a major effect on global health, both as a direct cause of global morbidity and mortality and as an important risk factor for cardiovascular disease. CKD is largely preventable and treatable and deserves greater attention in global health policy decision making, particularly in locations with low and middle SDI.

DOI: 10.1016/S0140-6736(20)30045-3

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30045-3/fulltext

 

期刊信息

LANCET:《柳叶刀》,创刊于1823年。隶属于爱思唯尔出版社,最新IF:59.102
官方网址:http://www.thelancet.com/
投稿链接:http://ees.elsevier.com/thelancet