研究估計50%中年人的慢性腎病個別風險達到高峰


  【24drs.com】根據發表於2015年3月美國腎臟病期刊的一篇模擬研究,慢性腎病(Chronic kidney disease,CKD)比率預計在未來20年內大幅上升,30至64歲者有超過半數可能會受到影響。
  
  隨著美國30歲以上人口在2020年達到2億400萬,在2030年將近2億2500萬,研究者估計,30歲以上成人患有慢性腎病的人數,在2020年將有2800萬,在2030年將達約3800萬人。
  
  資深研究員、北卡羅萊納州Research Triangle Park RTI International衛生經濟學家Thomas J. Hoerger博士等人寫道,這個增加趨勢意謂著,慢性腎病照顧費用與喪失的生活品質都將隨之增加,必須發展新的介入方式來減緩慢性腎病的發作與病程。
  
  慢性腎病目前影響約七分之一的美國成人,最近的研究認為慢性腎病相關死亡在過去廿年內加倍,在2010年,末期腎病共花費Medicare 329億美元,初期慢性腎病則花費了480億美元。
  
  Hoerger博士等人預估,美國的慢性腎病成人比率將從目前的13.2%增加到2020年的14.4%以及2030年的16.7%。
  
  Hoerger博士在國家腎病基金會的新聞稿中表示,我們對於一生中發生慢性腎病的高可能性感到驚訝。就個人而言,對於一開始沒有慢性腎病的30至49歲、50至64歲與65歲以上的這三個年齡層的人來說,可能餘命時的慢性腎病發生率分別是54%、52%與42%。中年時的女性乳癌、糖尿病、高血壓的餘命發生率分別是12.5%、33%至38%、90%。
  
  Hoerger博士和同事為疾病控制與預防中心(CDC)完成了預測研究,他們使用之前發展的慢性腎病健康政策模式,從研究對象目前的年齡追蹤到死亡或到90歲,模擬慢性腎病的餘命發生率,預測2020年與2030年時的慢性腎病發生率。
  
  模擬樣本是來自1999-2010年「美國全國健康及營養調查(National Health and Nutrition Examination Surveys)」30歲以上者的全國代表性資料。研究者寫道,我們聚焦在30歲以上者的慢性腎病發生率,是因為估計腎絲球過濾速率(eGFR)從20-30歲之後開始下滑。
  
  這個模式模擬疾病病程和追蹤研究對象的eGFRs衰退與/或發生持續的白蛋白尿,在這個模式中,個人的eGFR逐漸降低,有糖尿病、高血壓、嚴重白蛋白尿、eGFR低於60 mL/minute/1.73 m2者、50歲以上等風險因素者的衰退更快,降低速率略為上升。
  
  不過,研究者表示,因為資料有限,他們的估計模式是基於「eGFRs 是每年穩定的降低」這個可能並無根據的假設,他們結論指出,穩定衰退率這個假設可能過於簡單化,更好的eGFR資料將能獲得更佳的模式估計結果。
  
  資料來源:http://www.24drs.com/

CKD: Individual Risk Tops 50% in Midlife, Study Estimates

By Diana Swift
Medscape Medical News

Chronic kidney disease (CKD) rates are projected to rise dramatically during the next 20 years, with more than half of individuals aged 30 to 64 years likely to be affected, according to a simulation study published in the March 2015 issue of the American Journal of Kidney Disease.

As the US population aged 30 years and older reaches 204 million in 2020 and almost 225 million in 2030, the researchers estimate that the number of adults older than 30 years with CKD will reach 28 million in 2020, and nearly 38 million in 2030.

"This increase suggests that CKD health care costs and quality-of-life losses will increase accordingly and further emphasizes the need to develop new interventions to slow the onset and progression of CKD," write Thomas J. Hoerger, PhD, health economist and senior fellow, RTI International, Research Triangle Park, North Carolina, and colleagues.

CKD currently affects nearly 1 in 7 US adults, and recent research suggests CKD-related deaths have doubled in the last 2 decades. In 2010, end-stage renal disease cost Medicare $32.9 billion; earlier CKD stages cost the system $48 billion.

Dr Hoerger and colleagues project that the proportion of US adults with CKD will rise from its current 13.2% to 14.4% in 2020, and to 16.7% in 2030.

"We were surprised by the high probability of developing CKD during a lifetime," Dr Hoerger said in a National Kidney Foundation new release. At the individual level, for persons in the three age brackets (30 - 49, 50 - 64, and 65 years and older) with no CKD at baseline, the probable residual lifetime incidence of CKD is 54%, 52%, and 42%, respectively. By comparison, the residual rates are 12.5%, 33% to 38%, and 90% for female breast cancer, diabetes, and hypertension, respectively, among adults in the middle-age range.

Dr Hoerger and associates completed the projection study for the Centers for Disease Control and Prevention (CDC). Using a previously developed CKD health policy model, they followed individuals from their current age to death or age 90 years, to simulate the residual lifetime incidence of CKD and project the prevalence of CKD in 2020 and 2030.

The simulation sample was based on nationally representative data on persons aged 30 years and older from the National Health and Nutrition Examination Surveys, 1999 to 2010. "We focused on CKD prevalence among adults 30 years or older because [estimated glomerular filtration rate (eGFR)] typically begins declining after age 20 to 30 years," the investigators write.

The model simulates disease progression and follows persons as their eGFRs decline and/or they develop persistent albuminuria. In the model, a person's eGFR declines annually, with higher decrements in those who have certain risk factors, including diabetes, hypertension, severely increased albuminuria, or an eGFR lower than 60 mL/minute per 1.73 m2 or who are older than 50 years, when decline speeds up slightly.

The researchers acknowledge, however, that because of limited data, their model estimates are based on possibly unwarranted assumptions about steady annual decrements in eGFRs. "The assumption of constant rates is probably an oversimplification," they concede, adding that "[b]etter data for eGFR trajectories could lead to better model projections."

This study was supported by funding from the CDC. The authors have disclosed no relevant financial relationships.

Am J Kidney Dis. 2015;65:403-411.

    
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