Taiwan Renal Registry-2004 Annual Data Report

台灣慢性腎衰竭登錄系統－2004年透析年報

黃秋錦(Chiu-Ching Huang) ； 陳永銘(Yung-Ming Chen) ； 台灣腎臓醫學會(Taiwan Society of Nephrology)

《Acta Nephrologica》 21卷4期 (2007/10) Pp. 285-298

摘要

本年報是根據台灣腎臟醫學會慢性腎衰竭登錄系統，收集2004年正在透析和新進入透析治療人口的數據作為研究對象（收納之病人為透析後存活大於1個月者）。本透析資料庫先與外部資料庫進行比對清整後再進行分析，樣本涵蓋98%台灣接受長期透析（存活大於一個月）的透析人口。
截至2004年年底，臺灣共有443家血液透析中心和57家腹膜透析中心。而正在透析的病人共有38709人（盛行率1706人／百萬人口），其中7.7%接受腹膜透析(PD)，92.3%接受血液透析(HD)。相較於2003年，盛行年增率為-4.7%。新加入之透析人口有8525人（發生率376人／百萬人口），其中8.7%接受PD，91.3%接受HD。相較於2003年新發個案年增率為-6%，既有個案及新個案的平均年齡分別為59.4±14.5及62.3±15.0歲，接受透析的老年人數目呈現上升趨勢。
2004年盛行病人中有39.8%為大於65歲的國民，而新發個案中有48.9%年齡大於65歲。38709名盛行透析病患中，男性有17981名，女性有20722名，男女比例為0.87。末期腎病的主要成因在盛行個案是慢性腎絲球炎(38.9%)、糖尿病(28.2%)及高血壓(7.2%)。新發個案的主要成因以糖尿病(39.5%)最多，慢性腎絲球炎(29.6%)、高血壓(7%)及慢性腎小管間質性腎炎(3.6%)分居二、三及四位。調整年齡和性別後，發生率最高的三縣市為台南市、高雄市和嘉義市；盛行率最高的三縣市分別為台南市、嘉義市和高雄縣。
台灣的透析目前仍以血液透析為主，但近10年來個案接受腹膜透析的比例逐年上升。2004年接受腹膜透析的2964人中，74.0%為連續可攜式腹膜透析(CAPD)，15%為自動腹膜透析(APD)。
我國透析醫療品質指標普遍良好，自2004年1月1日至2004年12月31日的一年內，共有6196人死亡，透析病人的粗死亡率為每千人137.98人，其中血液透析為每千人141.22人，腹膜透析為每千人96.89人。死因以心肺疾病、感染及惡性腫瘤為主。存活病人的復健狀況良好，只有11.7%的病人臥床需人照顧。
隨著醫學的進步及近年來大力發展慢性腎臟病防治及宣導，末期腎臟病之盛行率及發生率之成長都見到抑制現象。針對發生率最高的三縣市，年齡大於65歲及罹患糖尿病的國民，應是吾等未來慢性腎臟病防治的重點對象。

並列摘要

The 2004 annual data report is based on data of incident and prevalent patients collected by the Taiwan Renal Registry in year 2004. This data accounted for 98% of dialysis patients in Taiwan. Patients who expired within one month after start of dialysis were excluded.
As of December 31st, 2004, 443 hemodialysis (HD) units and 57 peritoneal dialysis (PD) units provided dialysis services in Taiwan. There were 38,709 patients undergoing maintenance dialysis therapy. The prevalence rate was 1706 per million population (pmp). Among them, 92.3% received hemodialysis (HD) and 7.7% received peritoneal dialysis (PD). Among the PD patients, 74% used continuous ambulatory peritoneal dialysis and 15% received automated peritoneal dialysis. Compared to 2003, the growth rate of prevalence was -4.7%. There were 8525 new patients who initiated dialysis therapy in 2004. The incidence rate was 376 pmp. Compared to 2003, the growth rate of incident patients was -6%. The mean ages of prevalent and incident patients were 59.4±14.5 and 62.3±15.0 years respectively.
Aging of our dialysis patients was noted as 39.8% of prevalent patients who were older than 65 years, while 48.9% of incidents patients were older than 65 years. Among the 38709 prevalent patients, there were 17989 males and 20720 females (male to female ratio was 0.87). The three leading causes of end stage renal disease (ESRD) in prevalent patients were chronic glomerulonephritis (38.9%), diabetes mellitus (28.2%), and hypertension (7.2%); while diabetes mellitus (39.5%), chronic glomerulonephritis (29.6%) and hypertension (7%) were three leading causes of ESRD for incident patients. After adjusting for age and gender, the three highest incident districts were Tainan City, Kaohsiung City, and Chiayi City, while three highest prevalent districts were Tainan City, Chiayi City and Kaohsiung County.
In 2004, from January 1 through December 31, 6196 patients expired. The crude annual mortality rate was 137.98 per thousand dialysis patients- 141.22 per thousand for HD patients and 96.89 per thousand for PD patients. The main causes of death were cardiovascular disease, infection and malignancy. Both the quality indices of HD and PD in prevalent patients were satisfactory. The rehabilitation status of either PD or HD patients were acceptable.
In conclusion, Taiwan remained the top country with the highest ESRD incidence in the world. The dialysis quality and rehabilitation status of dialysis patients were satisfactory. In order to prevent ESRD, we need to focus our prevention programs particularly on elderly and diabetic patients. In addition, we have to pay special attention to the high incident districts, such as Tainan, Kaohsiung and Chiayi areas.