Incidence of kidney replacement therapy (KRT) stabilizes or declines both in Europe and in the US; however, it is predictable that global prevalence of KRT will double by 2030. In this paper, we focus on the patterns of incidence, mortality, and prevalence of KRT in Italy, and we compare, when possible, the findings with other countries. The Italian Dialysis and Transplantation Registry (IDTR) currently collects aggregate data from regional registries. In Italy, KRT yearly incidence is around 160 patients per million population (pmp). This incidence showed an increasing trend up until 2011 with an average annual percentage change (AAPC) of 1.8%, after which it stabilized. Older age is an important determinant for KRT incidence, and it is strongly associated with the variability between Italian regions. Incidence is very stable within patients less than 50 years old; however, it greatly differs between regions for patients over 75 years old, ranging from 400 to 900 pmp. Moreover, the incidence for patients over 50 years old declined from 366 pmp in 2011 to 285 in 2017. An age-period-cohort (APC) model showed a very strong cohort effect, which shows the decline in incidence seems mainly due to the better health conditions of people born after 1940. Mortality rate in KRT patients was 109 per 1000 patient-year (py) between 2011 and 2017 with great differences among treatment modalities: 162 per 1000 py in haemodialysis, 117 per 1000 py in peritoneal dialysis, and 16 per 1000 py in kidney transplantation. Premature death is better detected by the standard expected years of life lost (YLL). The distribution of YLL rate per age shows a sharp increase between 40 and 70 years old both in haemodialysis and peritoneal dialysis patients with an AAPC of 5.2% and 4.1% respectively. Transplanted patients experience a very low YLL rate at any age. KRT prevalence was 1118 pmp in 2017 and it should be close to 1175 pmp by 2025 with a projected increase of transplanted patients’ prevalence to 500 pmp, and a decrease of dialysis patients from 714 to 680 pmp. The proportion of patients treated with one of the three modalities strictly depends on age, with a sharp increase of haemodialysis after the age of 50. All data suggests the necessity to improve the care of middle and older age patients who experience the higher incidence of disease and mortality.

在欧洲和美国，肾脏替代疗法 (KRT) 的发生率稳定或下降；然而，可以预见的是，到 2030 年，全球 KRT 的流行率将翻一番。在本文中，我们重点关注意大利 KRT 的发病率、死亡率和流行率模式，并在可能的情况下将调查结果与其他国家进行比较。意大利透析和移植登记处 (IDTR) 目前从区域登记处收集汇总数据。在意大利，KRT 的年发病率约为每百万人口 160 人 (pmp)。这种发病率在 2011 年之前呈上升趋势，年均变化百分比 (AAPC) 为 1.8%，之后趋于稳定。年龄较大是 KRT 发病率的重要决定因素，并且与意大利地区之间的差异密切相关。50 岁以下患者的发病率非常稳定；然而，对于 75 岁以上的患者，不同地区之间的差异很大，从 400 到 900 pmp。此外，50 岁以上患者的发病率从 2011 年的 366 pmp 下降到 2017 年的 285 pmp。 APC 模型显示出非常强的队列效应，这表明发病率的下降似乎主要是由于更好的1940 年后出生人群的健康状况。 2011 年至 2017 年间 KRT 患者的死亡率为 109/1000 患者年（py），治疗方式之间存在很大差异：血液透析为每 1000 py 162，腹膜透析为每 1000 py 117肾移植中每 1000 py 16。通过标准的预期寿命损失年数 (YLL) 可以更好地检测到过早死亡。血液透析和腹膜透析患者各年龄 YLL 率的分布在 40 至 70 岁之间急剧增加，AAPC 分别为 5.2% 和 4.1%。移植患者在任何年龄的 YLL 率都非常低。2017 年 KRT 患病率为 1118 pmp，到 2025 年应接近 1175 pmp，预计移植患者的患病率将增加至 500 pmp，透析患者从 714 pmp 降至 680 pmp。三种方式之一治疗的患者比例严格取决于年龄，50岁以后血液透析急剧增加。 所有数据都表明有必要改善对疾病发病率较高的中老年患者的护理和死亡率。