Nephrology and renal replacement therapy in Romania--transition still continues (Cinderella story revisited).

INTRODUCTION. This report describes the current status of nephrology and renal replacement therapy (RRT) in Romania, a country with previously limited facilities, highlighting national changes in the European context. METHODS: Trends in RRT development were analysed in 2003, on a national basis, using the same questionnaires as in previous surveys (1991, 1995). Survival data and prognostic risk factors were calculated retrospectively from a large representative sample of 2284 patients starting RRT between January 1, 1995 and December 31, 2001 (44% of the total RRT population investigated). RESULTS: In 2003, RRT incidence [128 per million population (p.m.p.)] and prevalence (250 p.m.p.) were six and five times higher, respectively, than in 1995. The annual rate of increase in the stock of RRT patients (11%) was supported mainly by an exponential development of the continuous ambulatory peritoneal dialysis (CAPD) population (+600%), while the haemodialysis (HD) growth rate was stable (+33%) and renal transplantation made a marginal contribution. Renal care infrastructure followed the same trend: nephrology departments (+100%) and nephrologists (+205%). The characteristics of RRT incident patients changed accordingly to current European epidemiology (increasing age and prevalence of diabetes and nephroangiosclerosis). The estimated overall survival of RRT patients in Romania was 90.6% at 1 year [confidence interval (CI) 89.4-91.8] and 62.2% at 5 years (CI 59.4-65.0). Patients' survival was negatively influenced (Cox regression analysis) by age >65 years (P < 0.001), lack of pre-dialysis monitoring by a nephrologist [P = 0.01, hazards ratio (HR) = 0.8], severe anaemia, lack of erythropoetin treatment (P < 0.001, HR = 0.6), and co-morbidity, e.g. cardiovascular diseases (P < 0.001, HR = 1.8) and diabetes mellitus (P < 0.001, HR = 2.2). CONCLUSIONS: Although the rate of increase in RRT patient stock in 1996-2003 in Romania was the highest in Europe, the prevalence remained below the European mean. As CAPD had the greatest expansion, followed by HD, an effective transplantation programme must be set up to overcome the imbalance. The quality of RRT appears to be good and survival was similar to that in other registries. Further evolution implies strategies of prevention, based on national surveys, supported by the Romanian Renal Registry.     

Anti-SARS-CoV-2 IgG antibody titer after BNT162b2 mRNA COVID-19 vaccination in Japanese patients who underwent renal replacement therapy,hemodialysis, peritoneal dialysis,and kidney transplantation

Clinical and Experimental Nephrology - Coronavirus disease (COVID-19) vaccination is recommended for patients undergoing renal replacement therapy (RRT), including hemodialysis (HD), peritoneal...     

Renal replacement therapy for diabetic end-stage renal disease: data from 10 registries in Europe (1991-2000)

BACKGROUND: There is concern about the rising prevalence of type 2 diabetes mellitus and of the resultant nephropathy. This study uses data from the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) Registry to provide information on the epidemiology and outcome of renal replacement therapy (RRT) for end-stage renal disease (ESRD) due to diabetic nephropathy (DN). METHODS: Data from the following 10 registries: Austria, French-speaking Belgium, Denmark, Finland, Greece, Norway, Scotland (UK), Catalonia (Spain), Sweden, and The Netherlands were combined. Average annual changes (%) were estimated by Poisson regression. Analyses of mortality were performed by Cox regression. RESULTS: An increase in patients with type 2 DN entering RRT has been observed (+11.9% annually, P < 0.05), while large differences in RRT incidence in this disease continue to exist between countries in Europe. There was a reduction in mortality during the first 2 years on dialysis therapy among patients with type 2 DN (AHR 0.96, 95%CI 0.94-0.97 annually). The mortality among transplant recipients decreased for both type 1 DN and nondiabetic ESRD (non DN) within the 1995-1998 cohort (type 1 DN: AHR 0.49, 95% CI 0.35-0.68; non DN: AHR 0.79, 95% CI 0.69-0.90) compared to the 1991-1994 cohort. CONCLUSION: This report has shown that during the last decade there has been a marked increase in the incidence of RRT for type 2 DN. Survival analysis showed that over the period 1991-1999 the mortality rates of all dialysis patients and of type 1 diabetic and nondiabetic renal transplant recipients have fallen.     

Nephrology, dialysis and transplantation in Turkey.

The establishment of the Turkish Society of Nephrology (TSN) in 1970 coincided with that of many western European nephrology societies. The TSN organized the 15th ERA-EDTA Congress in Istanbul in 1978, earlier than many European Countries, and currently has 286 active members. At present, Turkey has 161 nephrologists, which equals 2.5 nephrologists per million population (p.m.p.). The number of original articles submitted by Turkish authors to the journal Nephrology Dialysis Transplantation ranks 7th-8th amongst total submissions to the journal. Turkey also ranks 2nd-4th in the number of abstracts submitted to recent ERA-EDTA Congresses. With 18 063 patients undergoing intermittent haemodialysis treatment in 348 dialysis centres, Turkey has the 5th largest chronic haemodialysis patient population among European countries. In addition, 1903 patients are currently undergoing continuous ambulatory peritoneal dialysis. However, with a total of 4693 renal transplants since 1975, of which only 21.3% were of cadaveric origin, Turkey lags considerably behind other European countries in renal transplantation. In Turkey, the prevalence and incidence of renal replacement therapy (RRT) are at present 358 and 52 p.m.p. respectively, and the expansion rate of the RRT stock is 17% (HD 18.5%, CAPD 6%, and transplantation 1.7%). The yearly gross mortality rate of the total RRT population is 9.4%. The present priorities of the Turkish nephrological community include high-standard research activity and long-term, prospective clinical and epidemiological studies, an increase in the total number and percentage of cadaveric transplants, further improvement of the quality and cost-effectiveness of RRT, and finally the further development of scientific and educational collaboration with the world nephrological community.     

1996 Hong Kong Renal Registry Report

Summary: This report was based on the data from the Renal Registry of the Hospital Authority of Hong Kong and accounted for approximately 90-95% of all the patients on Renal replacement therapy (RRT) in Hong Kong. Patients receiving treatment under the private sectors were not included in this report. the data were as of 31 December 1996. There were 15 renal units (2.4 unit per million population [pmp]) and four major renal transplant centres. the number of patients on RRT was 3337 (530 pmp), of which 56% (299 pmp) were on peritoneal dialysis (PD), 15% (79 pmp) on haemodialysis (HD) and 29% (152 pmp) with functioning kidney transplants (TX). the net increase in the number of patients on RRT was +12% from the previous year. the incidence of end stage renal failure was 640 (102 pmp). the median age of patients on RRT was 49 years, of which 27% were above the age of 61 years. For new patients who commenced on RRT during 1996, the median age was 56 years, of which 36% were above the age of 61 years. the causes of renal failure were glomerulonephritis 37%, unknown 30%, diabetes 13%, inherited and congenital 5%, infection/reflux 3%, hypertensive/renal vascular disease 3%, urolithiasis 2%, obstructive 1% and others 5%. For new patients entered into the programme during 1996, 25% were due to diabetic nephropathy. Ten per cent of all the patients on RRT were serologically positive for hepatitis B infection (PD 12%, HD 6%, TX 9%). 5% of all the patients on RRT were positive for hepatitis C infection (PD 3%, HD 12%, TX 7%). Seventy-nine per cent of all the patients on dialysis were on PD (1885 patients, 299 pmp), of which 96% were on CAPD. Thirty-eight per cent of the patients on CAPD were on straight-line systems, 35% on disconnecting systems and 20% on UV flash systems. Four-hundred and ninety-five patients (79 pmp) were on HD, of which 59% were on hospital based HD, 15% on satellite centre based HD, 10% on charitable centre based HD and 5% on home HD. Nine-hundred and fifty-seven patients (152 pmp) had a functioning kidney graft. 542 (57%) were transplanted in Hong Kong, of which 50% were cadaveric kidney transplantations. During 1996, 121 patients (19 pmp) received a kidney transplantation. Eighty-four transplants were performed in Hong Kong, of which 58 were with cadaveric kidneys and 26 with living related kidneys. the annual mortality rate for all RRT was 7.3% (10% for PD, 8% for HD and 1% with TX). the major causes of death were infection (28%), cardiovascular (26%) and cerebral vascular accident (9%). Outcome indicators were on patients entered into the RRT programme during 1995, thus allowing for 1 year of follow up. For CAPD as the first RRT, 1 year patient and technique survival (censored for death and non-technique failure) were 94% and 93%. For living related kidney transplants performed in Hong Kong, 1 year patient and graft survival (censored for death) were both 100%. For cadaveric kidney transplants, 1 year patient and graft survival were 98% and 96%     

Renal replacement therapy in Bosnia and Herzegovina: report of the Society of Nephrology, Dialysis and Transplantation of Bosnia and Herzegovina.

Introduction Renal replacement therapy (RRT) had been established in Bosniaand Herzegovina before the war in 1992–1995. During thewar, the activity of the dialysis centres could only continuebecause of donations of supply provided by Medicine Du Mondeand the European Union [1]. Since 1997, the expenses of dialysistreatment are again met by the government of Bosnia and Herzegovina. In 1997, the Society of Nephrology, Dialysis and Transplantationof Bosnia Herzegovina was founded and continues to receive organizationaland financial help from Medicine Du Monde. In 1999, the societyfounded the renal registry of Bosnia and Herzegovina. Completedata reporting was achieved in 2001, covering all 20 dialysiscentres in Bosnia Herzegovina, with a return rate of 100%. Inthe following,     

Current structure and organization for renal patient assistance in Italy

Background. Given the public health challenge and burden ofchronic kidney disease, the Italian Society of Nephrology (SIN)has compiled a national census of Renal Units (RU) existingin the twenty Italian regions related to the year 2004. Methods. An on-line questionnaire including 158 items exploredstructural and human resources, organization aspects, activitiesand epidemiological data in SIN, 2004. Results. The census identified 363 public RU, 303 satelliteDialysis Centres (DC) and 295 private DC totalling 961 DC [16.4per million population (pmp)]. The inpatient renal beds were2742 (47 pmp). Renal and dialysis activity was performed by3728 physicians (64 pmp), of whom 2964 (80%) were nephrologists.There was no permanent medical assistance in 41% of satelliteDC. There were 1802 renal admissions pmp and 99 renal biopsiespmp. The management of acute renal failure (13 456 cases;230 pmp) represented a relevant proportion of the activitiesconducted in public RU. In 2004 there were 9858 new cases ofend-stage kidney disease requiring renal replacement therapy(RRT) (169 pmp). On 31 December 2004, 60 058 patients wereon RRT (1027 pmp), 43 293 of which (740 pmp) were on dialysisand 16 765 (287 pmp) with renal graft. Conclusions. This census of the Italian RU and DC in 2004 providesdecision makers and healthcare stakeholders with detailed datafor benchmarking and has financial implications for the publichealth system. Similar analyses may be conducted in other countriespermitting standardization of medical and cost-related aspectsof renal care.     

Patient-nephrologist prognostic awareness and discordance in end stage renal disease on renal replacement therapy

International Urology and Nephrology - The 1-year mortality rate of patients with end-stage renal disease (ESRD) on renal replacement therapy (RRT) is 20–25% comparable to many cancers....     

Renal replacement therapy in an era of socioeconomic changes - report from the Polish registry

During the era of so-called 'real' socialism, renal replacement therapy was in a very poor condition in Poland. Here we present data on the influence that the socioeconomic changes in Poland had on the status of dialysis therapy. All data are based on analysis of annual questionnaires from all dialysis and renal transplant units. During the period 1989-1995, the number of dialysis units increased by 39%, the number of stations by 68%, and the number of patients by 136%. Not only quantitative but also qualitative changes occurred in the introduction of new, modern machines, individualization of dialysis treatment, the start of a peritoneal dialysis programme, and an increasing number of patients on erythropoietin therapy. Also, broader criteria for the admission of patients with secondary nephropathies (especially diabetes) and aged people were adopted. The gross mortality rate (9.5-10.5%) during the period of observation was satisfactory and comparable with that of western European countries. Progress was the result of the implementation of the programme of the National Committee for the Promotion of Nephrology, approved by the Ministry of Health and the Parliamentary Health Commission, and supported by the central funding system. Further consequent development of all alternative renal replacement therapy methods (among them especially renal transplantation) is necessary to achieve an acceptance rate comparable with developed countries by the beginning of the next century.     

Ten-years trends in renal replacement therapy for end-stage renal disease in mainland France: Lessons from the French Renal Epidemiology and Information Network (REIN) registry

BackgroundThe incidence rate of renal replacement therapy (RRT) for end-stage renal disease (ESRD) is decreasing in several countries, but not in France. We studied the RRT trends in mainland France from 2005 to 2014 to understand the reasons for this discrepancy and determine the effects of ESRD management changes.MethodsData were extracted from the French Renal Epidemiology and Information Network registry. Time trends of RRT incidence and prevalence rates, patients’ clinical and treatment characteristics were analysed using the Joinpoint regression program and annual percentage changes. Survival within the first year of RRT was analysed using Kaplan-Meier estimates for 4 periods of time.ResultsThe overall age- and gender-adjusted RRT incidence rate increased from 144 to 159 individuals per million inhabitants (pmi) (+0.8% per year; 95% CI: 0.5–1.2) and the prevalence from 903 to 1141 pmi (+2.4% per year; 95% CI: 2.2–2.7). This increase concerned exclusively ESRD associated with type 2 diabetes (+4.0%; 3.4–4.6) and mostly elderly men. Despite patient aging and increasing comorbidity burden and a persistent 30% rate of emergency dialysis start, the one-year survival rate slightly improved from 82.1% (81.4–82.8) to 83.8% (83.3–84.4). Pre-emptive wait listing for renal transplantation and the percentage of wait-listed patients within one year after dialysis start strongly increased (from 5.6% to 15.5% and from 29% to 39%, respectively).ConclusionKidney transplantation and survival significantly improved despite the heavier patient burden. However, the rise in type 2 diabetes-related ESRD and the stable high rate of emergency dialysis start remain major issues.     

Epidemiology of renal disease in Romania: a 10 year review of two regional renal biopsy databases.

BACKGROUND: Epidemiological data of renal disease are available from large national renal biopsy registries from Central and Western European countries; in contrast, detailed epidemiological data from Eastern European countries are missing. This report is the first review of histological data, over a period of 10 years (1995-2004), covering a population of over 6 million inhabitants and two distinct regions from an East European country - Romania. METHODS: 635 eco-guided kidney biopsies from the Moldova (North-Eastern Romania, 8 counties, 4 754 048 inhabitants) and Banat (Western Romania, 3 counties, 1 454 747 inhabitants) regions were analysed. Data on serum creatinine concentration (sCr), 24 h proteinuria, haematuria, clinical diagnosis, histological diagnosis and complications after renal biopsy were collected. RESULTS: The number of biopsies performed varied between 10.9 p.m.p./year in 1995 and 11.3 p.m.p./year in 2004. The most common clinical syndromes - as indication for performing the renal biopsy - were: nephrotic syndrome (52.3%), followed by nephritic syndrome (21.9%), acute renal failure (ARF) (12.4%), chronic kidney disease (CKD) (10.2%) and asymptomatic urinary abnormalities (AUA) (3.3% of the cases). The major histological groups identified were: primary glomerulonephritis (GN) (66.2%), secondary GN (26.4%), vascular nephropathies (2.3%), and tubulointerstitial nephropathies (TIN) (1.5%) of the cases. Among primary GN's, the most frequent diagnoses were: membranoproliferative GN (MPGN) (29.4%, incidence in 2004 - 9.3 p.m.p./year), mesangioproliferative GN (MesGN) (28.9%, incidence - 10 p.m.p./year), membranous GN (MGN) (11.2%, incidence - 5.3 p.m.p./year), minimal change disease (MCD) (8.5%, incidence - 7.3 p.m.p./year), focal and segmental glomerulosclerosis (FSGS) (11.5%, incidence - 3.3 p.m.p./year) and crescentic GN (CGN) (7.9%, incidence - 3.3 p.m.p./year). The prevalence of membranoproliferative GN significantly decreased from 1995 to 2004. The prevalence of different types of secondary GN was similar to Western and Central European countries, with the particular difference of higher infectious diseases associated GN. CONCLUSION: The present data are an important contribution to the epidemiology of renal diseases in Europe, highlighting not only numerous similarities but also significant epidemiological differences in Western and Central European countries, particularly a higher, albeit declining, incidence and prevalence of membranoproliferative GN. This report represents the basis for the future of Romanian Registry of Renal Biopsies and is intended to serve as a source of information for nephrologists concerned with East European renal pathology.     

Malaysian Dialysis and Transplant Registry Report

SUMMARY: This report summarizes data for dialysis and transplant patients up to the end of 1995. We estimate coverage to be about 30% of dialysis patients and near complete ascertainment of transplant patients. On the 31 December 1995, there were 2224 patients on renal replacement therapy (RRT), comprising 50% on haemodialysis (HD), 12% on continuous ambulatory peritoneal dialysis (CAPD) and 38% with functioning transplants. the prevalence rate for dialysis was 68 per million population (p.m.p.) and that of transplant 42 p.m.p. the new dialysis acceptance rate was 15 p.m.p. and transplant 5 p.m.p. Forty-seven per cent of new patients had unknown primary renal disease and 30% was due to non-insulin dependent diabetes mellitus. Mean age of prevalent HD patients was 42 years, CAPD 46 years and 34 years for transplant. Patient survival on CAPD was 85% at 1 year and for HD was 88%. One year transplant patient survival was 94% and graft survival 91%.     

Invasive coronary artery disease assessment and myocardial infarction in patients on renal replacement therapy

International Urology and Nephrology - The incidence of myocardial infarction (MI) is elevated in patients receiving renal replacement therapy (RRT). We hypothesized that an invasive strategy of...     

Regional effects of satellite haemodialysis units on renal replacement therapy in non-urban Ontario, Canada.

BACKGROUND: To provide better dialysis care to rural communities, the Ministry of Health chose to build satellite haemodialysis (HD) units, which are affiliated with, but are distant to, a main renal centre. We considered whether constructing such units in rural regions of Ontario, Canada, alleviated under-service of rates of renal replacement therapy (RRT) locally, decreased patient travel distance and decreased local peritoneal dialysis (PD) utilization. METHODS: We compared two groups of rural regions at two time points (years 1995 and 2002) in a before and after cross-sectional study. These regions were either already serviced by a satellite unit in 1995 (control group, 10 communities), or had new satellite units built between the years 1995 and 2002 (exposure group, 24 communities). RESULTS: The exposure group had a slightly greater increase in prevalent rate of RRT over time, but this did not reach statistical significance (control group increased 401 per million, exposure group 436 per million, P = 0.8). The mean weekly travel distance was reduced by 210.6 km after the construction of new satellite units (P < 0.001). There was no significant difference between the groups in reduction of PD proportion (P = 0.4). There was a significant increase in the number of elderly receiving RRT once local access was provided. CONCLUSIONS: In conclusion, constructing satellite units increased access to renal care for elderly patients and reduced travel time for HD patients living in rural communities.     

Should CAPD be the first choice for dialysis in Romania? Audit of the Iasi 'C. I. Parhon' Dialysis Center: 1995-2000.

Peritoneal dialysis was first introduced in Romania in 1995.We are reporting data on patient and technique outcomes, basedon the 5-year experience of one of the first two Romanian continuousambulatory peritoneal dialysis (CAPD) centres. During this period,Romania had the highest rate of increase in renal replacementtherapy (RRT) and CAPD (28 times over baseline) in Europe: CAPDincrease in Romania vs Eastern Europe was 6.7 compared to asimilarly defined ratio of 5.6 for haemodialysis (HD). Between 1995 and 2000, at the ‘C. I. Parhon’ Hospitalin Iasi, 259 patients were started on HD and 102 on CAPD. The90 CAPD patients we followed were treated for a total of 1896months. 86.7% of the patients were alive on 31 July 2000—67.8%continuing on CAPD, 15.6% on HD and 3.3% transplanted. The 61patients still on PD on that date, represented 11.1% of theactual Romanian CAPD population and 31% of our RRT population(compared to 13.7% nationwide). The gross mortality rate was comparable to the mean calculatedfor the HD population nationwide. Mean survival of the CAPDpatients was 45.4±2.6 months (95% CI=40.4–50.4months). One-year and 5-year patient survival rates were 97.5%and 52.7% respectively, superior and similar to mean figuresnationwide. Mean technique survival was 36.6±0.6 months(95% CI=31.5–41.6 months). One- and 5-year technique survivalrates were 83.1% and 34.3% respectively. Technique failure wasmainly due to dialysis inefficiency: 50% of cases. Mean weeklyKt/V for the 5-year period was 1.92±0.21 while mean weeklycreatinine clearance was 61.2±12.4 ml/1.73 m²/week. Eighty-four episodes of peritonitis were recorded in 46 patients(0.25 episodes/patient/year); mean duration to peritonitis was23 months (95% CI=18.2–27.5). Malnutrition was noted (SGAscore) in 25.5% of the cases. Blood pressure (assessed by 24-hABPM) was adequately controlled in 83.3% of the patients. Leftventricular hypertrophy was ubiquitous (77.7%), but left ventriculardilatation and systolic dysfunction (fractioning shorteningindex <25%) were rare—4.4% and 3.3% respectively (similarin prevalence to the Iasi HD population). No statistically significantchanges in echocardiographic parameters were recorded betweenthe first and subsequent years on CAPD treatment. Peritoneal dialysis had a rapid increase in the last 5 yearsin Romania and particularly in the region of Moldova. Outcomesand complication rates are equal or superior to nationwide HDdata and comparable to distinguished centres of CAPD in economicallydeveloped countries. We conclude that, provided that optimalmedical practice is available, CAPD should be the RRT of choicein Romania, and that it represents the only solution to thecountry's limited dialysis resources.     

Likelihood of children with end-stage kidney disease in Europe to live with a functioning kidney transplant is mainly explained by nonmedical factors

Background

Registry data can be used to assess associations between medical and health-policy factors and the likelihood of children on renal replacement therapy (RRT) to live with a functioning kidney transplant in Europe.

Methods

A survey questionnaire was distributed among renal registry representatives in 38 European countries, and additional data was obtained from the European Society for Pediatric Nephrology/European Renal Association–European Dialysis and Transplant Association (ESPN/ERA-EDTA) registry.

Results

Thirty-two countries with a pediatric RRT program responded. The median percentage of children by country on RRT with a functioning transplant was 62 % (interquartile range 39–77). One per million population increase in donation rate from deceased donors was associated with a 5 % increase in the percentage of functioning transplants; the existence of an intermediate and high pediatric priority policy doubled and tripled this percentage, respectively, compared with no priority, whereas an increase in living donor pediatric kidney transplant rate of one per million children was associated with a 14 % higher percentage of functioning transplants. The percentage of functioning transplants was also strongly associated with the gross domestic product (GDP).

Conclusion

Considerable variations exist in the percentages of prevalent pediatric RRT populations with functioning renal transplants across Europe. A macroeconomic indicator such as GDP is the most important determinant of these international differences. Efforts should be made for living donation programs and pediatric allocation priority to increase access to kidney transplantation for children.     

End stage renal disease in Brunei Darussalam – report from the first Brunei Dialysis Transplant Registry (BDTR)

Abstract

The Brunei Dialysis and Transplant Registry (BDTR) was established in 2011 to collect data from patients undergoing renal replacement therapy (RRT) in Brunei Darussalam. The chief aims of the registry are to obtain general demographic data for RRT patients and to determine disease burden attributable to End Stage Renal Disease (ESRD). The registry population comprises of all ESRD patients treated in Brunei Darussalam. Data domains include general demographic data, medical history, ESRD etiological causes, laboratory investigations, dialysis treatment and outcomes. There were 545 prevalent RRT patients in Brunei at the end of 2011. The incidence and prevalence of ESRD were 265 and 1250 per million population. Hemodialysis (HD), Peritoneal Dialysis (PD) and Transplant comprised of 83%, 11% and 6% of the RRT population, respectively. Diabetes mellitus accounted for 57% of all new incident cases. The mean serum hemoglobin, phosphate, calcium and iPTH were 11.0?±?1.6?g/dL, 1.9?±?0.5?mmol/L, 2.3?±?0.2?mmol/L and 202.5?±?323.4?ng/mL. Dialysis adequacy for HD and PD were 65.1 (urea reduction ratio) and 2.0?±?0.3 (Kt/v). 71 % of all prevalent HD had functioning AV fistulae and the peritonitis incidence was one in 24.5 patient-month/episode. The first BDTR has identified some deficiencies in the renal services in Brunei. However, it signals an important milestone for the establishment of benchmarked renal practice in the country. We hoped to maintain and improve our registry for years to come and will strive to align our standards to acceptable international practice.     

The Latin American Dialysis and Renal Transplantation Registry Annual Report 2002

Latin America is a conglomerate of adjacent countries having in common a Latin extraction and language (Spanish or Portuguese) and exhibiting extreme variations in socioeconomic status. The Latin American Society of Nephrology and Hypertension Dialysis and Renal Transplantation Registry was created in 1991. Annual data are sent by local societies in 3 forms: patient, center, and country. The prevalence of renal replacement therapy (RRT) (all modalities) increased from 119 patients per million population (pmp) in 1991 to 349 pmp in 2001; the acceptance rate was 91.7 pmp in 2001. Dialysis prevalence was 277 pmp; hemodialysis was the predominant modality, except in Mexico (86% on peritoneal dialysis). The highest dialysis prevalence and acceptance rates were reported by Puerto Rico, Uruguay, and Chile. Among incident patients, diabetic nephropathy (33%) and nephroangioesclerosis (32%) were the primary causes; 38% were older than 65 years old. Renal transplants increased from 3.7 pmp in 1987 to 13.7 pmp in 2001. In 2003, 6357 transplants were performed (55% living donor); the cumulative number performed since 1987 reached 55,947. Prevalence and incidence are low because not all patients with end-stage renal disease have access to RRT because of restricted availability, difficulties in referral, and inequities in coverage. The annual increase in the number of patients on RRT (8%-10%) is higher, proportionally, than the annual growth of the Latin American population in general (1.5%). Efforts must be focused on prevention and treatment of chronic kidney disease, especially in diabetic and older patients, and in implementing better organ donation programs to improve the pool of cadaveric donors.     

From registry data collection to international comparisons: examples of haemodialysis duration and frequency

Background. The purpose of this study was to investigate haemodialysis(HD) dose practice patterns in different European countriesin the light of the European Best Practice Guidelines (EBPG)and to study the associations of patient characteristics andcountry with weekly dialysis duration. Methods. Renal registries in Europe were asked to contributeto the study with individual patient data on weekly HD duration,number of HD sessions a week and last measured Kt/V. Additionalitems were age, sex, date of first renal replacement therapy(RRT), dry weight, height, HD modality, HD technique, diabetesstatus and vascular access type. Multivariate logistic regressionwas used to study the probability of receiving HD for <12h per week. Results. Seven registries contributed data on 26 136 patientson HD on 31 December 2005. Eighty-three percent of the patientsreceived HD for at least 12 h per week as recommended by theEBPG (range 49.0–97.3% across countries). Multivariateanalysis showed significant differences across countries concerningthe risk of receiving <12 h. Other risk factors includedage (older), sex (female), BMI (low) and duration of RRT (shorter).Diabetes was associated with longer total HD duration. Conclusion. This study shows a great international variabilityin weekly HD duration and some discrepancies between currentpractices and the EBPG. It also points out the difficulty ofobtaining and comparing Kt/V values under current registry practices.     

Cost analysis of renal replacement therapy by transplant in a system of bundled payment of dialysis

Renal replacement therapies (RRT) for patients with end-stage renal failure represent a high burden on European countries' healthcare budget. Our purpose was to report and compare the costs of RRT by hemodialysis (HD) or peritoneal dialysis (PD) and renal transplantation (RT) after introduction of a bundled payment system of dialysis. We analyzed average annual cost of RT in a public national health system hospital - surgical/anesthesiologist team and material, induction and maintenance immunosuppression therapy, hospital stay, diagnostic examinations (DE), and post-transplant office visits (including DE). Incentives paid to hospitals performing RT were included. Annual cost of HD or PD was estimated by bundled payment established in a recently revised law - 537.25 €/wk. Total first year cost or RT is 61 658.14 € and from the second year forth 543.86 €/month. Dialysis costs 28 033.71 €/yr. Break-even point for cost is at 32 months, and from there on, RT is less expensive. Strategies aimed at increasing RT are needed as it confers better survival than RRT by dialysis with lower costs to Portuguese health system.