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Helve J, Kramer A, Abad-Diez JM, Couchoud C, de Arriba G, de Meester J, Evans M, Glaudet F, Grönhagen-Riska C, Heaf JG, Lezaic V, Nordio M, Palsson R, Pechter Ü, Resic H, Santamaria R, Santiuste de Pablos C, Massy ZA, Zurriaga Ó, Jager KJ, Finne P. Factors associating with differences in the incidence of renal replacement therapy among elderly: data from the ERA-EDTA Registry. Nephrol Dial Transplant 2018; 33:1428-1435. [DOI: 10.1093/ndt/gfy056] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 02/01/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jaakko Helve
- Finnish Registry for Kidney Diseases, Helsinki, Finland
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anneke Kramer
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | | | - Cecile Couchoud
- Coordination nationale de REIN, Agence de la biomédecine, France
| | - Gabriel de Arriba
- Sección de Nefrologia, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - Johan de Meester
- Department of Nephrology, Dialysis and Hypertension, Dutch-speaking Belgian Renal Registry (NBVN), Sint-Niklaas, Belgium
| | - Marie Evans
- Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Florence Glaudet
- Service de Néphrologie, Centre hospitalier et universitaire de Limoges, Limoges, France
| | | | - James G Heaf
- Department of Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Visnja Lezaic
- Department of Nephrology, Clinical Centre of Serbia, Belgrade, Serbia
| | - Maurizio Nordio
- Veneto Dialysis and Transplantation Registry, Regional Epidemiology System, Padua, Italy
- Nephrology Dialysis Unit, Padua, Italy
| | - Runolfur Palsson
- Division of Nephrology, Landspitali–The National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Ülle Pechter
- Department of Internal Medicine, University of Tartu, Estonia
| | - Halima Resic
- Clinic for Hemodialysis, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | | | - Carmen Santiuste de Pablos
- Registro de Enfermos Renales de la Región de Murcia, Servicio de Epidemiologia, Consejeria de Sanidad, IMIB-Arrixaca, Murcia, Spain
| | - Ziad A Massy
- Division of Nephrology, Ambroise Paré University Hospital, APHP, Boulogne-Billancourt, Paris, France
- Institut National de la Santé et de la Recherche Medical Unit 1018 team5, Research Centre in Epidemiology and Population Health, University of Paris Ouest-Versailles-St Quentin-en-Yveline, Villejuif, France
| | - Óscar Zurriaga
- Dirección General de Salud Pública. Conselleria de Sanitat Universal i Salut Pública, Valencia, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain
| | - Kitty J Jager
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Patrik Finne
- Finnish Registry for Kidney Diseases, Helsinki, Finland
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Chesnaye NC, Schaefer F, Groothoff JW, Caskey FJ, Heaf JG, Kushnirenko S, Lewis M, Mauel R, Maurer E, Merenmies J, Shtiza D, Topaloglu R, Zaicova N, Zampetoglou A, Jager KJ, van Stralen KJ. Disparities in treatment rates of paediatric end-stage renal disease across Europe: insights from the ESPN/ERA-EDTA registry. Nephrol Dial Transplant 2015; 30:1377-85. [PMID: 25839740 DOI: 10.1093/ndt/gfv064] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 02/24/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Considerable disparities exist in the provision of paediatric renal replacement therapy (RRT) across Europe. This study aims to determine whether these disparities arise from geographical differences in the occurrence of renal disease, or whether country-level access-to-care factors may be responsible. METHODS Incidence was defined as the number of new patients aged 0-14 years starting RRT per year, between 2007 and 2011, per million children (pmc), and was extracted from the ESPN/ERA-EDTA registry database for 35 European countries. Country-level indicators on macroeconomics, perinatal care and physical access to treatment were collected through an online survey and from the World Bank database. The estimated effect is presented per 1SD increase for each indicator. RESULTS The incidence of paediatric RRT in Europe was 5.4 cases pmc. Incidence decreased from Western to Eastern Europe (-1.91 pmc/1321 km, P < 0.0001), and increased from Southern to Northern Europe (0.93 pmc/838 km, P = 0.002). Regional differences in the occurrence of specific renal diseases were marginal. Higher RRT treatment rates were found in wealthier countries (2.47 pmc/€10 378 GDP per capita, P < 0.0001), among those that tend to spend more on healthcare (1.45 pmc/1.7% public health expenditure, P < 0.0001), and among countries where patients pay less out-of-pocket for healthcare (-1.29 pmc/11.7% out-of-pocket health expenditure, P < 0.0001). Country neonatal mortality was inversely related with incidence in the youngest patients (ages 0-4, -1.1 pmc/2.1 deaths per 1000 births, P = 0.10). Countries with a higher incidence had a lower average age at RRT start, which was fully explained by country GDP per capita. CONCLUSIONS Inequalities exist in the provision of paediatric RRT throughout Europe, most of which are explained by differences in country macroeconomics, which limit the provision of treatment particularly in the youngest patients. This poses a challenge for healthcare policy makers in their aim to ensure universal and equal access to high-quality healthcare services across Europe.
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Affiliation(s)
| | - Franz Schaefer
- Division of Paediatric Nephrology, University of Heidelberg Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany
| | - Jaap W Groothoff
- Department of Pediatric Nephrology, Emma Children's Hospital AMC, Amsterdam, Netherlands
| | | | - James G Heaf
- Department of Nephrology, University of Copenhagen, Herlev, Denmark
| | | | | | - Reiner Mauel
- Department of Pediatric Nephrology, University of Gent, Gent, Belgium
| | | | - Jussi Merenmies
- Department of Pediatric Nephrology and Transplantation, University of Helsinki, Helsinki, Finland
| | - Diamant Shtiza
- Department of Pediatrics Nephrology Unit, University Hospital Centre 'Mother Tereza', Tirana, Albania
| | - Rezan Topaloglu
- Department of Pediatric Nephrology, Hacettepe University, Ankara, Turkey
| | | | - Argyroula Zampetoglou
- Department of Pediatric Nephrology, 'A. and P. Kyriakou' Children's Hospital, Athens, Greece
| | - Kitty J Jager
- ESPN/ERA-EDTA Registry and ERA-EDTA Registry, Amsterdam, Netherlands
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Abstract
In their study based on data from the Dialysis Outcomes and Practice Patterns Study (DOPPS) census database, including 86,886 hemodialysis patients from 11 countries, Robinson and colleagues show that in all countries studied, mortality is higher in the first 120 days after the start of dialysis than after this period. We discuss factors that may affect international differences in early mortality, including current dialysis initiation practices and withdrawal from dialysis.
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Qureshi AR, Evans M, Stendahl M, Prütz KG, Elinder CG. The increase in renal replacement therapy (RRT) incidence has come to an end in Sweden-analysis of variations by region over the period 1991-2010. Clin Kidney J 2013; 6:352-7. [PMID: 26064505 PMCID: PMC4400478 DOI: 10.1093/ckj/sft032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 02/27/2013] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Renal replacement therapy (RRT) incidence has increased significantly in Sweden during the past decades. This study analyses variations in time and regional trends in RRT incidence in Sweden, adjusted for age and gender, focusing on the impact change in incidence during the last decade. METHODS Using data from the Swedish Renal Registry (SRR) (21 counties in Sweden, total population 9 million), we identified all incident subjects starting RRT from 1991 through 2010. Only individuals alive following 90 days of RRT start were included. Gender- and age-specific standardized RRT incidences on an annual and regional basis were calculated, and differences between counties and variations over time were examined. We compared the overall age and gender-adjusted RRT incidence rates for Sweden by calendar year. Furthermore, we also calculated the age and gender-adjusted RRT incidence in each county during two time periods (1991-1999 versus 2000-2010). RESULTS There were 20 172 new subjects treated with RRT between January 1991 and December 2010. The most common cause of end-stage renal disease (ESRD) was diabetes (24%) and hypertension/renal vascular disease (19%), followed by glomerulonephritis (16%). Sixty-four percent of new patients were male; the median age when commencing RRT was 66 years (10-90 percentiles; 39-80). The overall standardized RRT incidence reached its peak in 2000, and slowly decreased thereafter. A decrease in RRT incidence was observed over the study period in eight regions. The standardized RRT incidence varied between the different counties, from 0.82 to 1.19. CONCLUSIONS Adjusted for demographic changes in the population, an overall decrease in RRT incidence was observed from the year 2000 onwards-suggesting that the previously reported steady increase in RRT incidence is coming to an end in Sweden. Noteworthy differences were found between counties and in 8 out of 21 counties, a decreased incidence of RRT was found. Further studies need to identify the factors that contribute to this decrease.
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Affiliation(s)
- Abdul Rashid Qureshi
- Division of Baxter Novum, Department of Clinical Science, Intervention and Technology at Karolinska Institute, Stockholm, Sweden
| | - Marie Evans
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology at Karolinska Institute, Stockholm, Sweden
| | - Maria Stendahl
- Department of Internal Medicine, Ryhov Hospital, Jönköping, Sweden
| | - Karl-Göran Prütz
- Department of Internal Medicine, Helsingborg Hospital, Helsingborg, Sweden
| | - Carl-Gustaf Elinder
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology at Karolinska Institute, Stockholm, Sweden
- Evidence Based Medicine Unit, Stockholm County Council, Stockholm, Sweden
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