Current ESRD burden and its future trend in Beijing, China

Capacity for the management of kidney failure in the International Society of Nephrology North and East Asia region: report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA)

Globally, there remain significant disparities in the capacity and quality of kidney care, as evidenced by the third edition of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA). In the ISN North and East Asia region, the chronic kidney disease (CKD) burden varied widely; Taiwan had the heaviest burden of treated kidney failure (3679 per million population [pmp]) followed by Japan and South Korea. Except in Hong Kong, hemodialysis (HD) was the main dialysis modality for all other countries in the region and was much higher than the global median prevalence. Kidney transplantation services were generally available in the region, but the prevalence was much lower than that of dialysis. Most countries had public funding for kidney replacement therapy (KRT). The median prevalence of nephrologists was 28.7 pmp, higher than that of any other ISN region, with variation across countries. Home HD was available in only 17% of the countries, whereas conservative kidney management was available in 50%. All countries had official registries for dialysis and transplantation; however, only China and Japan had CKD registries. Advocacy groups for CKD, kidney failure, and KRT were uncommon throughout the region. Overall, all countries in the region had capacity for KRT, albeit with some shortages in their kidney care workforce. These data are useful for stakeholders to address gaps in kidney care and to reduce workforce shortages through increased use of multidisciplinary teams and telemedicine, policy changes to promote prevention and treatment of kidney failure, and increased advocacy for kidney disease in the region.

Knowledge, attitude, and practice of patients receiving maintenance hemodialysis regarding hemodialysis and its complications: a single-center, cross-sectional study in Nanjing

BACKGROUND

Good knowledge of and attitudes toward hemodialysis and its complications might be expected to promote good practices and improve adherence. This study investigated, the knowledge, attitude, and practice of patients receiving hemodialysis regarding hemodialysis and its complications.

METHODS

This cross-sectional study enrolled patients with uremia who were receiving hemodialysis at the Second Affiliated Hospital of Nanjing Medical University (China) between January 9, 2023, and January 16, 2023. A questionnaire was designed that included the following dimensions: demographic/clinical information, knowledge, attitude, and practice. Correlations between knowledge, attitude, and practice scores were evaluated by Pearson correlation analysis.

RESULTS

The analysis included 493 patients (305 males, 61.87%). The average knowledge, attitude, and practice score was 19.33 ± 7.07 (possible range, 0-31), 28.77 ± 3.58 (possible range, 8-40), and 43.57 ± 6.53 (possible range, 11-55) points, respectively. A higher knowledge score was associated with younger age (P < 0.001), a higher education level (P < 0.001), and not living alone (P < 0.001), while a higher practice score was associated with a shorter history of hemodialysis (P < 0.001). There were positive correlations between the knowledge and practice scores (r = 0.220, P < 0.001) and between the attitude and practice scores (r = 0.453, P < 0.001), although the knowledge and attitude scores were not significantly correlated.

CONCLUSIONS

The results provide important insights into the knowledge, attitudes, and practices of patients with uremia in Nanjing (China) regarding hemodialysis and its complications. These findings may facilitate education programs to improve self-care practices in patients receiving maintenance hemodialysis in Nanjing (China).

Influence of continuity of care on self-management ability and quality of life in outpatient maintenance hemodialysis patients

INTRODUCTION

The objective of this study was to evaluate the effect of continuity of care on self-management ability and quality of life (QOL) in patients undergoing maintenance hemodialysis (MHD).

METHODS

One hundred patients were randomly assigned to the observation group and the control group. In the observation group, patients received a 12-month continuity of care. In the control group, patients were given with routine nursing. Evaluate the patients' self-management ability and QOL between two groups 1 week before discharge and 6 and 12 months outpatient MHD.

RESULTS

Observation group had higher Hemodialysis Self-Management Instrument (HD-SMI) scores and Kidney Disease Quality of Life-Short Form (KDQOL-SF™) scores than control group at 6 and 12 months outpatient MHD. But patients in observation group had a much lower systolic blood pressure than those in control group at 12 months outpatient MHD.

CONCLUSIONS

Our study suggested that continuity of care in the form of online education, telephone visit, and outpatient visit could improve self-management ability and QOL of patients undergoing MHD.

Relationship between chronic periodontitis and inflammatory cytokines in patients undergoing maintenance hemodialysis

OBJECTIVES

To investigate the correlation between serum and gingival crevicular fluid (GCF) levels of inflammatory cytokines and the association with periodontal parameters in patients with maintenance hemodialysis (MHD) and healthy control.

MATERIALS AND METHODS

Patients who were undergoing MHD were enrolled as the MHD group. Healthy individuals who underwent oral examination were selected as the control group after matching for the MHD group. All participants underwent a full-mouth periodontal evaluation, and the levels of eight inflammatory cytokines, including IL-1β, IL-17, IL-6, IL-8, and tumor necrosis factor-α (TNF-α), monocyte chemoattractant protein-1 (MCP-1), matrix metalloproteinase-8 (MMP-8), and C-reactive protein (CRP), in the GCF and serum were measured.

RESULTS

A total of 63 MHD patients and 75 healthy persons were included. The prevalence of moderate/severe periodontitis was significantly higher in the MHD group than in the control group (88.9 vs. 66.7%, P < 0.05). The GCF levels of CRP, TNF-α, MCP-1, and MMP-8 were higher in patients in the MHD group with moderate/severe periodontitis than in the control group (P < 0.05). Serum CRP, MCP-1, TNF-α, and MMP-8 levels were positively correlated with the GCF CRP levels (P < 0.05). The GCF and serum CRP levels were positively correlated with the periodontal clinical parameters (P < 0.05).

CONCLUSIONS

Serum CRP, MCP-1, TNF-α, and MMP-8 may relate with the GCF CRP levels. The GCF and serum CRP levels correlated positively with the periodontal clinical parameters, including the VPI, PPD, and CAL, indicating that CRP may play an important role between periodontitis and ESRD.

CLINICAL RELEVANCE

The present study indicated that GCF and serum CRP levels correlated positively with the periodontal clinical parameters, and the CRP levels may be selected as an indicator to evaluate the severity of inflammation and the effectiveness, prognosis of periodontal treatment in ESRD patients.

Hepatitis C Prevalence, Incidence, and Treatment in Chinese Hemodialysis Patients: Results From the Dialysis Outcomes and Practice Patterns Study-China (2019–21)

Background

Prior work from the Dialysis Outcomes and Practice Patterns Study (DOPPS) showed HCV prevalence in China in 2012–2015 being in the upper third and HCV incidence the 2nd highest among 15 different countries/regions investigated. The goal of the present investigation was to: (1) determine if HCV prevalence and incidence has changed, and (2) collect detailed data to understand how HCV is treated, monitored, and managed in Chinese HD facilities and non-dialysis chronic kidney disease (CKD) clinics.

Data and Methods

Detailed data for 1,700 randomly selected HD patients were reported by 39 randomly selected HD facilities from Beijing, Shanghai, and Guangzhou participating in the DOPPS 7-China study from 2019 to 2021. The study site medical directors completed a survey regarding numerous aspects of HCV treatment and management in HD and ND-CKD patients.

Results

In this 2019 to 2021 cohort, HCV prevalence was 7.4%, which was lower than the 14.8 and 11.5% HCV prevalence for the 2009–2011 and 2012–2015 cohorts, respectively. HCV incidence of 1.2 cases per 100 pt-yrs also was lower compared to the incidence of 2.1 for the 2012–2015 cohort. Although the great majority of study site medical directors indicated that all or nearly HCV+ patients should be treated for their HCV, very few HCV+ patients have been treated presumably due to substantial cost barriers for affording the new direct acting antivirals (DAAs). The randomly selected facilities in our DOPPS 7-China study appear to have excellent programs in place for frequent monitoring of patients and staff for HCV, education of staff, and referral of HCV cases to external infectious disease, gastroenterology, and liver disease specialists. Liver biopsies were not commonly performed in HCV+ HD patients. HCV genotyping also was rarely performed in participating units.

Conclusions

Our study indicates a 50% decline in HCV prevalence and a &gt;40% decline in HCV incidence in Chinese HD patients over the past 10–12 yrs. Chinese HD facilities and associated specialists appear to be well-equipped and organized for successfully treating and managing their HCV+ HD and CKD patients in order to achieve the WHO goal of eliminating HCV by 2030.

Interaction of circulating TGFβ regulatory miRNAs in different severity of diabetic kidney disease

AIMS

To explore the interaction of TGFβ regulatory microRNAs (miRNAs) with different severities of diabetic kidney disease (DKD).

METHODS

According to different UACR (30 and 300 mg/g), 436 subjects were included, and high glucose induced RMCs were cultured. Real-time PCR, ELISA, and automatic biochemical analysis were used to measure miRNAs, TGFβ1, and other biochemical indicators in serum and RMCs. Target genes of miRNA were predicted and visualised by bioinformatics.

RESULTS

HbA1c, TGFβ1, miR-217, and miR-224 in T2DM patients increased with UACR, while miR-192 and miR-216a decreased. Ln UACR was positively correlated with HbA1c, TGFβ1, miR-217, and miR-224, and negatively correlated with miR-192 and miR-216a. High glucose and TGFβ1 affected miRNAs and these miRNAs affected each other. The miRNA target genes mainly revolve around PTEN, PI3K/Akt, and MAPK signalling pathways.

CONCLUSION

TGFβ regulatory miRNAs and different severity of DKD have a potential interaction regulating fibrosis through PTEN, PI3K/Akt, and MAPK pathways.

Undernutrition when young and the risk of poor renal function in adulthood in women with diabetes in Shanghai, China

Objective

To evaluate the effect of undernutrition when young on the risk of poor renal function in adulthood in women with diabetes mellitus.

Methods

We studied diabetic women born between 1921 and 1958 who were exposed to the 1959-to-1962 Chinese famine when they were 0 to 37 years old. Exposure age was classified as young adulthood (18 to 37 years), adolescence (10 to 17 years), or childhood (0 to 9 years). The Adolescence group, which was provided with the largest amount of food during the famine, was used as the control group, and variance and binary logistic regression analyses were performed.

Results

The prevalences of low estimated glomerular filtration rate (eGFR) in the Childhood, Adolescence, and Young adulthood groups were 5.26%, 22.39%, and 79.24%, respectively. The risk of low eGFR for the Young adulthood group (odds ratio [OR] 1.65, 95% confidence interval [CI] 1.10, 2.48), but not for the Childhood group (OR 1.10, 95% CI 0.68, 1.78), was higher than that for the Adolescence group after adjustment for potential confounders.

Conclusions

Undernutrition during young adulthood significantly increases the risk of renal dysfunction in adult women with diabetes. Therefore, the nutrition of less affluent young women should be improved.

Estimation of risk for major bleeding in native kidney biopsies in patients with multiple risk factors

BACKGROUND AND AIMS

Individuals undergoing kidney biopsy are increasingly older and may have concurrent illnesses that cause deranged hematological and renal parameters that are associated with post-biopsy bleeding. We aimed to develop a clinical risk model to quantify bleeding risks in high-risk individuals with multiple risk factors.

METHODS

Single-center retrospective cohort study of consecutive adults with serum creatinine ≥ 2 mg/dL (176 µmol/L) and had ultrasound-guided percutaneous native kidney biopsies between June 2011 and July 2015 in our tertiary referral center. The primary outcome was major bleeding, defined as need for red cell transfusion, radiological or surgical intervention, or if bleeding led to death within 7 days after kidney biopsy.

RESULTS

Among 184 native kidney biopsies with serum creatinine ≥ 2 mg/dL, median age was 54.1 years and eGFR was 18.8 ml/min/1.73 m². Major bleeding occurred in 19 biopsies (10.3%). Multivariate analysis accounting for age, weight, hemoglobin, platelet, prothrombin time and urea found that higher hemoglobin (adjusted OR 0.51, 95% CI 0.33-0.79, p = 0.003) and platelet (adjusted OR 0.99, 95% CI 0.98-0.99, p = 0.01) were independently associated with reduced major bleeding. A risk model that included (1) age ≥ 62 years old, (2) hemoglobin < 10 g/dL and (3) platelets ≤ 216 × 10⁹/L as categorical variables predicted major bleeding post-biopsy.

CONCLUSION

We developed a risk model that included multiple risk factors to quantify bleeding risks in native kidney biopsies with renal impairment.

International Society of Nephrology Global Kidney Health Atlas: structures, organization and services for the management of kidney failure in North and East Asia

Kidney failure (KF) is a public health problem in all regions of the world. We aim to provide comprehensive information regarding the disease burden of KF and capacity for providing optimal care in the International Society of Nephrology North and East Asia region based on data from the International Society of Nephrology Global Kidney Health Atlas project. Seven of eight jurisdictions participated, and wide variation was found in terms of KF burden and care capacity. Prevalence of long-term dialysis ranged from 88.4 per million population in mainland China to 3251 per million population in Taiwan. Hemodialysis was the predominant modality of dialysis in all jurisdictions, except for Hong Kong, where peritoneal dialysis (PD) was much more prevalent than hemodialysis. All jurisdictions provided public funding for kidney replacement therapy (dialysis and transplantation). Although the frequency and duration of hemodialysis followed a standard pattern in all investigated jurisdictions, the density of nephrologists and kidney replacement therapy centers varied according to income level. Conservative care, whether medically advised or chosen by patients, was available in most jurisdictions. All jurisdictions had official registries for KF and recognized KF as a health priority. These comprehensive data provide information about the burden of KF and capacity to provide optimal care in North and East Asia, which varied greatly across jurisdictions in the region.

The Prevalence of Diabetic Microvascular Complications in China and the USA

PURPOSE OF REVIEW

Diabetes can lead to development of devastating microvascular complications, such as nephropathy, retinopathy, and peripheral sensory and autonomic neuropathy. While China and the USA both face the threat of this major public health challenge, the literature is limited in describing similarities and differences in the prevalence, and risk factors for the development, of diabetic microvascular complications between these two countries.

RECENT FINDINGS

The current review discusses the following: (1) the most recent evidence on prevalence of diabetic microvascular complications in China and the USA (including downtrends of diabetes retinopathy and neuropathy in the USA); (2) differences in patient risk factors of these complications; (3) challenges and current knowledge gaps (such as lacking national epidemiological data of diabetic complications in China); and (4) potential future clinical and research opportunities (including needs in diabetes evaluation and management in remote areas and standardization of methods in evaluating diabetic complications across countries). Diabetic microvascular complications remain to be health threats in both China and the USA. Further investigations are needed for comprehensive understanding and effect prevention and management of these complications.

Impact of twice- or three-times-weekly maintenance hemodialysis on patient outcomes: A multicenter randomized trial

AIM

Maintenance hemodialysis (MHD) frequency is associated with survival and complication rates. Achieving the optimal balance between healthcare, quality of life (QOL), and medical costs is challenging. We compared complications, inflammatory status, nutritional status, and QOL between patients with different MHD frequencies.

MATERIAL AND METHODS

This was a multicenter randomized trial of patients treated between May 2011 and August 2017 at 3 tertiary hospitals in Wenzhou. Patients were grouped according to their treatment schedule over 1 year: twice-weekly or 3-times-weekly. Complications, biochemistry parameters, and QOL (KDQOL-SFTM 1.3 scale) were assessed.

RESULTS

One hundred forty patients were included aged 29 to 68 years (mean age, 50.9 ± 4.3 years). There were no significant differences in infection, heart failure, or cerebral hemorrhage complications between the 2 groups (P = .664). Pre-dialysis hemoglobin, high-sensitivity C-reactive protein, serum albumin, total cholesterol, triglyceride, calcium, phosphate, parathyroid hormone, and ejection fraction were similar in both groups (P > .05). After 1 year of MHD, both groups exhibited significant improvements in these parameters (all P < .05) with no significant differences between groups. Serum creatinine, blood urea nitrogen (BUN), and weekly standard hemodialysis treatment adequacy did not improve after treatment (all P > .05), although a difference in BUN was observed between the 2 groups (P < .001). QOL was superior in the twice-weekly group than in the 3-times-weekly group (all P < .05), except for social support, which was slightly better in the 3-times-weekly group than in the twice-weekly group.

CONCLUSIONS

Twice- and 3-times-weekly MHD resulted in comparable inflammatory and nutritional clinical outcomes and adverse events. QOL was better for the twice-weekly schedule. Even for patients with economic constraints, twice- or 3-times-weekly MHD should be selected with caution after consideration of BUN levels at baseline.

Incidence Rates of Four Major Non-Communicable Chronic Diseases in the Chinese Adult Population from 2007 to 2016: A Study Based on a National Commercial Claims Database

Background

The spread of non-communicable chronic diseases (NCDs) is a global crisis. Understanding the dynamics of NCDs at the population level is crucial to develop prevention strategies as well as to evaluate the effectiveness of intervention. However, studies investigating the incidence rate of NCDs among the general population are limited, especially for developing countries like China. We aim to evaluate the incidence rates of four major NCDs from 2007 to 2016, based on a national commercial claims database in China.

Methods

Cancer, stroke, coronary heart disease (CHD) and end-stage kidney disease (ESKD) accounted for over 90% of claims data were included as major NCDs. The definition of the above diseases followed the guideline of disease definitions of critical illness insurance released by the Insurance Association of China. Age-standardized incidence rates (ASRs) of those major NCDs among subgroups of sex, demographic regions, and China city tiers were reported. The trends of incidence rates were described as annual percent change (APC) as well as average annual percent change (AAPC) and were then examined by joinpoint models.

Results

For the population insured in 2007, the average 10-year ASRs of cancer, CHD, stroke, and ESKD were 221.0, 55.5, 43.5, 11.0 per 100,000 person-years, respectively. For males, the ASRs of cancer, CHD, ESKD continuously increase in the past decade with AAPC of 1.4%, 5.2%, and 3.3%; while the ASRs of stroke were decreased with APC of 3.7% after 2009. For females, the increased ASRs of cancer with AAPC of 4.2% and CHD with AAPC of 2.0%; while decreased trends of ASRs were observed for stroke and ESKD. Patterns of ASRs changing varied between different demographic regions and city tiers.

Conclusion

Commercial claims data could be a valuable data source to evaluate the disease burden for major NCDs in China. The disease burden of severe stroke was decreasing while cancer, CHD and ESKD were still increasing in China. More efforts should be put into control of CHD, especially in the northern part of China.

The history of hemodialysis in China

The technique of hemodialysis was introduced into China more than 50 years ago; and both research and use of clinical hemodialysis began in mid-1960s to late-1960s. A brief review of the history of hemodialysis in China is presented here, including a brief description of pioneers and their contributions, local development and use of dialyzers, hemodialysis machines, and vascular access, and dialysis management and logistics.

Using electronic health record data to establish a chronic kidney disease surveillance system in China: protocol for the China Kidney Disease Network (CK-NET)-Yinzhou Study

INTRODUCTION

Chronic kidney disease (CKD) is an important public health problem worldwide. However, there are few active disease surveillance systems for it. The China Kidney Disease Network (CK-NET) was established as a comprehensive surveillance system for CKD using various data sources. As part of this, the proposed CK-NET-Yinzhou study aims to build a regional surveillance system in a developed coastal area in China to obtain detailed dynamic information about kidney disease and to improve the ability to manage the disease effectively.

METHODS AND ANALYSIS

Yinzhou is a district of Ningbo city, Zhejiang province. The district has a population of more than 1 million. By 2016, 98% were registered in a regional health information system that started in 2009. This system includes administrative databases containing general demographic characteristics, health check information, inpatient and outpatient electronic medical records, health insurance information, disease surveillance and management information, and death certificates. We will use longitudinal individual electronic health record data to identify people with CKD by repeated laboratory measurements and diagnostic codes. We will also evaluate the associated risk factors, prognosis and disease management. An intelligent clinical decision support system (CDSS) will be developed based on clinical guidelines, domain expert knowledge and real-world data, and will be integrated into the hospital information system.

ETHICS AND DISSEMINATION

The CK-NET-Yinzhou study has been reviewed and approved by the Peking University First Hospital Ethics Committee. Privacy of local residents registered with the health information system will be tightly protected through the study process. The findings of the study will be disseminated through peer-reviewed journal articles, posters and presentations in national and international scientific conferences, as well as among local practitioners through the CDSS.

Desmopressin for the prevention of bleeding in percutaneous kidney biopsy: efficacy and hyponatremia

BACKGROUND

Desmopressin is used to reduce bleeding complications for kidney biopsies with azotemia but little is known about desmopressin-induced hyponatremia in these individuals. We aimed to evaluate the impact of desmopressin prophylaxis on severe hyponatremia and bleeding after kidney biopsies in individuals with renal impairment.

METHOD

This is a single-center retrospective cohort study of consecutive adults with serum creatinine ≥ 150 µmol/L and had ultrasound-guided percutaneous native or transplant kidney biopsies between June 2011 and July 2015. Data were retrieved from electronic medical records. Primary outcomes were the use of desmopressin prophylaxis and severe hyponatremia (serum sodium ≤ 125 mmol/L) within 7 days post-biopsy. Secondary outcome was post-biopsy bleeding.

RESULTS

240 native kidney and 196 allograft biopsies were performed. Median age was 51 (IQR 42.3, 60) years and eGFR was 21.9 (12.9, 30.1) ml/min/1.73 m². Although patients prescribed desmopressin prophylaxis (n = 226) had higher serum creatinine [279 (201, 392) vs. 187 (160, 241), p < 0.001], bleeding (15.0% vs. 13.3%, p = 0.60) was not significantly different with and without desmopressin. Severe hyponatremia occurred in 30 biopsies (6.9%) with nadir serum sodium level of 122 (119, 124) mmol/L at 3 (2, 5) days after biopsy, more frequently among those with desmopressin prophylaxis (10.7% vs. 3.0%, p = 0.002). Multi-variate analysis found that pre-biopsy serum sodium level [adjusted OR 0.80 (95% CI 0.72, 0.90), p < 0.001] and desmopressin prophylaxis [adjusted OR 4.02 (95% CI 1.58, 10.21), p = 0.003] were independently associated with severe hyponatremia after kidney biopsy.

CONCLUSION

Pre-biopsy desmopressin was associated with severe hyponatremia in individuals with renal impairment; hence, susceptible patients given desmopressin should be closely monitored.

The Correlation between Serum Uric Acid and Renal Function in Elderly Chinese Diabetes with Normoalbuminuria

OBJECTIVE

The elder diabetic patients increases rapidly in China and often accompany with hyperuricemia. Recently evidences show that renal function has been impaired in part of diabetic patients with normoalbuminuria. Therefore, we investigated the relationship between serum uric acid (SUA) and renal function in Chinese elder diabetes with normoalbuminuria.

METHODS

The physical examination data from 1052 cases of diabetic residents with normoalbuminuria aged 70 years and over in the Jiangchuan community of Minhang District, Shanghai, from October 2011 to September 2014 was analyzed retrospectively. Each received height, body weight, waist circumference (WC), waist-to-hip ratio (WHR), blood pressure (BP), and collected samples of fasting blood and morning urine to detect blood routine, blood glucose, glycosylated hemoglobin (HbA1c), blood lipids, serum creatinine, urinary albumin, urine creatinine, and urine PH value. Correlation between SUA and renal function, an index of which is estimated using estimated glomerular filtration rate (eGFR), was analyzed.

RESULTS

The prevalence of hyperuricemia was 21.10%. Levels of WC and triglyceride (TG) increased and the levels of HbA1c, high density lipoprotein-cholesterol (HDL-C), eGFR, and urine PH decreased while the levels of SUA increased. Moreover, negative correlation of eGFR with age, WC, leukocyte, and SUA (Pearson r=0.415) was observed via Pearson correlation analysis. It indicates the strong association between SUA and eGFR. Furthermore, eGFR independently associated with SUA, age, leukocyte, hemoglobin (Hb), and fasting blood glucose (FBG) was confirmed by multiple linear stepwise regression analysis.

CONCLUSION

SUA may play an important role in the decrease of eGFR in elderly Chinese diabetic patients with normoalbuminuria.

Diferenças e desigualdades no acesso a terapia renal substitutiva nos países do BRICS

Resumo A doença renal terminal (DRT) é um importante problema de saúde pública, sobretudo nos países em desenvolvimento, em vista dos altos recursos econômicos necessários para manutenção dos pacientes nas diversas formas de terapias renais substitutivas (TRS) existentes. O objetivo deste artigo é analisar as diferenças e as desigualdades que envolvem o acesso a TRS nos países que compõem o BRICS (Brasil, Rússia, Índia, China e África do Sul). Estudo aplicado, descritivo, transversal, qualitativo e quantitativo, com análise documental e pesquisa bibliográfica, tendo como fonte de dados censos nacionais e publicações científicas envolvendo o acesso a TRS em tais países. Verificou-se evidências de iniquidade no acesso a TRS em todos os países do BRICS, ausência de censos de diálise e transplante nacionais (Índia), ausência de legislações efetivas que inibam a comercialização de órgãos (Índia e África do Sul) e uso de transplantes de doador falecido de prisioneiros (China). A construção de mecanismos que promovam compartilhamento de benefícios e de solidariedade no campo da cooperação internacional na área da saúde renal passa pelo reconhecimento das questões bioéticas que envolvem o acesso a TRS nos países do BRICS.

Epidemiological Study of RRT-Treated ESRD in Nanjing - A Ten-Year Experience in Nearly Three Million Insurance Covered Population

BACKGROUND

The growing burden of end-stage renal disease (ESRD) has been a great challenge to the health care system of China. However, the exact epidemiological data for ESRD in China remain unclear. We aimed to investigate the epidemiology of ESRD treated by renal replacement therapy (RRT) in Nanjing based on analysing ten-year data of Nanjing three million insurance covered population.

METHODS

Using the electronic registry system of Urban Employee Basic Medical Insurance (UEBMI), we included all subjects insured by UEBMI in Nanjing from 2005 to 2014 and identified subjects who developed ESRD and started RRT in this cohort.

RESULTS

The UEBMI population in Nanjing increased from 1,301,882 in 2005 to 2,921,065 in 2014, among which a total of 5,840 subjects developed ESRD and received RRT. Over the 10-year period, the adjusted incidence rates of RRT in the UEBMI cohort gradually decreased from 289.3pmp in 2005 to 218.8pmp in 2014. However, the adjusted prevalence rate increased steadily from 891.7pmp in 2005 to 1,228.6pmp in 2014. The adjusted annual mortality rate decreased from 138.4 per 1000 patient-years in 2005 to 97.8 per 1000 patient-years in 2014. The long-term survival rate fluctuated over the past decade, with the 1-year survival rate ranging from 85.1% to 91.7%, the 3-year survival rate from 69.9% to 78.3% and the 5-year survival rate from 58% to 65.4%.

CONCLUSION

Nanjing is facing an increasing burden of ESRD with its improvement of medical reform. The ten-year complete registry data on RRT in urban employees in Nanjing provided a unique opportunity to understand the real threat of ESRD confronting China during its process of health care transition.