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Boenink R, Kramer A, Masoud S, Rodríguez-Benot A, Helve J, Bistrup C, Segelmark MM, Rodríguez Arévalo OL, Kerschbaum J, de Vries APJ, Lundgren T, Bell S, Crespo M, Sørensen SS, Ferraro PM, Arnol M, Bakkaloglu SA, Weekers L, Reisæter AV, Rebić D, Ortiz A, Jager KJ, Stel VS. International comparison and time trends of first kidney transplant recipient characteristics across Europe: an ERA Registry study. Nephrol Dial Transplant 2024; 39:648-658. [PMID: 37653455 DOI: 10.1093/ndt/gfad189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND The aim of this study was to provide an overview of age, sex and primary renal disease (PRD) distribution among first kidney transplant recipients across Europe. METHOD The European Renal Association (ERA) Registry database was used to obtain data on patients aged 20 years or older receiving their first kidney transplant between 2010 and 2019 from 12 European countries. The numbers and percentages of recipients in each age, sex and PRD group were calculated by country, donor type and year. RESULTS In total, 99 543 adults received a first kidney transplant. Overall, 23% of the recipients were 65 years or older, 36% were female, and 21% had glomerulonephritis and 15% diabetes mellitus as PRD. Compared with deceased donor kidney transplant recipients, living donor kidney transplant recipients were less often 65 years or older (13% versus 26%), more often had glomerulonephritis (25% versus 20%) and less often diabetes mellitus (8% versus 17%) as PRD. We found large international differences, which were most prominent for age and PRD and less prominent for sex. Over time, the largest change in recipient characteristics was observed for the percentage of recipients aged 65 years or older, increasing from 18% in 2010 to 28% in 2019 for all countries combined with a similar trend in most countries. CONCLUSION We observed large differences for age and PRD distribution between recipients of living and deceased donor kidneys and between European countries. Over time, the percentage of older first kidney transplant recipients increased.
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Affiliation(s)
- Rianne Boenink
- ERA Registry, Department of Medical Informatics, Amsterdam UMC location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care and Ageing & Later Life, Amsterdam, The Netherlands
| | - Anneke Kramer
- ERA Registry, Department of Medical Informatics, Amsterdam UMC location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care and Ageing & Later Life, Amsterdam, The Netherlands
| | - Sherry Masoud
- UK Renal Registry, UK Kidney Association, Bristol, UK
- DPMCN, School of Medicine, Cardiff University, Cardiff, UK
- Renal Medicine & Transplantation, North Bristol NHS Trust, Bristol, UK
| | - Alberto Rodríguez-Benot
- Kidney and Pancreas Transplantation Unit, Nephrology Dept University Hospital Reina Sofia, Cordoba, Spain
- Sistema de Información de la Coordinación Autonómica de Trasplantes de Andalucía (SICATA), Spain
| | - Jaakko Helve
- Finnish Registry for Kidney Diseases, Helsinki, Finland
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Claus Bistrup
- Department of Nephrology, Odense University Hospital, Odense, Denmark
| | - Mårten M Segelmark
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Endocrinology, Nephrology and Rheumatology, Skane University Hospital, Lund, Sweden
| | - Olga L Rodríguez Arévalo
- Registry of Renal Patients of the Valencian Community, General Directorate of Public Health and Addictions, Ministry of Universal Health and Public Health, Valencia, Spain
- Health and Well-being Technologies Program, Polytechnic University of Valencia, Valencia, Spain
| | - Julia Kerschbaum
- Austrian Dialysis and Transplant Registry, Department of Internal Medicine IV - Nephrology and Hypertension, Medical University Innsbruck, Innsbruck, Austria
| | - Aiko P J de Vries
- Department of Medicine, Division of Nephrology, Leiden Transplant Center, Leiden University Medical Center and Leiden University, Leiden, The Netherlands
| | - Torbjörn Lundgren
- Division of Transplantation Surgery, CLINTEC, Karolinska Institute, Stockholm, Sweden
| | - Samira Bell
- Scottish Renal Registry, Meridian Court, Glasgow, UK
- Division of Population Health and Genomics, University of Dundee, Dundee, UK
| | - Marta Crespo
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
- Institut Mar d'Investigacions Médiques, Barcelona, Spain
| | - Søren S Sørensen
- Department of Nephrology P, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Pietro Manuel Ferraro
- U.O.S. Terapia Conservativa della Malattia Renale Cronica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Miha Arnol
- Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | | | - Anna Varberg Reisæter
- Department of Transplantation Medicine, Oslo University hospital, Rikshospitalet, Oslo, Norway
| | - Damir Rebić
- Clinic for Nephrology, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Alberto Ortiz
- Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Fundación Renal Iñigo Alvarez de Toledo, Madrid, Spain
| | - Kitty J Jager
- ERA Registry, Department of Medical Informatics, Amsterdam UMC location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care and Ageing & Later Life, Amsterdam, The Netherlands
| | - Vianda S Stel
- ERA Registry, Department of Medical Informatics, Amsterdam UMC location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care and Ageing & Later Life, Amsterdam, The Netherlands
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Helve S, Helanterä I, Laine M, Nieminen T, Finne P, Helve J. Trends and Specific Causes of Cardiovascular Mortality after Kidney Transplantation in Finland. Clin J Am Soc Nephrol 2024; 19:355-363. [PMID: 37962909 PMCID: PMC10937022 DOI: 10.2215/cjn.0000000000000360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/08/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Cardiovascular diseases are an important cause of mortality in patients who have undergone kidney transplantation, but the knowledge on trends of cardiovascular mortality and specific causes of cardiovascular death among these patients is scarce. METHODS Our aim was to compare the cardiovascular mortality rates after kidney transplantation in Finland between 1990-1999, 2000-2009, and 2010-2019 using data from the Finnish Registry for Kidney Diseases. We analyzed 1-year and long-term cardiovascular mortality rates as well as the specific causes of cardiovascular death and the trends in them. RESULTS In total, 4946 patients underwent first kidney transplantation in 1990-2019. During the follow-up time (median 8.3 years, interquartile range 4.0-14.5), there were 1392 deaths, of which 582 were cardiovascular deaths. In an unadjusted Cox regression model, the risk of long-term cardiovascular mortality was similar in the different periods. However, when adjusted for age, sex, duration of dialysis, and cause of kidney disease, the long-term cardiovascular mortality risk was significantly lower in 2000-2009 and 2010-2019 (hazard ratio 0.60 [95% confidence interval, 0.49 to 0.73] and hazard ratio 0.51 [95% confidence interval, 0.39 to 0.66], respectively) compared with 1990-1999. The results were similar regarding 1-year cardiovascular mortality. The distribution of different causes of cardiovascular death remained unchanged during the study period, with coronary artery disease accounting for 47% of deaths. During the first year after transplantation, pulmonary embolisms and arrhythmias were more common than in the long term. CONCLUSIONS Cardiovascular disease remained the most common cause of death in kidney transplant recipients, but adjusted cardiovascular mortality risk has decreased significantly during the past three decades. Coronary artery disease was the most frequent cause of cardiovascular death, and the proportion of coronary artery disease-related cardiovascular deaths increased after the first year after transplantation.
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Affiliation(s)
- Salla Helve
- Department of Internal Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ilkka Helanterä
- Department of Transplantation and Liver Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mika Laine
- Heart and Lung Center, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Tuomo Nieminen
- The Wellbeing Services County of Päijät-Häme, Lahti, Finland
| | - Patrik Finne
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jaakko Helve
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Finnish Registry for Kidney Diseases, Helsinki, Finland
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Boerstra BA, Boenink R, Astley ME, Bonthuis M, Abd ElHafeez S, Arribas Monzón F, Åsberg A, Beckerman P, Bell S, Cases Amenós A, Castro de la Nuez P, ten Dam MAGJ, Debska-Slizien A, Gjorgjievski N, Giudotti R, Helve J, Hommel K, Idrizi A, Indriðason ÓS, Jarraya F, Kerschbaum J, Komissarov KS, Kozliuk N, Kravljaca M, Lassalle M, De Meester JM, Ots-Rosenberg M, Plummer Z, Radunovic D, Razvazhaieva O, Resic H, Rodríguez Arévalo OL, Santiuste de Pablos C, Seyahi N, Slon-Roblero MF, Stendahl M, Tolaj-Avdiu M, Trujillo-Alemán S, Ziedina I, Ziginskiene E, Ortiz A, Jager KJ, Stel VS, Kramer A. The ERA Registry Annual Report 2021: a summary. Clin Kidney J 2024; 17:sfad281. [PMID: 38638342 PMCID: PMC11024806 DOI: 10.1093/ckj/sfad281] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Indexed: 04/20/2024] Open
Abstract
Background The European Renal Association (ERA) Registry collects data on kidney replacement therapy (KRT) in patients with end-stage kidney disease (ESKD). This paper is a summary of the ERA Registry Annual Report 2021, including a comparison across treatment modalities. Methods Data was collected from 54 national and regional registries from 36 countries, of which 35 registries from 18 countries contributed individual patient data and 19 registries from 19 countries contributed aggregated data. Using this data, incidence and prevalence of KRT, kidney transplantation rates, survival probabilities and expected remaining lifetimes were calculated. Result In 2021, 533.2 million people in the general population were covered by the ERA Registry. The incidence of KRT was 145 per million population (pmp). In incident patients, 55% were 65 years or older, 64% were male, and the most common primary renal disease (PRD) was diabetes (22%). The prevalence of KRT was 1040 pmp. In prevalent patients, 47% were 65 years or older, 62% were male, and the most common PRDs were diabetes and glomerulonephritis/sclerosis (both 16%). On 31 December 2021, 56% of patients received haemodialysis, 5% received peritoneal dialysis, and 39% were living with a functioning graft. The kidney transplantation rate in 2021 was 37 pmp, a majority coming from deceased donors (66%). For patients initiating KRT between 2012-2016, 5-year survival probability was 52%. Compared to the general population, life expectancy was 65% and 68% shorter for males and females receiving dialysis, and 40% and 43% shorter for males and females living with a functioning graft.
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Affiliation(s)
- Brittany A Boerstra
- Department of Medical Informatics, University of Amsterdam, ERA Registry, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Public Health, Health Behaviours & Chronic Diseases, Amsterdam, The Netherlands
- Amsterdam Public Health, Ageing & Later Life, Amsterdam, The Netherlands
| | - Rianne Boenink
- Department of Medical Informatics, University of Amsterdam, ERA Registry, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Public Health, Ageing & Later Life, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
| | - Megan E Astley
- Department of Medical Informatics, University of Amsterdam, ERA Registry, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Public Health, Health Behaviours & Chronic Diseases, Amsterdam, The Netherlands
- Amsterdam Public Health, Global Health, Amsterdam, The Netherlands
| | - Marjolein Bonthuis
- Department of Medical Informatics, University of Amsterdam, ERA Registry, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
- Amsterdam Public Health, Methodology, Amsterdam, The Netherlands
| | - Samar Abd ElHafeez
- Department of Medical Informatics, University of Amsterdam, ERA Registry, Amsterdam UMC, Amsterdam, The Netherlands
- Epidemiology Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | | | - Anders Åsberg
- The Norwegian Renal Registry, Department of Transplantation Medicine, Oslo University Hospital – Rikshospitalet, Oslo, Norway
| | - Pazit Beckerman
- Institute of Nephrology and Hypertension, Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Samira Bell
- Scottish Renal Registry, Public Health Scotland, Glasgow, UK
- Division of Population Health & Genomics, University of Dundee, Ninewells Hospital, Dundee, UK
| | | | - Pablo Castro de la Nuez
- SICATA: Information System of the Autonomous Coordination of Transplants of Andalusia, Seville, Andalusia, Spain
| | | | - Alicja Debska-Slizien
- Department of Nephrology, Transplantology and Internal Medicine, Gdańsk Medical University, Gdańsk, Poland
| | - Nikola Gjorgjievski
- Clinic of Nephrology, Skopje, North Macedonia
- Faculty of Medicine, University ‘SS Cyril and Methodius’ Skopje, Skopje, North Macedonia
| | | | - Jaakko Helve
- Finnish Registry for Kidney Diseases, Helsinki, Finland
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kristine Hommel
- Department of Nephrology, Holbaek Hospital, Holbaek, Denmark
| | - Alma Idrizi
- Service of Nephrology, UHC ‘Mother Teresa’, Tirana, Albania
| | - Ólafur S Indriðason
- Division of Nephrology, Landspitali – The National University Hospital of Iceland, Reykjavik, Iceland
| | - Faiçal Jarraya
- Research Lab LR19ES11 and Nephrology, Faculty of Medicine, Sfax University, Sfax, Tunisia
| | - Julia Kerschbaum
- Austrian Dialysis and Transplant Registry, Department of Internal Medicine IV – Nephrology and Hypertension, Medical University Innsbruck, Innsbruck, Austria
| | - Kirill S Komissarov
- Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology, Minsk, Belarus
| | | | - Milica Kravljaca
- Clinic of Nephrology, Clinical Center of Serbia, Belgrade, Serbia
| | - Mathilde Lassalle
- REIN registry (Renal Epidemiology and Information Network), Agence de la Biomédecine, Saint-Denis La Plaine, France
| | | | - Mai Ots-Rosenberg
- Tartu University, Faculty of Medicine, Department of Internal Medicine, Tartu, Estonia
- Tartu University Hospital, Department of Internal Medicine, Tartu, Estonia
| | | | - Danilo Radunovic
- Clinic for Nephrology, Clinical Center of Montenegro, Podgorica, Montenegro
| | | | - Halima Resic
- Society for Nephrology, Dialysis, and Transplantation of Bosnia and Herzegovina, Sarajevo, Bosnia and Herzegovina
| | - Olga Lucía Rodríguez Arévalo
- Registry of Kidney Patients of the Valencian Community, General Directorate of Public Health, Ministry of Health, Valencia, Spain
- Health and Well-being Technologies Program, Polytechnic University of Valencia, Valencia, Spain
| | - Carmen Santiuste de Pablos
- Murcia Renal Registry, Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Nurhan Seyahi
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Nephrology, Istanbul, Turkey
| | | | - Maria Stendahl
- Swedish Renal Registry, Dept of Internal Medicine, Jonkoping Hospital, Jonkoping, Sweden
| | | | - Sara Trujillo-Alemán
- Health Quality Assessment and Information System Service, Dirección General de Programas Asistenciales, Servicio Canario de la Salud, Canary Islands, Spain
| | - Ieva Ziedina
- Center of Nephrology, Pauls Stradins Clinical University Hospital, Riga, Latvia
- Department of Internal Medicine, Riga Stradins University, Riga, Latvia
- Latvian Association of Nephrology, Riga, Latvia
| | - Edita Ziginskiene
- Lithuanian Nephrology, Dialysis and Transplantation Association, Kaunas, Lithuania
- Nephrology Department, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Alberto Ortiz
- Department of Nephrology and Hypertension, IIS-Fundacion Jimenez Diaz UAM, Madrid, Spain
- Department of Medicine, Universidad Autonoma de Madrid, Madrid, Spain
| | - Kitty J Jager
- Department of Medical Informatics, University of Amsterdam, ERA Registry, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Public Health, Ageing & Later Life, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
| | - Vianda S Stel
- Department of Medical Informatics, University of Amsterdam, ERA Registry, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Public Health, Ageing & Later Life, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
| | - Anneke Kramer
- Department of Medical Informatics, University of Amsterdam, ERA Registry, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Public Health, Methodology, Amsterdam, The Netherlands
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Astley ME, Boenink R, Abd ElHafeez S, Trujillo-Alemán S, Arribas F, Åsberg A, Beckerman P, Bell S, Bouzas-Caamaño ME, Farnés JC, Galvão AA, Gjorgjievski N, Kelmendi VG, Guidotti R, Helve J, Idrizi A, Indriðason ÓS, Ioannou K, Kerschbaum J, Komissarov K, Castro de la Nuez P, Lassalle M, Nordio M, Arévalo OLR, Santiuste C, Seyahi N, Roblero MFS, Steenkamp R, ten Dam MAGJ, Zakharova EV, Ziginskiene E, Bonthuis M, Stel VS, Ortiz A, Jager KJ, Kramer A. The ERA Registry Annual Report 2020: a summary. Clin Kidney J 2023; 16:1330-1354. [PMID: 37529647 PMCID: PMC10387405 DOI: 10.1093/ckj/sfad087] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Indexed: 08/03/2023] Open
Abstract
Background The European Renal Association (ERA) Registry collects data on kidney replacement therapy (KRT) in patients with ESKD. This paper is a summary of the ERA Registry Annual Report 2020, also including comparisons among primary renal disease (PRD) groups. Methods Data were collected from 52 national and regional registries from 34 European countries and countries bordering the Mediterranean Sea: 35 registries from 18 countries providing individual level data and 17 registries from 17 countries providing aggregated data. Using this data, KRT incidence and prevalence, kidney transplantation rates, expected remaining lifetimes and survival probabilities were calculated. Results A general population of 654.9 million people was covered by the ERA Registry in 2020. The overall incidence of KRT was 128 per million population (p.m.p.). In incident KRT patients, 54% were older than 65 years, 63% were men and the most common PRD was diabetes mellitus (21%). Regarding initial treatment modality in incident patients, 85% received haemodialysis (HD), 11% received peritoneal dialysis (PD) and 4% received a pre-emptive kidney transplant. On 31 December 2020, the prevalence of KRT was 931 p.m.p. In prevalent patients, 45% were older than 65 years, 60% were men and glomerulonephritis was the most common PRD (18%). Of these patients, 58% were on HD, 5% on PD and 37% were living with a kidney transplant. The overall kidney transplantation rate in 2020 was 28 p.m.p., with a majority of kidney grafts from deceased donors (71%). The unadjusted 5-year survival, based on incident dialysis patient from 2011-15, was 41.8%. For patients having received a deceased donor transplant, the unadjusted 5-year survival probability was 86.2% and for patients having received a living donor transplant it was 94.4%. When comparing data by PRD group, differences were found regarding the distribution of age groups, sex and treatment modality received.
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Affiliation(s)
| | - Rianne Boenink
- ERA Registry, Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care and Ageing & Later Life, Amsterdam, The Netherlands
| | - Samar Abd ElHafeez
- ERA Registry, Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Epidemiology Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Sara Trujillo-Alemán
- Health Quality Assessment and Information System Service, Dirección General de Programas Asistenciales, Servicio Canario de la Salud, Canary Islands, Spain
| | - Federico Arribas
- Department of Aragon Health, General Direction of Health Care, Zaragoza, Spain
| | - Anders Åsberg
- The Norwegian Renal Registry, Department of Transplantation Medicine, Oslo University Hospital – Rikshospitalet, Oslo, Norway
| | - Pazit Beckerman
- Sheba Medical Center, Ramat Gan, and School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Samira Bell
- Scottish Renal Registry, Public Health Scotland, Glasgow, UK
- Division of Population Health & Genomics, University of Dundee, Ninewells Hospital, Dundee, United Kingdom
| | | | - Jordi Comas Farnés
- Catalan Renal Registry, Catalan Transplant Organization, Health Department, Generalitat of Catalonia, Barcelona, Spain
| | | | - Nikola Gjorgjievski
- Hospital of Nephrology, Skopje, N. Macedonia
- Faculty of Medicine, University “SS Cyril and Methodius” Skopje, Skopje, N. Macedonia
| | | | - Rebecca Guidotti
- Institute of Nephrology, City Hospital Zurich, Zurich, Switzerland
| | - Jaakko Helve
- Finnish Registry for Kidney Diseases and Abdominal Center Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Alma Idrizi
- Service of Nephrology, UHC Mother Teresa, Tirana, Albania
| | - Ólafur S Indriðason
- Division of Nephrology, Landspitali–The National University Hospital of Iceland, Reykjavik, Iceland
| | | | - Julia Kerschbaum
- Austrian Dialysis and Transplant Registry, Department of Internal Medicine IV–Nephrology and Hypertension, Medical University Innsbruck, Innsbruck, Austria
| | - Kirill Komissarov
- Minsk Scientific and Practical Center of Surgery, Transplantation and Hematology, Minsk, Belarus
| | - Pablo Castro de la Nuez
- SICATA: Information System of the Autonomous Coordination of Transplants of Andalusia, Seville, Andalucia, Spain
| | - Mathilde Lassalle
- REIN Registry, Agence de la Biomédecine, Saint-Denis La Plaine, France
| | - Maurizio Nordio
- Division of Nephrology, AULSS 2, Treviso General Hospital, Treviso, Italy
| | - Olga Lucía Rodríguez Arévalo
- Registry of Renal Patients of the Valencian Community, General Directorate of Public Health and Addictions, Ministry of Universal Health and Public Health, Valencia, Spain
- Health and Well-being Technologies Program, Polytechnic University of Valencia, Valencia, Spain
| | - Carmen Santiuste
- Murcia Renal Registry, Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Nurhan Seyahi
- Department of Nephrology, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | | | | | | | - Elena V Zakharova
- Nephrology, Botkin Hospital, Moscow, Russia
- Nephrology and Hemodialysis, Russian Medical Academy of Continuing Professional Education, Moscow, Russia
| | - Edita Ziginskiene
- Lithuanian Nephrology, Dialysis and Transplantation Association, Kaunas, Lithuania
- Nephrology Department, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Marjolein Bonthuis
- ERA Registry, Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
- ESPN/ERA Registry, Amsterdam UMC location University of Amsterdam, Department of Medical Informatics, Amsterdam, The Netherlands
| | - Vianda S Stel
- ERA Registry, Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care and Ageing & Later Life, Amsterdam, The Netherlands
| | - Alberto Ortiz
- Department of Nephrology and Hypertension, IIS-Fundacion Jimenez Diaz UAM, Madrid, Spain
- Department of Medicine, Universidad Autonoma de Madrid, Madrid, Spain
| | - Kitty J Jager
- ERA Registry, Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care and Ageing & Later Life, Amsterdam, The Netherlands
| | - Anneke Kramer
- ERA Registry, Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
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Bitar W, Helve J, Kanerva M, Honkanen E, Rauta V, Haapio M, Finne P. Severe infections in peritoneal dialysis and home hemodialysis patients: An inception cohort study. PLoS One 2023; 18:e0286579. [PMID: 37314998 DOI: 10.1371/journal.pone.0286579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 05/19/2023] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVES Infections are the most common non-cardiovascular cause of death among dialysis patients. Earlier studies have shown similar or higher risk of infectious complications in peritoneal dialysis (PD) compared to hemodialysis (HD) patients, but comparisons to home HD patients have been rare. We investigated the risk of severe infections after start of continuous ambulatory PD (CAPD) and automated PD (APD) as compared to home HD. METHODS All adult patients (n = 536), who were on home dialysis at day 90 from starting kidney replacement therapy (KRT) between 2004 and 2017 in Helsinki healthcare district, were included. We defined severe infection as an infection with C-reactive protein of 100 mg/l or higher. Cumulative incidence of first severe infection was assessed considering death as a competing risk. Hazard ratios were estimated using Cox regression with propensity score adjustment. RESULTS The risk of getting a severe infection during the first year of dialysis was 35% for CAPD, 25% for APD and 11% for home HD patients. During five years of follow-up, the hazard ratio of severe infection was 2.8 [95% CI 1.6-4.8] for CAPD and 2.2 [95% CI 1.4-3.5] for APD in comparison to home HD. Incidence rate of severe infections per 1000 patient-years was 537 for CAPD, 371 for APD, and 197 for home HD patients. When excluding peritonitis, the incidence rate was not higher among PD than home HD patients. CONCLUSIONS CAPD and APD patients had higher risk of severe infections than home HD patients. This was explained by PD-associated peritonitis.
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Affiliation(s)
- Wisam Bitar
- Department of Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Jaakko Helve
- Department of Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
- Finnish Registry for Kidney Diseases, Finnish Kidney and Liver Association, Helsinki, Finland
| | - Mari Kanerva
- Department of Infectious Diseases, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Eero Honkanen
- Department of Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Virpi Rauta
- Department of Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
- IT Management, Helsinki and Uusimaa Hospital District, Helsinki, Finland
| | - Mikko Haapio
- Department of Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Patrik Finne
- Department of Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
- Finnish Registry for Kidney Diseases, Finnish Kidney and Liver Association, Helsinki, Finland
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Haapio M, van Diepen M, Steenkamp R, Helve J, Dekker FW, Caskey F, Finne P. Predicting mortality after start of long-term dialysis-International validation of one- and two-year prediction models. PLoS One 2023; 18:e0280831. [PMID: 36812268 PMCID: PMC9946236 DOI: 10.1371/journal.pone.0280831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 01/10/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Mortality prediction is critical on long-term kidney replacement therapy (KRT), both for individual treatment decisions and resource planning. Many mortality prediction models already exist, but as a major shortcoming most of them have only been validated internally. This leaves reliability and usefulness of these models in other KRT populations, especially foreign, unknown. Previously two models were constructed for one- and two-year mortality prediction of Finnish patients starting long-term dialysis. These models are here internationally validated in KRT populations of the Dutch NECOSAD Study and the UK Renal Registry (UKRR). METHODS We validated the models externally on 2051 NECOSAD patients and on two UKRR patient cohorts (5328 and 45493 patients). We performed multiple imputation for missing data, used c-statistic (AUC) to assess discrimination, and evaluated calibration by plotting average estimated probability of death against observed risk of death. RESULTS Both prediction models performed well in the NECOSAD population (AUC 0.79 for the one-year model and 0.78 for the two-year model). In the UKRR populations, performance was slightly weaker (AUCs: 0.73 and 0.74). These are to be compared to the earlier external validation in a Finnish cohort (AUCs: 0.77 and 0.74). In all tested populations, our models performed better for PD than HD patients. Level of death risk (i.e., calibration) was well estimated by the one-year model in all cohorts but was somewhat overestimated by the two-year model. CONCLUSIONS Our prediction models showed good performance not only in the Finnish but in foreign KRT populations as well. Compared to the other existing models, the current models have equal or better performance and fewer variables, thus increasing models' usability. The models are easily accessible on the web. These results encourage implementing the models into clinical decision-making widely among European KRT populations.
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Affiliation(s)
- Mikko Haapio
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- * E-mail:
| | - Merel van Diepen
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Jaakko Helve
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Finnish Registry for Kidney Diseases, Helsinki, Finland
| | - Friedo W. Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Fergus Caskey
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Patrik Finne
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Finnish Registry for Kidney Diseases, Helsinki, Finland
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7
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Boenink R, Kramer A, Tuinhout RE, Savoye E, Åsberg A, Idrizi A, Kerschbaum J, Ziedina I, Ziginskiene E, Farrugia E, Garneata L, Zakharova EV, Bell S, Arnol M, Segelmark M, Ioannou K, Hommel K, Rosenberg-Ots M, Vazelov E, Helve J, Mihály S, Pálsson R, Nordio M, Gjorgjievski N, de Vries APJ, Seyahi N, Magadi WA, Resić H, Kalachyk A, Rahmel AO, Galvão AA, Naumovic R, Lundgren T, Arici M, de Meester JM, Ortiz A, Jager KJ, Stel VS. Trends in kidney transplantation rate across Europe: Study from the ERA Registry. Nephrol Dial Transplant 2023; 38:1528-1539. [PMID: 36610723 DOI: 10.1093/ndt/gfac333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The aim of this study was to identify trends in total, deceased donor and living donor kidney transplantation (KT) rates in European countries. METHODS The European Renal Association (ERA) Registry and the Global Observatory on Donation and Transplantation (GODT) databases were used to obtain the number of KTs in individual European countries between 2010 and 2018. General population counts were obtained from Eurostat or the national bureaus of statistics. The KT rate per million population (pmp) and the average annual percentage change (APC) were calculated. RESULTS The total KT rate in the 40 participating countries increased with 1.9% annually (95% confidence interval (CI): 1.5, 2.2) from 29.6 pmp in 2010 to 34.7 pmp in 2018, reflecting an increase of 3.4 pmp in the deceased donor KT rate (from 21.6 pmp to 25.0 pmp, APC: 1.9% [95%CI: 1.3, 2.4]) and of 1.5 pmp in the living donor KT rate (from 8.1 pmp to 9.6 pmp, APC: 1.6% [95%CI: 1.0, 2.3]). The trends in KT rate varied widely across European countries. An East-West gradient was observed for deceased donor KT rate with Western European countries performing more KTs. In addition, most countries performed less living donor KTs. In 2018, Spain had the highest deceased donor KT rate (64.6 pmp) and Turkey the highest living donor KT rate (37.0 pmp). CONCLUSIONS The total KT rate increased due to a rise in the KT rate from deceased donors and to a lesser extent from living donors, with large differences between individual European countries.
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Affiliation(s)
- Rianne Boenink
- ERA Registry, Amsterdam UMC location University of Amsterdam, Department of Medical Informatics, Amsterdam, The Netherlands.,Amsterdam Public Health, Quality of Care and Ageing & Later Life, Amsterdam, The Netherlands
| | - Anneke Kramer
- ERA Registry, Amsterdam UMC location University of Amsterdam, Department of Medical Informatics, Amsterdam, The Netherlands.,Amsterdam Public Health, Quality of Care and Ageing & Later Life, Amsterdam, The Netherlands
| | - Rosalie E Tuinhout
- ERA Registry, Amsterdam UMC location University of Amsterdam, Department of Medical Informatics, Amsterdam, The Netherlands
| | - Emilie Savoye
- Direction Prélèvement Greffe Organes-Tissus, Agence de la biomédecine, Saint-Denis La Plaine, France
| | - Anders Åsberg
- The Norwegian Renal Registry, Department of Transplantation, Oslo University Hospital - Rikshospitalet, Oslo, Norway.,Department of Pharmacy, University of Oslo, Oslo, Norway
| | - Alma Idrizi
- Service of Nephrology, UHC "Mother Teresa, Tirana, Albania
| | - Julia Kerschbaum
- Austrian Dialysis and Transplant Registry, Department of Internal Medicine IV - Nephrology and Hypertension, Medical University Innsbruck, Innsbruck, Austria
| | - Ieva Ziedina
- Pauls Stradins clinical university hospital, Riga, Latvia
| | - Edita Ziginskiene
- Lithuanian Nephrology, Dialysis and Transplantation Association, Lithuania.,Nephrology Department, Medical Academy, Lithuanian University of Health Sciences, Lithuania
| | | | - Liliana Garneata
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of Internal Medicine and Nephrology, Dr Carol Davila Teaching Hospital of Nephrology, Bucharest, Romania
| | - Elena V Zakharova
- Nephrology and Hemodialysis, Russian Medical Academy of Continuing Professional Education, Moscow, Russian Federation
| | - Samira Bell
- Scottish Renal Registry, Public Health Scotland, Meridian Court, Glasgow, United Kingdom.,Division of Population Health & Genomics, University of Dundee, Ninewells Hospital, Dundee, United Kingdom
| | - Miha Arnol
- Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Mårten Segelmark
- Department of Clinical Sciences in Lund, Lund University and Skane University Hospital, Lund, Sweden
| | | | - Kristine Hommel
- Department of Cardiology, Endocrinology and Nephrology, Holbaek Hospital, Holbaek, Denmark
| | - Mai Rosenberg-Ots
- Department of Internal Medicine, Tartu University and Tartu University Hospital, Tartu, Estonia
| | | | - Jaakko Helve
- Finnish Registry for Kidney Diseases, Helsinki, Finland.,Nephrology, Abdominal Center, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Sándor Mihály
- Hungarian National Blood Transfusion Service, Budapest, Hungary
| | - Runólfur Pálsson
- Division of Nephrology, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland.,Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | | | - Nikola Gjorgjievski
- University Hospital of Nephrology, Skopje, North Macedonia.,Faculty of Medicine, University Ss Cyril and Methodius, Skopje, North Macedonia
| | - Aiko P J de Vries
- Department of Medicine, Division of Nephrology, Leiden Transplant Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Nurhan Seyahi
- Department of nephrology, Istanbul University-Cerrahpasa, Cerrahpasa medical faculty, Istanbul, Turkey
| | | | - Halima Resić
- Society of nephrology and dialysis of Bosnia and Herzegovina, Sarajevo, Bosnia and Herzegovina
| | - Aleh Kalachyk
- Minsk Scientific and Practical Center for Surgery, Transplantation and Hematology, State Institution, Minsk, Republic of Belarus
| | - Axel O Rahmel
- Deutsche Stiftung Organtransplantation, Frankfurt am Main, Germany
| | - Ana A Galvão
- Portuguese Society of Nephrology, Coimbra, Portugal
| | - Radomir Naumovic
- Zvezdara University Clinical Hospital, Belgrade, Serbia.,High Medical School, University of Belgrade, Belgrade, Serbia
| | - Torbjörn Lundgren
- Division of Transplantation Surgery, CLINTEC, Karolinska Institute, Stockholm, Sweden
| | - Mustafa Arici
- Department of Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Johan M de Meester
- Department of Nephrology, Dialysis and Hypertension, Dutch-speaking Belgian Renal Registry (NBVN), VITAZ, Sint-Niklaas, Belgium
| | - Alberto Ortiz
- Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Fundación Renal Iñigo Alvarez de Toledo, Madrid, Spain
| | - Kitty J Jager
- ERA Registry, Amsterdam UMC location University of Amsterdam, Department of Medical Informatics, Amsterdam, The Netherlands.,Amsterdam Public Health, Quality of Care and Ageing & Later Life, Amsterdam, The Netherlands
| | - Vianda S Stel
- ERA Registry, Amsterdam UMC location University of Amsterdam, Department of Medical Informatics, Amsterdam, The Netherlands.,Amsterdam Public Health, Quality of Care and Ageing & Later Life, Amsterdam, The Netherlands
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8
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Huijben JA, Kramer A, Kerschbaum J, de Meester J, Collart F, Arévalo OLR, Helve J, Lassalle M, Palsson R, Ten Dam M, Casula A, Methven S, Ortiz A, Ferraro PM, Segelmark M, Mingo PU, Arici M, Reisæter AV, Stendahl M, Stel VS, Jager KJ. Increasing numbers and improved overall survival of patients on kidney replacement therapy over the last decade in Europe: an ERA Registry study. Nephrol Dial Transplant 2022; 38:1027-1040. [PMID: 35974693 PMCID: PMC10064979 DOI: 10.1093/ndt/gfac165] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The aim of this study was to describe the trends in the incidence, prevalence and survival of patients on kidney replacement therapy (KRT) for end-stage kidney disease (ESKD) across Europe from 2008 to 2017. METHODS Data from renal registries in 9 countries and 16 regions that provided individual patient data to the ERA Registry from 2008 to 2017 were included. These registries cover 34% of the general population in Europe. Crude and standardized incidence and prevalence per million population (pmp) were determined. Trends over time were studied using Joinpoint regression. Survival probabilities were estimated using Kaplan-Meier analysis and hazard ratios (HRs) using Cox regression analysis. RESULTS The standardized incidence of KRT was stable (annual percentage change [APC]: -1.48 [-3.15; 0.21]) from 2008 (146.0 pmp) to 2011 (141.6 pmp), followed by a slight increase (APC: 1.01 [0.43; 1.60]) to 148.0 pmp in 2017, although trends in incidence varied across countries. This increase was primarily due to a rise in the incidence of KRT in men older than 65 years. Moreover, as a cause of kidney failure, diabetes mellitus is increasing. The standardized prevalence increased from 2008 (990.0 pmp) to 2017 (1166.8 pmp) (APC: 1.82 [1.75; 1.89]). Patient survival on KRT improved in the time period 2011-2013 compared with 2008-2010 (adjusted HR: 0.94 [0.93; 0.95). CONCLUSION This study showed an overall increase in the incidence and prevalence of KRT for ESKD as well as an increase in the KRT patient survival over the last decade in Europe.
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Affiliation(s)
- Jilske A Huijben
- Department of Medical Informatics, ERA-EDTA Registry, Amsterdam UMC, Academic Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Anneke Kramer
- Department of Medical Informatics, ERA-EDTA Registry, Amsterdam UMC, Academic Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Julia Kerschbaum
- Austrian Dialysis and Transplant Registry, Department of Internal Medicine IV - Nephrology and Hypertension, Medical University Innsbruck, Austria
| | - Johan de Meester
- Department of Nephrology, Dialysis and Hypertension, Dutch-speaking Belgian Renal Registry (NBVN), Sint-Niklaas, Belgium
| | | | - Olga Lucía Rodríguez Arévalo
- Valencia Region Renal Registry, Dirección General de Salut Publica i Adiccions, Valencia, Spain.,Doctoral student of the Technologies for Health and Well-being program, Universidad Politécnica de Valencia, Valencia, Spain
| | - Jaakko Helve
- Finnish Registry for Kidney Diseases, Helsinki, Finland.,Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mathilde Lassalle
- REIN Registry, Agence de la Biomédecine, Saint-Denis La Plaine, France
| | - 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
| | - Marc Ten Dam
- Dutch Registry RENINE, Nefrovisie, Utrecht, The Netherlands
| | - Anna Casula
- UK Renal Registry, the Renal Association, Bristol, UK
| | - Shona Methven
- Department of Renal Medicine, Aberdeen Royal Infirmary, Foresterhill Health Campus, Aberdeen, UK
| | - Alberto Ortiz
- School of Medicine, IIS-Fundacion Jimenez Diaz, University Autonoma of Madrid, FRIAT and REDINREN, Madrid, Spain
| | - Pietro Manuel Ferraro
- U.O.S. Terapia Conservativa della Malattia Renale Cronica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mårten Segelmark
- Department of Clinical Sciences, Division of Nephrology, Lund University and Skane University Hospital, Lund, Sweden.,Swedish Renal Registry, Department of Internal Medicine, Ryhov County Hospital, Jönköping, Sweden
| | - Pablo Ucio Mingo
- Coordinador Autonómico de Trasplantes de Castilla y León, Dirección General de Planificación y Asistencia Sanitaria, Valladolid, Castilla y León, Spain
| | - Mustafa Arici
- Department of Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Anna Varberg Reisæter
- Department of Transplantation Medicine, Oslo University hospital, Rikshospitalet, Norway
| | - Maria Stendahl
- Swedish Renal Registry, Department of Internal Medicine, Ryhov County Hospital, Jönköping, Sweden
| | - Vianda S Stel
- Department of Medical Informatics, ERA-EDTA Registry, Amsterdam UMC, Academic Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Kitty J Jager
- Department of Medical Informatics, ERA-EDTA Registry, Amsterdam UMC, Academic Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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9
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Ocak G, Boenink R, Noordzij M, Bos WJW, Vikse BE, Cases A, Kerschbaum J, Helve J, Nordio M, Arici M, Mercadal L, Wanner C, Palsson R, Hommel K, De Meester J, Kostopoulou M, Santamaria R, Rodrigo E, Rydell H, Bell S, Massy ZA, Jager KJ, Kramer A. Trends in Mortality Due to Myocardial Infarction, Stroke, and Pulmonary Embolism in Patients Receiving Dialysis. JAMA Netw Open 2022; 5:e227624. [PMID: 35435972 PMCID: PMC9016490 DOI: 10.1001/jamanetworkopen.2022.7624] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE During the past decades, improvements in the prevention and management of myocardial infarction, stroke, and pulmonary embolism have led to a decline in cardiovascular mortality in the general population. However, it is unknown whether patients receiving dialysis have also benefited from these improvements. OBJECTIVE To assess the mortality rates for myocardial infarction, stroke, and pulmonary embolism in a large cohort of European patients receiving dialysis compared with the general population. DESIGN, SETTING, AND PARTICIPANTS In this cohort study, adult patients who started dialysis between 1998 and 2015 from 11 European countries providing data to the European Renal Association Registry were and followed up for 3 years. Data were analyzed from September 2020 to February 2022. EXPOSURES Start of dialysis. MAIN OUTCOMES AND MEASURES The age- and sex-standardized mortality rate ratios (SMRs) with 95% CIs were calculated by dividing the mortality rates in patients receiving dialysis by the mortality rates in the general population for 3 equal periods (1998-2003, 2004-2009, and 2010-2015). RESULTS In total, 220 467 patients receiving dialysis were included in the study. Their median (IQR) age was 68.2 (56.5-76.4) years, and 82 068 patients (37.2%) were female. During follow-up, 83 912 patients died, of whom 7662 (9.1%) died because of myocardial infarction, 5030 (6.0%) died because of stroke, and 435 (0.5%) died because of pulmonary embolism. Between the periods 1998 to 2003 and 2010 to 2015, the SMR of myocardial infarction decreased from 8.1 (95% CI, 7.8-8.3) to 6.8 (95% CI, 6.5-7.1), the SMR of stroke decreased from 7.3 (95% CI, 7.0-7.6) to 5.8 (95% CI, 5.5-6.2), and the SMR of pulmonary embolism decreased from 8.7 (95% CI, 7.6-10.1) to 5.5 (95% CI, 4.5-6.6). CONCLUSIONS AND RELEVANCE In this cohort study of patients receiving dialysis, mortality rates for myocardial infarction, stroke, and pulmonary embolism decreased more over time than in the general population.
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Affiliation(s)
- Gurbey Ocak
- Department of Internal Medicine, Sint Antonius Hospital, Nieuwegein, the Netherlands
| | - Rianne Boenink
- European Renal Association Registry, Department of Medical Informatics, Amsterdam Universitair Medische Centra, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Marlies Noordzij
- European Renal Association Registry, Department of Medical Informatics, Amsterdam Universitair Medische Centra, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Willem Jan W. Bos
- Department of Internal Medicine, Sint Antonius Hospital, Nieuwegein, the Netherlands
- Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Bjorn E. Vikse
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Medicine, Haugesund Hospital, Haugesund, Norway
| | - Aleix Cases
- Nephrology Department, Hospital Clínic, Universitat de Barcelona, August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain
- Registre de Malalts Renals de Catalunya, Barcelona, Spain
| | - Julia Kerschbaum
- Department of Internal Medicine IV - Nephrology and Hypertension, Austrian Dialysis and Transplant Registry, Medical University Innsbruck, Innsbruck, Austria
| | - Jaakko Helve
- Finnish Registry for Kidney Diseases, Helsinki, Finland
- Abdominal Center Nephrology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Maurizio Nordio
- Veneto Dialysis and Transplantation Registry, Regional Epidemiology System, Padua, Italy
- Nephrology Dialysis and Renal Transplantation Unit, Treviso, Italy
| | - Mustafa Arici
- Department of Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Lucile Mercadal
- Department of Nephrology and Renal Transplantation, Assistance Publique-Hôpitaux de Paris, Hôpital de La Pitié Salpêtrière Hospital, Paris, France
| | - Christoph Wanner
- Division of Nephrology, Department of Medicine, University Hospital of Würzburg, Würzburg, Germany
| | - 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
| | | | - Johan De Meester
- Department of Nephrology, Dialysis and Hypertension, Dutch-speaking Belgian Renal Registry (NBVN), Sint-Niklaas, Belgium
| | | | - Rafael Santamaria
- Andalusian Autonomous Transplant Coordination Information System, Seville, Spain
- Nephrology ServiceReina Sofia University Hospital, Cordoba, Spain
| | - Emilio Rodrigo
- Nephrology Service, University Hospital Marqués de Valdecilla/IDIVAL, University of Cantabria, Santander, Spain
| | - Helena Rydell
- Division of Renal Medicine, Department of Clinical Sciences Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Swedish Renal Registry, Department of Internal Medicine, Ryhov Regional Hospital, Jönköping, Sweden
| | - Samira Bell
- Scottish Renal Registry, Meridian Court, Glasgow, United Kingdom
- Division of Population health And Genomics, University of Dundee, Dundee, United Kingdom
| | - Ziad A. Massy
- Division of Nephrology, Ambroise Paré University Hospital, Boulogne-Billancourt, France
- Institut National de la Santé et de la Recherche Médicale, Research Centre in Epidemiology and Population Health, University of Paris Ouest-Versailles-St Quentin-en-Yveline, Villejuif, France
| | - Kitty J. Jager
- European Renal Association Registry, Department of Medical Informatics, Amsterdam Universitair Medische Centra, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Anneke Kramer
- European Renal Association Registry, Department of Medical Informatics, Amsterdam Universitair Medische Centra, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, the Netherlands
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10
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Helve J, Haapio M, Groop PH, Finne P. Primary kidney disease modifies the effect of comorbidities on kidney replacement therapy patients' survival. PLoS One 2021; 16:e0256522. [PMID: 34415958 PMCID: PMC8378722 DOI: 10.1371/journal.pone.0256522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 08/09/2021] [Indexed: 11/19/2022] Open
Abstract
Background Comorbidities are associated with increased mortality among patients receiving long-term kidney replacement therapy (KRT). However, it is not known whether primary kidney disease modifies the effect of comorbidities on KRT patients’ survival. Methods An incident cohort of all patients (n = 8696) entering chronic KRT in Finland in 2000–2017 was followed until death or end of 2017. All data were obtained from the Finnish Registry for Kidney Diseases. Information on comorbidities (coronary artery disease, peripheral vascular disease, left ventricular hypertrophy, heart failure, cerebrovascular disease, malignancy, obesity, underweight, and hypertension) was collected at the start of KRT. The main outcome measure was relative risk of death according to comorbidities analyzed in six groups of primary kidney disease: type 2 diabetes, type 1 diabetes, glomerulonephritis (GN), polycystic kidney disease (PKD), nephrosclerosis, and other or unknown diagnoses. Kaplan-Meier estimates and Cox regression were used for survival analyses. Results In the multivariable model, heart failure increased the risk of death threefold among PKD and GN patients, whereas in patients with other kidney diagnoses the increased risk was less than twofold. Obesity was associated with worse survival only among GN patients. Presence of three or more comorbidities increased the age- and sex-adjusted relative risk of death 4.5-fold in GN and PKD patients, but the increase was only 2.5-fold in patients in other diagnosis groups. Conclusions Primary kidney disease should be considered when assessing the effect of comorbidities on survival of KRT patients as it varies significantly according to type of primary kidney disease.
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Affiliation(s)
- Jaakko Helve
- Finnish Registry for Kidney Diseases, Helsinki, Finland
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- * E-mail:
| | - Mikko Haapio
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Per-Henrik Groop
- Finnish Registry for Kidney Diseases, Helsinki, Finland
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Institute of Genetics, Folkhälsan Research Center Biomedicum Helsinki, Helsinki, Finland
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, Australia
| | - 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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11
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Bitar W, Helve J, Honkanen E, Rauta V, Haapio M, Finne P. Similar survival on home hemodialysis and automated peritoneal dialysis: an inception cohort study. Nephrol Dial Transplant 2021; 37:1545-1551. [PMID: 34363472 PMCID: PMC9317172 DOI: 10.1093/ndt/gfab233] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Several studies have shown superior survival of patients on home hemodialysis (HD) compared to peritoneal dialysis (PD), but patients on automated PD (APD) and continuous ambulatory PD (CAPD) have not been considered separately. As APD allows larger fluid volumes and may be more efficient than CAPD, we primarily compared patient survival between APD and home HD. METHODS All adult patients who started kidney replacement therapy (KRT) between 2004 and 2017 in the district of Helsinki-Uusimaa in Finland, and who were on one of the home dialysis modalities at 90 days from starting KRT, were included. We used intention-to-treat analysis.Survival of home HD, APD and CAPD patients was studied using Kaplan-Meier curves and Cox regression with adjustment for propensity scores that were based on extensive data on possible confounding factors. RESULTS The probability of surviving 5 years was 90% for home HD, 88% for APD and 56% for CAPD patients. After adjustment for propensity score, the hazard ratio of death was 1.1 [95% CI 0.52-2.4] for APD and 1.6 [95% CI 0.74-3.6] for CAPD in comparison to home HD. Censoring at the time of kidney transplantation or at transfer to in-center hemodialysis did not change the results. Characteristics of home HD and APD patients at the start of dialysis were similar, whereas patients on CAPD had higher median age and more comorbidities, and received kidney transplantation less frequently. CONCLUSIONS Home HD and APD patients had comparable characteristics and their survival appeared similar.
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Affiliation(s)
- Wisam Bitar
- Nephrology Department, University of Helsinki, Helsinki University Central Hospital, Helsinki, Finland
| | - Jaakko Helve
- Nephrology Department, University of Helsinki, Helsinki University Central Hospital, Helsinki, Finland.,Finnish Registry for Kidney Diseases, Helsinki, Finland
| | - Eero Honkanen
- Nephrology Department, University of Helsinki, Helsinki University Central Hospital, Helsinki, Finland
| | - Virpi Rauta
- Nephrology Department, University of Helsinki, Helsinki University Central Hospital, Helsinki, Finland.,Helsinki University Central Hospital, IT Management
| | - Mikko Haapio
- Nephrology Department, University of Helsinki, Helsinki University Central Hospital, Helsinki, Finland
| | - Patrik Finne
- Nephrology Department, University of Helsinki, Helsinki University Central Hospital, Helsinki, Finland.,Finnish Registry for Kidney Diseases, Helsinki, Finland
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12
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Helve J, Kramer A, Abad Diez JM, Aresté-Fosalba N, Arici M, Cases A, Collart F, Heaf J, De Meester J, Nordio M, Palsson R, Pobes A, Rydell H, Reisæter AV, Massy ZA, Jager KJ, Finne P. Effect of comorbidities on survival in patients >80 years of age at onset of renal replacement therapy: data from the ERA-EDTA Registry. Nephrol Dial Transplant 2021; 36:688-694. [PMID: 33537775 DOI: 10.1093/ndt/gfaa278] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 09/15/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The number of elderly patients on renal replacement therapy (RRT) is increasing. The survival and quality of life of these patients may be lower if they have multiple comorbidities at the onset of RRT. The aim of this study was to explore whether the effect of comorbidities on survival is similar in elderly RRT patients compared with younger ones. METHODS Included were 9333 patients ≥80 years of age and 48 352 patients 20-79 years of age starting RRT between 2010 and 2015 from 15 national or regional registries submitting data to the European Renal Association-European Dialysis and Transplantation Association Registry. Patients were followed until death or the end of 2016. Survival was assessed by Kaplan-Meier curves and the relative risk of death associated with comorbidities was assessed by Cox regression analysis. RESULTS Patients ≥80 years of age had a greater comorbidity burden than younger patients. However, relative risks of death associated with all studied comorbidities (diabetes, ischaemic heart disease, chronic heart failure, cerebrovascular disease, peripheral vascular disease and malignancy) were significantly lower in elderly patients compared with younger patients. Also, the increase in absolute mortality rates associated with an increasing number of comorbidities was smaller in elderly patients. CONCLUSIONS Comorbidities are common in elderly patients who enter RRT, but the risk of death associated with comorbidities is less than in younger patients. This should be taken into account when assessing the prognosis of elderly RRT patients.
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Affiliation(s)
- Jaakko Helve
- Finnish Registry for Kidney Diseases, Helsinki, Finland.,Abdominal Center Nephrology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Anneke Kramer
- Department of Medical Informatics, ERA-EDTA Registry, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | | | - Nuria Aresté-Fosalba
- Department of Nephrology, University Hospital Virgen Macarena, Seville, Spain.,Information System of the Autonomic Transplant Coordination of Andalucía (SICATA), Andalucía, Spain
| | - Mustafa Arici
- Department of Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Aleix Cases
- Department of Nephrology, Hospital Clinic, Universitat de Barcelona, IDIBAPS, Barcelona, Spain.,Registre de Malalts Renals de Catalunya, Barcelona, Spain
| | | | - James Heaf
- Department of Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Johan De Meester
- Department of Nephrology, Dialysis and Hypertension, Dutch-speaking Belgian Renal Registry (NBVN), Sint-Niklaas, Belgium
| | - 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
| | - Alfonso Pobes
- Area Gestation Clinica Nefrología VII-VIII Asturias, Spain
| | - Helena Rydell
- Department of Clinical Sciences Intervention and Technology, Karolinska Institutet, Huddinge, Sweden.,Department of Internal Medicine, Swedish Renal Registry, Ryhoy County Hospital, Jönköping, Sweden
| | - Anna Varberg Reisæter
- Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Ziad A Massy
- Division of Nephrology, Amboise Paré University Hospital, APHP, Boulogne-Billancourt, Paris, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) Unit 1018 team5, Research Centre in Epidemiology and Population Health (CESP), University of Paris Ouest-Versailles-St Quentin-en-Yveline, Villejuif, France
| | - Kitty J Jager
- Department of Medical Informatics, ERA-EDTA Registry, 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, Helsinki University Hospital, Helsinki, Finland
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13
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Jakulj L, Kramer A, Åsberg A, de Meester J, Santiuste de Pablos C, Helve J, Hemmelder MH, Hertig A, Arici M, Bell S, Mercadal L, Diaz-Corte C, Palsson R, Benitez Sanchez M, Kerschbaum J, Collart F, Massy ZA, Jager KJ, Noordzij M. Recovery of kidney function in patients treated with maintenance dialysis-a report from the ERA-EDTA Registry. Nephrol Dial Transplant 2020; 36:1078-1087. [PMID: 33355661 DOI: 10.1093/ndt/gfaa368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Literature on recovery of kidney function (RKF) in patients with end-stage kidney disease treated with maintenance dialysis (i.e. >90 days) is limited. We assessed the incidence of RKF and its associated characteristics in a European cohort of dialysis patients. METHODS We included adult patients from the European Renal Association-European Dialysis and Transplant Association Registry who started maintenance dialysis in 1997-2016. Sustained RKF was defined as permanent discontinuation of dialysis. Temporary discontinuation of ≥30 days (non-sustained RKF) was also evaluated. Factors associated with RKF adjusted for potential confounders were studied using Cox regression analyses. RESULTS RKF occurred in 7657 (1.8%) of 440 996 patients, of whom 71% experienced sustained RKF. Approximately 90% of all recoveries occurred within the first 2 years after Day 91 of dialysis. Of patients with non-sustained RKF, 39% restarted kidney replacement therapy within 1 year. Sustained RKF was strongly associated with the following underlying kidney diseases (as registered by the treating physician): tubular necrosis (irreversible) or cortical necrosis {adjusted hazard ratio [aHR] 20.4 [95% confidence interval (CI) 17.9-23.1]}, systemic sclerosis [aHR 18.5 (95% CI 13.8-24.7)] and haemolytic uremic syndrome [aHR 17.3 (95% CI 13.9-21.6)]. Weaker associations were found for haemodialysis as a first dialysis modality [aHR 1.5 (95% CI 1.4-1.6)] and dialysis initiation at an older age [aHR 1.8 (95% CI 1.6-2.0)] or in a more recent time period [aHR 2.4 (95% CI 2.1-2.7)]. CONCLUSIONS Definitive discontinuation of maintenance dialysis is a rare and not necessarily an early event. Certain clinical characteristics, but mostly the type of underlying kidney disease, are associated with a higher likelihood of RKF.
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Affiliation(s)
- Lily Jakulj
- Department of Internal Medicine and Nephrology, Dianet Dialysis Center, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Anneke Kramer
- Department of Medical Informatics, European Renal Association-European Dialysis and Transplant Association Registry, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Anders Åsberg
- Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Johan de Meester
- Department of Nephrology, Dialysis and Hypertension, Dutch-speaking Belgian Renal Registry (NBVN), Sint-Niklaas, Belgium
| | - Carmen Santiuste de Pablos
- Department of Epidemiology, Murcia Renal Registry, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain.,CIBER Epidemiologíca y Salud Públican, Madrid, Spain
| | - Jaakko Helve
- Finnish Registry for Kidney Diseases and Abdominal Center Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Marc H Hemmelder
- Dutch Renal Registry Renine, Nefrovisie Foundation, Utrecht, The Netherlands
| | - Alexandre Hertig
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Kidney Transplantation, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Mustafa Arici
- Department of Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Samira Bell
- Scottish Renal Registry, Meridian Court, ISD Scotland, Glasgow, UK
| | - Lucile Mercadal
- Institut National de la Santé et de la Recherche Médicale, Center for Renal and Cardiovascular Epidemiology, Villejuif, France.,Department of Nephrology and Renal Transplantation, Assistance Publique-Hôpitaux de Paris, Hôpital de La Pitié Salpêtrière Hospital, Paris, France
| | - Carmen Diaz-Corte
- Nephrology Department, Hospital Universitario Central de Asturias, Oviedo, Spain.,Red de Investigación Renal, Madrid, Spain
| | - Runolfur Palsson
- Division of Nephrology, Landspítali-The National University Hospital of Iceland, Reykjavik, Iceland.,Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | | | - Julia Kerschbaum
- Department for Internal Medicine IV-Nephrology and Hypertension, Austrian Dialysis and Transplant Registry, Medical University Innsbruck, Innsbruck, Austria
| | | | - Ziad A Massy
- Division of Nephrology, Ambroise Paré University Hospital, Boulogne-Billancourt, Paris, France.,Institut National de la Santé et de la Recherche Médicale Unit 1018 Team 5, Research Centre in Epidemiology and Population Health, University of Paris Ouest-Versailles-St Quentin-en-Yveline, Villejuif, France
| | - Kitty J Jager
- Department of Medical Informatics, European Renal Association-European Dialysis and Transplant Association Registry, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Marlies Noordzij
- Department of Medical Informatics, European Renal Association-European Dialysis and Transplant Association Registry, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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14
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Kramer A, Boenink R, Noordzij M, Bosdriesz JR, Stel VS, Beltrán P, Ruiz JC, Seyahi N, Comas Farnés J, Stendahl M, Garneata L, Winzeler R, Golan E, Lopot F, Korejwo G, Bonthuis M, Lassalle M, Slon Roblero MF, Kuzema V, Hommel K, Stojceva-Taneva O, Asberg A, Kramar R, Hemmelder MH, De Meester J, Vazelov E, Andrusev A, Castro de la Nuez P, Helve J, Komissarov K, Casula A, Magaz Á, Santiuste de Pablos C, Bubić I, Traynor JP, Ioannou K, Idrizi A, Palsson R, des Grottes JM, Spustova V, Tolaj-Avdiu M, Jarraya F, Nordio M, Ziginskiene E, Massy ZA, Jager KJ. The ERA-EDTA Registry Annual Report 2017: a summary. Clin Kidney J 2020; 13:693-709. [PMID: 32897277 PMCID: PMC7467580 DOI: 10.1093/ckj/sfaa048] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 03/16/2020] [Indexed: 11/17/2022] Open
Abstract
Background This article presents a summary of the 2017 Annual Report of the European Renal Association–European Dialysis and Transplant Association (ERA-EDTA) Registry and describes the epidemiology of renal replacement therapy (RRT) for end-stage renal disease (ESRD) in 37 countries. Methods The ERA-EDTA Registry received individual patient data on patients undergoing RRT for ESRD in 2017 from 32 national or regional renal registries and aggregated data from 21 registries. The incidence and prevalence of RRT, kidney transplantation activity and survival probabilities of these patients were calculated. Results In 2017, the ERA-EDTA Registry covered a general population of 694 million people. The incidence of RRT for ESRD was 127 per million population (pmp), ranging from 37 pmp in Ukraine to 252 pmp in Greece. A total of 62% of patients were men, 52% were ≥65 years of age and 23% had diabetes mellitus as the primary renal disease. The treatment modality at the onset of RRT was haemodialysis for 85% of patients. On 31 December 2017, the prevalence of RRT was 854 pmp, ranging from 210 pmp in Ukraine to 1965 pmp in Portugal. The transplant rate in 2017 was 33 pmp, ranging from 3 pmp in Ukraine to 103 pmp in the Spanish region of Catalonia. For patients commencing RRT during 2008–12, the unadjusted 5-year patient survival probability for all RRT modalities combined was 50.8%.
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Affiliation(s)
- Anneke Kramer
- ERA-EDTA Registry, Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Rianne Boenink
- ERA-EDTA Registry, Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Marlies Noordzij
- ERA-EDTA Registry, Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Jizzo R Bosdriesz
- ERA-EDTA Registry, Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Vianda S Stel
- ERA-EDTA Registry, Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Palma Beltrán
- Public Health Directorate, RERCA Registry, Oviedo, Asturias, Spain
| | - Juan C Ruiz
- Department of Nephrology, Valdecilla Hospital, University of Cantabria, IDIVAL, Santander, Cantabria, Spain
| | - Nurhan Seyahi
- Department of Nephrology, Cerrahpasa Medical Faculty, Istanbul University, Cerrahpasa, Istanbul, Turkey
| | - Jordi Comas Farnés
- Catalan Renal Registry, Catalan Transplant Organization, Health Department, Generalitat of Catalonia, Barcelona, Spain
| | - Maria Stendahl
- Swedish Renal Registry, Department of Internal Medicine, Jonkoping Regional Hospital, Jonkoping, Sweden
| | - Liliana Garneata
- Romanian Renal Registry, Department of Internal Medicine and Nephrology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Rebecca Winzeler
- Institute of Nephrology, Waid and Triemli City Hospital, Zurich, Switzerland
| | - Eliezer Golan
- Israel Renal Registry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - František Lopot
- Department of Medicine, General University Hospital, Prague - Strahov, Czech Republic
| | - Grzegorz Korejwo
- Department of Nephrology, Gdańsk Medical University, Gdansk, Poland
| | - Marjolein Bonthuis
- ESPN/ERA-EDTA Registry, Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Mathilde Lassalle
- Renal Epidemiology and Information Network Registry, Agence de la biomédecine, Saint-Denis La Plaine, France
| | | | - Viktorija Kuzema
- Department of Nephrology, Riga Stradins Clinical University Hospital, Riga, Latvia.,Department of Internal Medicine, Riga Stradins University, Riga, Latvia.,Latvian Nephrology Association, Riga, Latvia
| | | | | | - Anders Asberg
- Department of Transplantation Medicine, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | | | - Marc H Hemmelder
- Dutch Renal Registry, Nefrovisie Foundation, Utrecht, The Netherlands
| | | | - Evgueniy Vazelov
- Dialysis Clinic, "Alexandrovska" University Hospital, Sofia Medical University, Sofia, Bulgaria
| | - Anton Andrusev
- Chronic Dialysis, Russia & CIS Medical Department, Company "Baxter" AO, Moscow, Russia.,Renal Replacement Registry, Russian Dialysis Society, Moscow, Russia
| | - Pablo Castro de la Nuez
- Information System of the Autonomic Transplant Coordination of Andalucia (SICATA), Seville, Andalucia, Spain
| | - Jaakko Helve
- Finnish Registry for Kidney Diseases, Helsinki, Finland.,Abdominal Center, Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kirill Komissarov
- Minsk Scientific and Practical Center of Surgery, Transplantation and Hematology, Minsk, Belarus
| | | | - Ángela Magaz
- Unidad de Información de Pacientes Renales - UNIPAR, Basque Country, Spain
| | - Carmen Santiuste de Pablos
- Murcia Renal Registry, Department of Epidemiology, Murcia Regional Health Authority, IMIB-Arrixaca, Murcia, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Ivan Bubić
- Department of Internal Medicine, Faculty of Medicine, University of Rijeka, Rijeka, Croatia.,Department of Clinical Sciences I, Faculty of Health Sciences, University of Rijeka, Rijeka, Croatia
| | - Jamie P Traynor
- Scottish Renal Registry, Meridian Court, ISD Scotland, Glasgow, UK
| | - Kyriakos Ioannou
- Cyprus Renal Registry, Nicosia, Cyprus.,Nephrology Department, American Medical Center, Nicosia, Cyprus
| | - Alma Idrizi
- Service of Nephrology, UHC "Mother Teresa", Tirana, Albania
| | - 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
| | | | - Viera Spustova
- Department of Clinical and Experimental Pharmacotherapy, Slovak Medical University, Bratislava, Slovakia
| | | | - Faical Jarraya
- Service de Néphrologie, Faculte de medicine, CHU H Chaker Sfax and LR19ES11, Sfax, Tunisia
| | - Maurizio Nordio
- Division of Nephrology, Dialysis and Transplantation, AULSS2 Treviso, Italy
| | - Edita Ziginskiene
- Lithuanian Nephrology, Dialysis and Transplantation Association, Kaunas, Lithuania.,Nephrology Department, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Ziad A Massy
- Division of Nephrology, Ambroise Paré University Hospital, Boulogne-Billancourt, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) Unit 1018, Team 5, Research Centre in Epidemiology and Population Health (CESP), University of Paris Ouest-Versailles-St Quentin-en-Yveline, Villejuif, France
| | - Kitty J Jager
- ERA-EDTA Registry, Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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15
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Helve J, Haapio M, Groop PH, Finne P. SP664PRIMARY RENAL DISEASE AND EFFECT OF COMORBIDITIES ON SURVIVAL OF PATIENTS ON RENAL REPLACEMENT THERAPY. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz103.sp664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jaakko Helve
- Finnish Registry for Kidney Diseases, Helsinki, Finland
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16
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Finne P, Groop PH, Arffman M, Kervinen M, Helve J, Grönhagen-Riska C, Sund R. Cumulative Risk of End-Stage Renal Disease Among Patients With Type 2 Diabetes: A Nationwide Inception Cohort Study. Diabetes Care 2019; 42:539-544. [PMID: 30692239 DOI: 10.2337/dc18-1485] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 01/01/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To estimate long-term cumulative risk of end-stage renal disease (ESRD) after diagnosis of type 2 diabetes. RESEARCH DESIGN AND METHODS This nationwide population-based inception cohort study included 421,429 patients with type 2 diabetes diagnosed in 1990-2011; patients were followed until the end of 2013. Data linkage between several national health care registers in Finland, covering 100% of the population, enabled the inclusion of almost all inhabitants who started taking diabetes medication or were hospitalized for diabetes. Cumulative risk of ESRD and hazard ratios [HR] for ESRD and death were estimated according to age, sex, and time period of diabetes diagnosis. RESULTS Among 421,429 patients with type 2 diabetes, 1,516 developed ESRD and 150,524 died during 3,458,797 patient-years of follow-up. Cumulative risk of ESRD was 0.29% at 10 years and 0.74% at 20 years from diagnosis of diabetes. Risk was higher among men than among women (HR 1.93 [95% CI 1.72-2.16]), decreased with older age at diagnosis (HR 0.70 [95% CI 0.60-0.81] for age 60-69 vs. 40-49 years), and was lower for those diagnosed in 2000-2011 than in 1990-1994 (HR 0.72 [95% CI 0.63-0.81]). Patients diagnosed with diabetes in 2000-2011 had lower risk of death during follow-up than those diagnosed in 1990-1994 (HR 0.64 [95% CI 0.63-0.65]). CONCLUSIONS Cumulative risk of ESRD is minimal among patients with type 2 diabetes compared with their risk of death. Patients diagnosed with diabetes at an older age have a lower risk of ESRD due to higher competing mortality.
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Affiliation(s)
- Patrik Finne
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland .,Finnish Registry for Kidney Diseases, Helsinki, Finland
| | - Per-Henrik Groop
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Folkhälsan Institute of Genetics, Folkhälsan Research Center Biomedicum Helsinki, Helsinki, Finland.,Department of Diabetes, Central Clinical School, Monash University, Melbourne, Australia
| | - Martti Arffman
- Department of Health and Social Care Systems, National Institute for Health and Welfare, Helsinki, Finland
| | - Marjo Kervinen
- Centre of Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Jaakko Helve
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Reijo Sund
- Department of Social Research, Centre for Research Methods, University of Helsinki, Helsinki, Finland.,Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
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17
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Kervinen MH, Lehto S, Helve J, Grönhagen-Riska C, Finne P. Type 2 diabetic patients on renal replacement therapy: Probability to receive renal transplantation and survival after transplantation. PLoS One 2018; 13:e0201478. [PMID: 30110346 PMCID: PMC6093678 DOI: 10.1371/journal.pone.0201478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 07/16/2018] [Indexed: 12/15/2022] Open
Abstract
Background Type 2 diabetic (T2DM) patients on renal replacement therapy (RRT) seldom receive a kidney transplant, which is partly due to age and comorbidities. Adjusting for case mix, we investigated whether T2DM patients have equal opportunity for renal transplantation compared to other patients on dialysis, and whether survival after transplantation is comparable. Methods Patients who entered RRT in Finland in 2000–2010 (n = 5419) were identified from the Finnish Registry for Kidney Diseases and followed until the end of 2012. Of these, 20% had T2DM, 14% type 1 diabetes (T1DM) and 66% other than diabetes as the cause of ESRD. Uni-/multivariate survival analysis techniques were employed to assess the probability of kidney transplantation after the start of dialysis and survival after transplantation. Results T2DM patients had a relative probability of renal transplantation of 0.18 (95% CI 0.15–0.22, P<0.001) compared to T1DM patients: this increased to 0.51 (95% CI 0.36–0.72, P<0.001) after adjustment for case mix (age, gender, laboratory values and comorbidities). When T2DM patients were compared to non-diabetic patients, the corresponding relative probabilities were 0.25 (95% CI 0.20–0.30, P<0.001) and 0.59 (95% CI 0.43–0.83, P = 0.002). After renal transplantation when adjusted for age and gender, relative risk of death was 1.25 (95% CI 0.64–2.44, P = 0.518) for T1DM patients and 0.72 (0.43–1.22, P = 0.227) for other patients compared to T2DM patients. Conclusions T2DM patients had a considerably lower probability of receiving a kidney transplant, which could not be fully explained by differences in the patient characteristics. Survival within 5 years after transplantation is comparably good in T2DM patients.
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Affiliation(s)
- Marjo H. Kervinen
- Centre of Medicine, Kuopio University Hospital, Kuopio, Finland
- * E-mail:
| | | | - Jaakko Helve
- Finnish Registry for Kidney Diseases, Helsinki, Finland
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Carola Grönhagen-Riska
- Finnish Registry for Kidney Diseases, Helsinki, Finland
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - 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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18
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Finne P, Groop PH, Arffman M, Kervinen M, Helve J, Grönhagen-Riska C, Sund R. SP300RISK OF DEVELOPING END-STAGE RENAL DISEASE AFTER DIAGNOSIS OF TYPE 2 DIABETES. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.sp300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Patrik Finne
- Abdominal Centre Nephrology, Helsinki University Hospital, Helsinki, Finland
| | - Per-Henrik Groop
- Abdominal Centre Nephrology, Helsinki University Hospital, Helsinki, Finland
| | - Martti Arffman
- Department of Health and Social Care Systems, National Institute for Health and Welfare, Helsinki, Finland
| | - Marjo Kervinen
- Centre of Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Jaakko Helve
- Abdominal Centre Nephrology, Helsinki University Hospital, Helsinki, Finland
| | | | - Reijo Sund
- Department of Social Research, University of Helsinki, Helsinki, Finland
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19
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Helve J, Sund R, Arffman M, Harjutsalo V, Groop PH, Grönhagen-Riska C, Finne P. Incidence of End-Stage Renal Disease in Patients With Type 1 Diabetes. Diabetes Care 2018; 41:434-439. [PMID: 29263163 DOI: 10.2337/dc17-2364] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 11/16/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate how risk of end-stage renal disease (ESRD) among patients with type 1 diabetes has changed over time and further how the risk is affected by age, sex, and time period of diagnosis of diabetes. RESEARCH DESIGN AND METHODS A cohort including all patients <30 years old diagnosed with type 1 diabetes in Finland in 1965-2011 was followed until start of renal replacement therapy, death, or end of follow-up at the end of 2013. Altogether, 29,906 patients were included. The main outcome was cumulative risk of ESRD, accounting for death as a competing risk. RESULTS The patients were followed up for a median of 20 years. During 616,403 patient-years, 1,543 ESRD cases and 4,185 deaths were recorded. The cumulative risk of ESRD was 2.2% after 20 years and 7.0% after 30 years from the diabetes diagnosis. The relative risk of ESRD was 0.13 (95% CI 0.08-0.22) among patients diagnosed in 1995-2011 compared with those diagnosed in 1965-1979. Patients <5 years old at the time of diagnosis had the lowest risk of ESRD after diagnosis. With the cumulative risk of ESRD estimated from time of birth, the patients aged 5-9 years at diabetes diagnosis were at highest risk. CONCLUSIONS The cumulative risk of ESRD has decreased markedly during the past five decades. This highlights the importance of modern treatment of diabetes and diabetic nephropathy.
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Affiliation(s)
- Jaakko Helve
- Finnish Registry for Kidney Diseases, Helsinki, Finland .,Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Reijo Sund
- Department of Social Research, Centre for Research Methods, University of Helsinki, Helsinki, Finland.,Insitute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Martti Arffman
- Insitute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,National Institute for Health and Welfare, Helsinki, Finland
| | - Valma Harjutsalo
- Diabetes and Obesity Research Program, Research Programs Unit, University of Helsinki, Helsinki, Finland.,Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland
| | - Per-Henrik Groop
- Finnish Registry for Kidney Diseases, Helsinki, Finland.,Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Diabetes and Obesity Research Program, Research Programs Unit, University of Helsinki, Helsinki, Finland.,Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland.,Baker IDI Heart & Diabetes Institute, Melbourne, Australia
| | | | - 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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Haapio M, Helve J, Grönhagen-Riska C, Finne P. One- and 2-Year Mortality Prediction for Patients Starting Chronic Dialysis. Kidney Int Rep 2017; 2:1176-1185. [PMID: 29270526 PMCID: PMC5733880 DOI: 10.1016/j.ekir.2017.06.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 05/24/2017] [Accepted: 06/20/2017] [Indexed: 11/30/2022] Open
Abstract
Introduction Mortality risk of patients with end-stage renal disease (ESRD) is highly elevated. Methods to estimate individual mortality risk are needed to provide individualized care and manage expanding ESRD populations. Many mortality prediction models exist but have shown deficiencies in model development (data comprehensiveness, validation) and in practicality. Therefore, our aim was to design 2 easy-to-apply prediction models for 1- and 2-year all-cause mortality in patients starting long-term renal replacement therapy (RRT). Methods We used data from the Finnish Registry for Kidney Diseases with complete national coverage of RRT patients. Model training group included all incident adult patients who started long-term dialysis in Finland in 2000 to 2008 (n = 4335). The external validation cohort consisted of those who entered dialysis in 2009 to 2012 (n = 1768). Logistic regression with stepwise variable selection was used for model building. Results We developed 2 prognostic models, both of which only included 6 to 7 variables (age at RRT start, ESRD diagnosis, albumin, phosphorus, C-reactive protein, heart failure, and peripheral vascular disease) and showed sufficient discrimination (c-statistic 0.77 and 0.74 for 1- and 2-year mortality, respectively). Due to a significantly lower mortality in the newer cohort, the models, to a degree, overestimated mortality risk. Discussion Mortality prediction algorithms could be more widely implemented into management of ESRD patients. The presented models are practical with only a limited number of variables and fairly good performance.
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Affiliation(s)
- Mikko Haapio
- Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Correspondence: Mikko Haapio, Helsinki University Hospital, P.O. Box 372, FI-00029 HUS, Finland.Helsinki University HospitalP.O. Box 372FI-00029 HUSFinland
| | - Jaakko Helve
- Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Patrik Finne
- Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Finnish Registry for Kidney Diseases, Helsinki, Finland
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Helve J, Haapio M, Groop PH, Grönhagen-Riska C, Finne P. Biochemical variables and survival of patients with type 1 diabetes on renal replacement therapy. Blood Purif 2014; 38:18-23. [PMID: 25228237 DOI: 10.1159/000362861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 04/13/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS End-stage renal disease (ESRD) is one of the most serious complications of type 1 diabetes, but scarcely studied. Our aim was to estimate the association between biochemical variables and survival among these patients. METHODS This was an incident cohort study of patients with type 1 diabetes entering chronic renal replacement therapy (RRT) in Finland 2000-2011 (n = 834). Biochemical variables were measured before the initiation of RRT. Adjusted relative risk of death according to biochemical variables was estimated by Cox regression. RESULTS When adjusted for age, sex, comorbidities, and initial treatment modality of RRT, the most important predictors of death were low creatinine and albumin and high C-reactive protein. CONCLUSION Among type 1 diabetes patients entering chronic RRT, biochemical variables independently associated with survival are creatinine, albumin and C-reactive protein. They reflect the nutritional status, proteinuria, liver function, and ongoing inflammatory process. Treatment of these might improve survival.
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Affiliation(s)
- Jaakko Helve
- Finnish Registry for Kidney Diseases, Helsinki, Finland
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Helve J, Sund R, Haapio M, Groop PH, Grönhagen-Riska C, Finne P. Medication among patients with type 1 diabetes and predialytic renal disease. Diabetes Res Clin Pract 2014; 103:510-5. [PMID: 24423442 DOI: 10.1016/j.diabres.2013.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Revised: 09/11/2013] [Accepted: 12/18/2013] [Indexed: 11/21/2022]
Abstract
AIMS To examine use and changes of medication in the three years before start of chronic renal replacement therapy (RRT) among patients with type 1 diabetes, and the association between predialytic medication and survival on RRT. METHODS We recorded medication of 496 patients with type 1 diabetes before and after start of RRT in 2000-2006 and followed up until death or end of 2009. Data were retrieved from the Finnish Registry for Kidney Diseases and from the FinDM diabetes database. We evaluated the use of renin-angiotensin system (RAS) blockers, calcium channel blockers, β-blockers, statins, vitamin D, erythropoiesis-stimulating agents, and phosphate binders over three years. The association between predialytic medication and survival was assessed using Cox proportional hazards regression. RESULTS Medication increased markedly with progressing renal insufficiency. Almost 70% of the patients used calcium channel blockers and β-blockers before initiating RRT. Use of calcium channel blockers (RR 0.72, 95% CI 0.53-0.95) and vitamin D (RR 0.70, 95% CI 0.52-0.94) at start of RRT were associated with better survival when adjusted for age and sex, but after further adjustment the association lost statistical significance. CONCLUSIONS Among type 1 diabetes patients in the predialysis phase, use of medication is abundant. Use of medication appears to keep patients at an equal survival level to those without the same medication. However, due to the observational nature of our study, conclusions regarding the effect of medication on survival must be made with caution.
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Affiliation(s)
- Jaakko Helve
- Finnish Registry for Kidney Diseases, Helsinki, Finland; Helsinki University Central Hospital, Department of Medicine, Helsinki, Finland.
| | - Reijo Sund
- National Institute for Health and Welfare (THL), Service Systems Research Unit, Helsinki, Finland
| | - Mikko Haapio
- Helsinki University Central Hospital, Division of Nephrology, Helsinki, Finland
| | - Per-Henrik Groop
- Helsinki University Central Hospital, Division of Nephrology, Helsinki, Finland; Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Finland; Baker IDI Heart & Diabetes Institute, Melbourne, Australia
| | - Carola Grönhagen-Riska
- Finnish Registry for Kidney Diseases, Helsinki, Finland; Helsinki University Central Hospital, Division of Nephrology, Helsinki, Finland
| | - Patrik Finne
- Finnish Registry for Kidney Diseases, Helsinki, Finland; Helsinki University Central Hospital, Division of Nephrology, Helsinki, Finland
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Haapio M, Helve J, Kyllonen L, Gronhagen-Riska C, Finne P. Modality of chronic renal replacement therapy and survival--a complete cohort from Finland, 2000-2009. Nephrol Dial Transplant 2013; 28:3072-81. [DOI: 10.1093/ndt/gft326] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Coentrao L, Ribeiro C, Santos-Araujo C, Neto R, Pestana M, Kleophas W, Kleophas W, Karaboyas A, LI Y, Bommer J, Pisoni R, Robinson B, Port F, Celik G, Burcak Annagur B, Yilmaz M, Demir T, Kara F, Trigka K, Dousdampanis P, Vaitsis N, Aggelakou-Vaitsi S, Turkmen K, Guney I, Turgut F, Altintepe L, Tonbul HZ, Abdel-Rahman E, Sclauzero P, Galli G, Barbati G, Carraro M, Panzetta GO, Van Diepen M, Schroijen M, Dekkers O, Dekker F, Sikole A, Severova- Andreevska G, Trajceska L, Gelev S, Amitov V, Pavleska- Kuzmanovska S, Karaboyas A, Rayner H, LI Y, Vanholder R, Pisoni R, Robinson B, Port F, Hecking M, Jung B, Leung M, Huynh F, Chung T, Marchuk S, Kiaii M, Er L, Werb R, Chan-Yan C, Beaulieu M, Malindretos P, Makri P, Zagkotsis G, Koutroumbas G, Loukas G, Nikolaou E, Pavlou M, Gourgoulianni E, Paparizou M, Markou M, Syrgani E, Syrganis C, Raimann J, Usvyat LA, Bhalani V, Levin NW, Kotanko P, Huang X, Stenvinkel P, Qureshi AR, Riserus U, Cederholm T, Barany P, Heimburger O, Lindholm B, Carrero JJ, Chang JH, Sung JY, Jung JY, Lee HH, Chung W, Kim S, Han JS, Kim S, Chang JH, Jung JY, Chung W, Na KY, Raimann J, Usvyat LA, Kotanko P, Levin NW, Fragoso A, Pinho A, Malho A, Silva AP, Morgado E, Leao Neves P, Joki N, Tanaka Y, Iwasaki M, Kubo S, Hayashi T, Takahashi Y, Hirahata K, Imamura Y, Hase H, Castledine C, Gilg J, Rogers C, Ben-Shlomo Y, Caskey F, Na KY, Kim S, Chung W, Jung JY, Chang JH, Lee HH, Sandhu JS, Bajwa GS, Kansal S, Sandhu J, Jayanti A, Nikam M, Ebah L, Summers A, Mitra S, Agar J, Perkins A, Simmonds R, Tjipto A, Amet S, Launay-Vacher V, Laville M, Tricotel A, Frances C, Stengel B, Gauvrit JY, Grenier N, Reinhardt G, Clement O, Janus N, Rouillon L, Choukroun G, Deray G, Bernasconi A, Waisman R, Montoya AP, Liste AA, Hermes R, Muguerza G, Heguilen R, Iliescu EL, Martina V, Rizzo MA, Magenta P, Lubatti L, Rombola G, Gallieni M, Loirat C, Loirat C, Mellerio H, Labeguerie M, Andriss B, Savoye E, Lassale M, Jacquelinet C, Alberti C, Aggarwal Y, Baharani J, Tabrizian S, Ossareh S, Zebarjadi M, Azevedo P, Travassos F, Frade I, Almeida M, Queiros J, Silva F, Cabrita A, Rodrigues R, Couchoud C, Kitty J, Benedicte S, Fergus C, Cecile C, Couchoud C, Sahar B, Emmanuel V, Christian J, Rene E, Barahimi H, Mahdavi-Mazdeh M, Nafar M, Petruzzi M, De Benedittis M, Sciancalepore M, Gargano L, Natale P, Vecchio MC, Saglimbene V, Pellegrini F, Gentile G, Stroumza P, Frantzen L, Leal M, Torok M, Bednarek A, Dulawa J, Celia E, Gelfman R, Hegbrant J, Wollheim C, Palmer S, Johnson DW, Ford PJ, Craig JC, Strippoli GF, Ruospo M, El Hayek B, Hayek B, Baamonde E, Bosch E, Ramirez JI, Perez G, Ramirez A, Toledo A, Lago MM, Garcia-Canton C, Checa MD, Canaud B, Canaud B, Lantz B, Pisoni R, Granger-Vallee A, Lertdumrongluk P, Molinari N, Ethier J, Jadoul M, Gillespie B, Port F, Bond C, Wang S, Alfieri T, Braunhofer P, Newsome B, Wang M, Bieber B, Guidinger M, Bieber B, Wang M, Zuo L, Pisoni R, Yu X, Yang X, Qian J, Chen N, Albert J, Yan Y, Ramirez S, Bernasconi A, Waisman R, Beresan M, Lapidus A, Canteli M, Heguilen R, Tong A, Palmer S, Manns B, Craig J, Ruospo M, Gargano L, Strippoli G, Mortazavi M, Vahdatpour B, Shahidi S, Ghasempour A, Taheri D, Dolatkhah S, Emami Naieni A, Ghassami M, Khan M, Abdulnabi K, Pai P, Ruospo M, Petruzzi M, De Benedittis M, Sciancalepore M, Gargano L, Vecchio M, Saglimbene V, Natale P, Pellegrini F, Gentile G, Stroumza P, Frantzen L, Leal M, Torok M, Bednarek A, Dulawa J, Celia E, Gelfman R, Hegbrant J, Wollheim C, Palmer S, Johnson DW, Ford PJ, Craig JC, Strippoli GF, Muqueet MA, Muqueet MA, Hasan MJ, Kashem MA, Dutta PK, Liu FX, Noe L, Quock T, Neil N, Inglese G, Qian J, Bieber B, Guidinger M, Bieber B, Chen N, Yan Y, Pisoni R, Wang M, Zuo L, Yu X, Yang X, Wang M, Albert J, Ramirez S, Ossareh S, Motamed Najjar M, Bahmani B, Shafiabadi A, Helve J, Haapio M, Groop PH, Gronhagen-Riska C, Finne P, Helve J, Haapio M, Sund R, Groop PH, Gronhagen-Riska C, Finne P, Cai M, Baweja S, Clements A, Kent A, Reilly R, Taylor N, Holt S, Mcmahon L, Usvyat LA, Carter M, Van der Sande FM, Kooman J, Raimann J, Levin NW, Kotanko P, Usvyat LA, Malhotra R, Ouellet G, Penne EL, Raimann J, Thijssen S, Levin NW, Kotanko P, Etter M, Tashman A, Guinsburg A, Grassmann A, Barth C, Marelli C, Marcelli D, Van der Sande FM, Von Gersdorff G, Bayh I, Kooman J, Scatizzi L, Lam M, Schaller M, Thijssen S, Toffelmire T, Wang Y, Sheppard P, Usvyat LA, Levin NW, Kotanko P, Neri L, Andreucci VA, Rocca-Rey LA, Bertoli SV, Brancaccio D, Tjipto A, Simmonds R, Agar J, Huang X, Stenvinkel P, Qureshi AR, Riserus U, Cederholm T, Barany P, Heimburger O, Lindholm B, Carrero JJ, Vecchio M, Palmer S, De Berardis G, Craig J, Lucisano G, Johnson D, Pellegrini F, Nicolucci A, Sciancalepore M, Saglimbene V, Gargano L, Bonifati C, Ruospo M, Navaneethan SD, Montinaro V, Stroumza P, Zsom M, Torok M, Celia E, Gelfman R, Bednarek-Skublewska A, Dulawa J, Graziano G, Gentile G, Ferrari JN, Santoro A, Zucchelli A, Triolo G, Maffei S, Hegbrant J, Wollheim C, De Cosmo S, Manfreda VM, Strippoli GF, Janus N, Janus N, Launay-Vacher V, Juillard L, Rousset A, Butel F, Girardot-Seguin S, Deray G, Hannedouche T, Isnard M, Berland Y, Vanhille P, Ortiz JP, Janin G, Nicoud P, Touam M, Bruce E, Rouillon L, Laville M, Janus N, Juillard L, Rousset A, Butel F, Girardot-Seguin S, Deray G, Hannedouche T, Isnard M, Berland Y, Vanhille P, Ortiz JP, Janin G, Nicoud P, Touam M, Bruce E, Rouillon L, Laville M, Janus N, Launay-Vacher V, Juillard L, Rousset A, Butel F, Girardot-Seguin S, Deray G, Hannedouche T, Isnard M, Berland Y, Vanhille P, Ortiz JP, Janin G, Nicoud P, Touam M, Bruce E, Rouillon L, Laville M, Grace B, Clayton P, Cass A, Mcdonald S, Baharani J, Furumatsu Y, Kitamura T, Fujii N, Ogata S, Nakamoto H, Iseki K, Tsubakihara Y, Chien CC, Wang JJ, Hwang JC, Wang HY, Kan WC, Kuster N, Kuster N, Patrier L, Bargnoux AS, Morena M, Dupuy AM, Badiou S, Canaud B, Cristol JP, Desmet JM, Fernandes V, Collart F, Spinogatti N, Pochet JM, Dratwa M, Goffin E, Nortier J, Zilisteanu DS, Voiculescu M, Rusu E, Achim C, Bobeica R, Balanica S, Atasie T, Florence S, Anne-Marie S, Michel L, Cyrille C, Emmanuel V, Strakosha A, Strakosha A, Pasko N, Kodra S, Thereska N, Lowney A, Lowney E, Grant R, Murphy M, Casserly L, O' Brien T, Plant WD, Radic J, Radic J, Ljutic D, Kovacic V, Radic M, Dodig-Curkovic K, Sain M, Jelicic I, Fujii N, Hamano T, Nakano C, Yonemoto S, Okuno A, Katayama M, Isaka Y, Nordio M, Limido A, Postorino M, Nichelatti M, Khil M, Dudar I, Khil V, Shifris I, Momtaz M, Soliman AR, El Lawindi MI, Dzekova-Vidimliski P, Pavleska-Kuzmanovska S, Trajceska L, Nikolov I, Selim G, Gelev S, Amitov V, Sikole A, Shoji T, Kakiya R, Hayashi T, Tatsumi-Shimomura N, Tsujimoto Y, Tabata T, Shima H, Mori K, Fukumoto S, Tahara H, Koyama H, Emoto M, Ishimura E, Nishizawa Y, Inaba M. Epidemiology and outcome research in CKD 5D. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Haapio M, Helve J, Kurimo P, Forslund T, Grönhagen-Riska C, Finne P. Decline in glomerular filtration rate during pre-dialysis phase and survival on chronic renal replacement therapy. Nephrol Dial Transplant 2011; 27:1157-63. [PMID: 21810761 DOI: 10.1093/ndt/gfr423] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Estimated glomerular filtration rate (eGFR) is widely used in follow-up and assessment of patients before start of chronic renal replacement therapy (RRT). Reported data on impact of eGFR decline pattern during pre-dialysis phase on consequent survival on RRT are, however, non-existent. METHODS Using the database of the Finnish Registry for Kidney Diseases, we conducted a cohort study of all incident adult patients (n = 457) entering chronic RRT in Finland in 1998, with follow-up until 31 December 2008. We included those (n = 319) with three serum creatinine measurements (at ∼12 and 3 months and 1 to 2 weeks prior to RRT start) and calculated their slopes of eGFR using the modification of diet in renal disease formula. According to eGFR slopes (in mL/min/1.73m(2)/year), patients were divided into tertiles: most rapid (>8.5, n = 107), intermediate (3.4-8.5, n = 107) and slowest decline (<3.4, n = 105). RESULTS Median survival time was 5.6 (95% confidence interval 4.2-7.0) years. Compared to the patient group with the slowest eGFR decline, age- and gender-adjusted relative risk of death was 1.1 (0.8-1.5) in the intermediate group and 1.7 (1.2-2.4, P = 0.002) in the most rapid decline group. When further adjusting for kidney disease diagnosis, comorbidities, use of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, body mass index, blood haemoglobin and serum albumin, the association was no longer significant. CONCLUSIONS Rapid decline in eGFR before entering chronic RRT associates with increased mortality on RRT. The elevated mortality appears to be caused by known risk factors for death on RRT.
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Affiliation(s)
- Mikko Haapio
- Division of Nephrology, Helsinki University Central Hospital, Helsinki, Finland.
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Helve J, Haapio M, Groop PH, Grönhagen-Riska C, Finne P. Comorbidities and survival of patients with type 1 diabetes on renal replacement therapy. Diabetologia 2011; 54:1663-9. [PMID: 21465326 DOI: 10.1007/s00125-011-2140-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Accepted: 03/17/2011] [Indexed: 11/30/2022]
Abstract
AIMS/HYPOTHESIS Comorbidities are frequent among type 1 diabetes patients on renal replacement therapy, yet the effect of comorbidities on survival is unknown. Our aim was to estimate this effect. METHODS An incident cohort of all patients with type 1 diabetes entering chronic renal replacement therapy (n = 656) in Finland between 2000 and 2008 was followed until death or the end of follow-up on 31 December 2008. All data were obtained from the Finnish Registry for Kidney Diseases, which collects information on comorbidities at the start of renal replacement therapy. The main outcome measure was relative risk of death according to comorbidities. RESULTS At start of renal replacement therapy, 22% of the patients with type 1 diabetes had coronary artery disease, 19% peripheral vascular disease, 11% cerebrovascular disease, 33% left ventricular hypertrophy and 7% heart failure. All these comorbidities were significant predictors of death in univariate analyses (RR 1.6-4.9). The 5 year survival probability of patients without comorbidities was 74%, while it was 56% and 37%, respectively, for those with one or more than one comorbidity. When the comorbidities were studied in a multivariate model, adjusting for age and sex, peripheral vascular disease (RR 1.9), left ventricular hypertrophy (RR 1.7) and heart failure (RR 2.5) remained independent risk factors for death. Calculations indicated that one-third of deaths in the study population could be attributed to comorbidities. CONCLUSIONS/INTERPRETATION Among patients with type 1 diabetes entering renal replacement therapy, comorbidities are common and strong predictors of death. Therefore, it is essential to identify and adequately treat comorbidities.
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Affiliation(s)
- J Helve
- Finnish Registry for Kidney Diseases, Kumpulantie 1 A, 6th floor, FI-00520 Helsinki, Finland.
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Abstract
OBJECTIVE Risks of end-stage renal disease and premature death in patients with type 1 diabetes have declined over the past decades. Data on the survival of patients receiving renal replacement therapy (RRT) are, however, limited. We investigated whether survival of patients with type 1 diabetes receiving RRT has improved over time and whether improvement can be attributable to progress in dialysis treatment or diabetes care. RESEARCH DESIGN AND METHODS An incident cohort of all patients with type 1 diabetes (n = 1,604) starting chronic RRT in Finland between 1980 and 2005 were followed until death or end of follow-up on 31 December 2007. The control group (n = 1,556) consisted of patients with glomerulonephritis who started RRT. All patients were identified from the Finnish Registry for Kidney Diseases. RESULTS Median survival time of patients with type 1 diabetes increased progressively from 3.60 years during 1980-1984 to >8 years in 2000-2005. In 2000-2005, the unadjusted relative risk of death was 0.55 compared with 1980-1984. After adjustment for the most important variables, the corresponding relative risk of death was only 0.23. For patients with glomerulonephritis, the adjusted relative risk decreased to a lesser extent to 0.30 (P = 0.007). CONCLUSIONS Survival of patients with type 1 diabetes and end-stage renal disease has improved since the 1980s despite a conspicuous increase in the age of patients who start RRT, suggesting not only true progress in dialysis therapy and overall treatment of patients with end-stage renal disease but possibly also improved management of diabetes.
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Affiliation(s)
- Mikko Haapio
- Helsinki University Central Hospital, Division of Nephrology, Helsinki, Finland.
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Abstract
The effects were studied of a standardised general anaesthesia on mean arterial blood pressure, central venous pressure, blood gas values and the course of cataract operations. The material consisted of 20 unselected senile cataract operations, the mean age of the patients being 71.3 years. The arterial blood pressure was continuously checked, using an intra-arterial cannula. In order to avoid vitreous loss, the blood pressure was successfully kept optimally low during the extraction of the lens. No vitreous problems were noted. The oxygenation and ventilation of the patients were sufficient during anaesthesia and immediately postoperatively.
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Helve J, Nieminen H. Autofluorescence of the human diabetic lens in vivo. Am J Ophthalmol 1976; 81:493-4. [PMID: 1266930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
We studied the in vivo measurements of the autofluorescence of the clear lens in 80 juvenile diabetics and 25 young healthy subjects. When the diabetes was of seven years' duration or more, no overlap with the control subjects was found. The pathologic autofluorescence of the diabetic lens showed a positive correlation with age and the duration of diabetes.
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Forsius H, Krause U, Helve J, Vuopala V, Mustonen E, Vainio-Mattila B, Fellman J, Eriksson AW. Visual acuity in 183 cases of X-chromosomal retinoschisis. Can J Ophthalmol 1973; 8:385-93. [PMID: 4742888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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