Factors influencing kidney transplantation rates: a study from the ERA Registry

BACKGROUND

Large international differences exist in kidney transplantation (KT) rates. We aimed to investigate which factors may explain the total, deceased donor, and living donor KT rates over the last decade.

METHODS

KT experts from 39 European countries completed the Kidney Transplantation Rate Survey on measures and barriers and their potential effect on the KT rate in their country. In the analyses, countries were divided into low, middle, and high KT rate countries based on the KT rate at the start of study period in 2010.

RESULTS

Experts from low KT rate countries reported more frequently to have taken measures regarding staff, equipment and facilities to increase total KT rate compared with middle and high KT rate countries. For donor type specific KT, the largest international differences in measures taken were reported for deceased donor KT, with middle and high KT rate countries taking more measures, such as the use of expanded criteria donor kidneys, the presence of transplantation coordinators, and (inter)national exchange of donor kidneys. Once a measure was taken, experts' opinion on its success was similar across the low, middle and high KT rate countries. Experts from low KT rate countries more often reported potential barriers, such as patients' lack of knowledge and distrust in the health care system.

CONCLUSIONS

In particular in low KT rate countries, KT rate might be stimulated by optimizing staff, equipment, and facilities. In addition, all countries may benefit from deceased and living donor specific measures.

MO158: The Association of Left Ventricular Diastolic Dysfunction and Heart Failure in Patients with Chronic Kidney Disease

BACKGROUND AND AIMS

Chronic kidney disease (CKD) has been linked with an increased risk of cardiovascular events, especially in dialysis population. According to literature data, in the patients with CKD heart function disturbances are twice as common as in the general population [1]. Bearing in the mind that left ventricular hypertrophy (and abnormal left ventricular relaxation) is considered to be one of the most important parameters for the occurrence of cardiovascular disease in CKD [2], the aim of our study was to evaluate the association of left ventricular diastolic dysfunction with heart failure in CKD patients.

METHOD

The research was conducted as a prospective observational study which included 30 patients with CKD, stage III and IV according KDIGO [3], and left ventricular diastolic dysfunction, and 30 control subjects who also had left ventricular diastolic dysfunction but without CKD. Pulse-wave (PW) Doppler echocardiography in the apical four-chamber view and tissue Doppler imaging were performed to assess left ventricular function [4]. The measurements of mitral inflow by PW Doppler covered early (E-wave) and late (A-wave) diastolic feeling velocities, peak early diastolic velocity at the septal (e′septal) and lateral (e′lateral) mitral annular sites, and E/A ratio.

RESULTS

A comparison of left ventricular function parameters between two groups of study participants indicated that left ventricular ejection fraction (0.57 ± 0.05% versus 0.61 ± 0.03%) was statistically reduced in CKD patients compared to control subjects (P < .001). Contrary, left ventricular mass index (119.8 ± 27.0 g/m2 versus 100.8 ± 20.4 g/m2P = .003) and interventricular septum thickness (11.8 ± 1.4 mm versus 10.8 ± 1.5 mm,  P = .012) were significantly higher in the patients with CKD. There were no significant differences in values of left ventricular end-diastolic (53.7 ± 4.6 mm versus 54.2 ± 3.5 mm,  P = .636) and left ventricular end-systolic (34.7 ± 4.5 mm versus 35.7 ± 2.3 mm,  P = .265) dimension between CKD patients and controls. The mitral inflow imaging pointed to more pronounced left ventricular diastolic dysfunction in CKD patients than in the subjects without CKD: e′septal (P = .009) and e′lateral (P < .001) velocity. E/A ratio showed no markedly deviation between two study groups (P = .787). On the other hand, when we analysed the frequency of heart failure, it was noted that newly developed episodes of cardiac decompensation were more frequent in patients with CKD than in the control group (Chi square = 6.667, P = .010). Regression analysis confirmed the predictive significance of left ventricular echosonographic characteristics on the occurrence of heart failure in patients with CKD (OR 1.56, 95% CI 1.11‒2.18, P = .011 for left ventricular mass index; OR 1.68, 95% CI 1.01‒2.80, P = .048 for e′).

CONCLUSION

Heart failure is more common in patients with CKD than in patients with normal kidney function. There is a positive relationship between the presence of left ventricular diastolic dysfunction and the occurrence of heart failure in patients with CKD.

The ERA-EDTA Registry Annual Report 2018: a summary

Background

The European Renal Association - European Dialysis and Transplant Association (ERA-EDTA) Registry collects data on kidney replacement therapy (KRT) via national and regional renal registries in Europe and countries bordering the Mediterranean Sea. This article summarizes the 2018 ERA-EDTA Registry Annual Report, and describes the epidemiology of KRT for kidney failure in 34 countries.

Methods

Individual patient data on patients undergoing KRT in 2018 were provided by 34 national or regional renal registries and aggregated data by 17 registries. The incidence and prevalence of KRT, the kidney transplantation activity and the survival probabilities of these patients were calculated.

Results

In 2018, the ERA-EDTA Registry covered a general population of 636 million people. Overall, the incidence of KRT for kidney failure was 129 per million population (p.m.p.), 62% of patients were men, 51% were ≥65 years of age and 20% had diabetes mellitus as cause of kidney failure. Treatment modality at the onset of KRT was haemodialysis (HD) for 84%, peritoneal dialysis (PD) for 11% and pre-emptive kidney transplantation for 5% of patients. On 31 December 2018, the prevalence of KRT was 897 p.m.p., with 57% of patients on HD, 5% on PD and 38% living with a kidney transplant. The transplant rate in 2018 was 35 p.m.p.: 68% received a kidney from a deceased donor, 30% from a living donor and for 2% the donor source was unknown. For patients commencing dialysis during 2009-13, the unadjusted 5-year survival probability was 42.6%. For patients receiving a kidney transplant within this period, the unadjusted 5-year survival probability was 86.6% for recipients of deceased donor grafts and 93.9% for recipients of living donor grafts.