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Stel VS, Boenink R, Astley ME, Boerstra BA, Radunovic D, Skrunes R, Ruiz San Millán JC, Slon Roblero MF, Bell S, Ucio Mingo P, Ten Dam MAGJ, Ambühl PM, Resic H, Rodríguez Arévalo OL, Aresté-Fosalba N, Tort I Bardolet J, Lassalle M, Trujillo-Alemán S, Indridason OS, Artamendi M, Finne P, Rodríguez Camblor M, Nitsch D, Hommel K, Moustakas G, Kerschbaum J, Lausevic M, Jager KJ, Ortiz A, Kramer A. A comparison of the epidemiology of kidney replacement therapy between Europe and the United States: 2021 data of the ERA Registry and the USRDS. Nephrol Dial Transplant 2024:gfae040. [PMID: 38439701 DOI: 10.1093/ndt/gfae040] [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] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND AND HYPOTHESIS This paper compares the most recent data on the incidence and prevalence of kidney replacement therapy (KRT), kidney transplantation rates, and mortality on KRT from Europe to those from the United States (US), including comparisons of treatment modalities (haemodialysis (HD), peritoneal dialysis (PD), and kidney transplantation (KTx)). METHODS Data were derived from the annual reports of the European Renal Association (ERA) Registry and the United States Renal Data System (USRDS). The European data include information from national and regional renal registries providing the ERA Registry with individual patient data. Additional analyses were performed to present results for all participating European countries together. RESULTS In 2021, the KRT incidence in the US (409.7 per million population (pmp)) was almost 3-fold higher than in Europe (144.4 pmp). Despite the substantial difference in KRT incidence, approximately the same proportion of patients initiated HD (Europe: 82%, US: 84%), PD (14%; 13% respectively), or underwent pre-emptive KTx (4%; 3% respectively). The KRT prevalence in the US (2436.1 pmp) was 2-fold higher than in Europe (1187.8 pmp). Within Europe, approximately half of all prevalent patients were living with a functioning graft (47%), while in the US, this was one third (32%). The number of kidney transplantations performed was almost twice as high in the US (77.0 pmp) compared to Europe (41.6 pmp). The mortality of patients receiving KRT was 1.6-fold higher in the US (157.3 per 1000 patient years) compared to Europe (98.7 per 1000 patient years). CONCLUSIONS The US had a much higher KRT incidence, prevalence, and mortality compared to Europe, and despite a higher kidney transplantation rate, a lower proportion of prevalent patients with a functioning graft.
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Affiliation(s)
- Vianda S Stel
- ERA Registry, Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, The Netherlands
| | - Rianne Boenink
- ERA Registry, Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, The Netherlands
| | - Megan E Astley
- ERA Registry, Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, The Netherlands
| | - Brittany A Boerstra
- ERA Registry, Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, The Netherlands
| | - Danilo Radunovic
- Clinical Center of Montenegro, Clinic for Nephrology, Podgorica, Montenegro
| | - Rannveig Skrunes
- Department of Medicine, Haukeland university Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Juan C Ruiz San Millán
- Nephrology Department, Hospital Universitario Marqués de Valdecilla, University of Cantabria, IDIVAL, Santander, Cantabria, Spain
| | | | - Samira Bell
- Scottish Renal Registry, Public Health Scotland, Meridian Court, Glasgow, UK
- Division of Population Health and Genomics, University of Dundee, Dundee, UK
| | - Pablo Ucio Mingo
- Coordinación Autonómica de Trasplantes de Castilla y León, Dirección General de Asistencia Sanitaria y Humanización, Gerencia Regional de Salud de Castilla y León, Valladolid, Castilla y León, Spain
| | | | | | - Halima Resic
- Society for Nephrology, Dialysis and Transplantation of Bosnia and Herzegovina, Sarajevo, Bosnia and Herzegovina
| | - Olga Lucia 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
| | - Nuria Aresté-Fosalba
- Nephrology Department, Virgen Macarena Hospital, Seville, Andalusia, Spain
- Information System of Andalusian Transplant Coordination (SICATA), Seville, Andalusia, Spain
| | - Jaume Tort I Bardolet
- Catalan Transplant Organization (OCATT), Catalan Health Service, Department of Health Barcelona, Spain
| | - Mathilde Lassalle
- REIN registry (Renal Epidemiology and Information Network), Paris, France
| | - Sara Trujillo-Alemán
- Health Quality Assessment and Information System Service, Dirección General de Programas Asistenciales, Servicio Canario de la Salud, Las Palmas de Gran Canaria, Spain
| | - Olafur S Indridason
- Division of Nephrology, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
| | - Marta Artamendi
- Nephrology Department, Hospital San Pedro, Logroño, La Rioja, Spain
| | - Patrik Finne
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine. Renal Unit, Royal Free London NHS Foundation Trust. UK Kidney Association, Bristol, UK
| | | | - George Moustakas
- Nephrology department, General hospital of Athens "G.Gennimatas", Athens, Greece
| | - Julia Kerschbaum
- Austrian Dialysis and Transplant Registry, Department of Internal Medicine IV - Nephrology and Hypertension, Medical University Innsbruck, Innsbruck, Austria
| | - Mirjana Lausevic
- School of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic of Nephrology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Kitty J Jager
- ERA Registry, Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, 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
| | - Anneke Kramer
- ERA Registry, Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, The Netherlands
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ElHafeez SA, Kramer A, Arici M, Arnol M, Åsberg A, Bell S, Belliere J, Corte CD, Fresnedo GF, Hemmelder M, Heylen L, Hommel K, Kerschbaum J, Naumović R, Nitsch D, Santamaria R, Finne P, Palsson R, Pippias M, Resic H, Rosenberg M, de Pablos CS, Segelmark M, Sørensen SS, Soler MJ, Vidal E, Jager KJ, Ortiz A, Stel VS. Incidence and outcomes of kidney replacement therapy for end-stage kidney disease due to primary glomerular disease in Europe: findings from the ERA Registry. Nephrol Dial Transplant 2024:gfae034. [PMID: 38327216 DOI: 10.1093/ndt/gfae034] [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] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND AND HYPOTHESIS Primary glomerular disease (PGD) is a major cause of end-stage kidney disease (ESKD) leading to kidney replacement therapy (KRT). We aimed to describe incidence (trends) in individuals starting KRT for ESKD due to PGD and to examine their survival and causes of death. METHODS We used data from the European Renal Association (ERA) Registry on 69 854 patients who started KRT for ESKD due to PGD between 2000 and 2019. ERA primary renal disease codes were used to define six PGD subgroups. We examined age and sex standardized incidence, trend of the incidence, and survival. RESULTS The standardized incidence of KRT for ESKD due to PGD was 16.6 per million population (pmp), ranging from 8.6 pmp in Serbia to 20.0 pmp in France. IgA nephropathy (IgAN) and focal segmental glomerulosclerosis (FSGS) had the highest incidence of 4.6 pmp and 2.6 pmp, respectively. Histologically non-examined PGDs represented over 50% of cases in Serbia, Bosnia and Herzegovina, and Romania and were also common in Greece, Estonia, Belgium, and Sweden. The incidence declined from 18.6 pmp in 2000 to 14.5 pmp in 2013, after which it stabilized. All PGD subgroups had five-year survival probabilities above 50%, with crescentic glomerulonephritis having the highest risk of death (adjusted hazard ratio: 1.8 [95% confidence interval: 1.6-1.9]) compared with IgAN. Cardiovascular disease was the most common cause of death (33.9%). CONCLUSION The incidence of KRT for ESKD due to PGD showed large differences between countries and was highest and increasing for IgAN and FSGS. Lack of kidney biopsy facilities in some countries may have affected accurate assignment of the cause of ESKD. The recognition of the incidence and outcomes of KRT among different PGD subgroups may contribute to a more individualized patient care approach.
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Affiliation(s)
- 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
| | - Anneke Kramer
- 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
| | - Mustafa Arici
- Department of Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Miha Arnol
- Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Anders Åsberg
- The Norwegian Renal Registry, Department of Transplantation Medicine, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Samira Bell
- Scottish Renal Registry, Meridian Court, Glasgow, UK
- Division of Population Health and Genomics, University of Dundee, Dundee, UK
| | - Julie Belliere
- Department of Nephrology and Organ Transplantation, Referral Centre for Rare Kidney Diseases, University Hospital of Toulouse, Toulouse, France
| | - Carmen Díaz Corte
- Department of Nephrology, Hospital Universitario Central de Asturias, Oviedo University, Oviedo, Spain
| | | | - Marc Hemmelder
- Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, University of Maastricht, Maastricht, The Netherlands
| | - Line Heylen
- Dutch-speaking Belgian Renal Registry (NBVN), Sint-Niklaas, Belgium
- Dienst Nefrologie, Ziekenhuis Oost-Limburg, Genk, Belgium
- University Hasselt, Hasselt, Belgium
| | | | - Julia Kerschbaum
- Austrian Dialysis and Transplant Registry, Department of Internal Medicine IV - Nephrology and Hypertension, Medical University Innsbruck, Innsbruck, Austria
| | | | - Dorothea Nitsch
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- UK Renal Registry, Bristol, UK
| | - Rafael Santamaria
- Andalusian Autonomous Transplant Coordination Information System, Seville, Spain
- Nephrology Service, Reina Sofia University Hospital, Cordoba, Spain
| | - Patrik Finne
- Helsinki University Central Hospital, Division of Nephrology, Helsinki, Finland
| | - 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
| | - Maria Pippias
- University of Bristol, Department of Health Care Evaluation, Population Health Sciences, Bristol, UK
- Bright Renal Unit, North Bristol NHS Trust, Bristol, UK
| | - Halima Resic
- Renal Registry of Society of Nephrology, Dialysis and Transplantation of Bosnia and Herzegovina, Clinic for Hemodialysis Sarajevo, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Mai Rosenberg
- Competence Centre for Rare Diseases, Tartu University Hospital, Tartu, Estonia
| | - 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
| | - Mårten Segelmark
- Division of Nephrology, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Endocrinology, Nephrology and Rheumatology, Skane University Hospital, Lund, Sweden
| | - Søren Schwartz Sørensen
- Department of Nephrology Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Maria Jose Soler
- Department of Nephrology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Enrico Vidal
- Department of Medicine (DAME), University of Udine, Udine, Italy
- Pediatric Nephrology Unit, University-Hospital of Padova, Padova, Italy
| | - 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
| | - Alberto Ortiz
- Department of Nephrology and Hypertension, IIS-Fundacion Jimenez Diaz UAM, Madrid, Spain
- Department of Medicine, Universidad Autonoma de Madrid, Madrid, Spain
| | - 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
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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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4
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Schild R, Dupont S, Harambat J, Vidal E, Balat A, Bereczki C, Bieniaś B, Brandström P, Broux F, Consolo S, Gojkovic I, Groothoff JW, Hommel K, Hubmann H, Braddon FEM, Pankratenko TE, Papachristou F, Plumb LA, Podracka L, Prokurat S, Bjerre A, Cordinhã C, Tainio J, Shkurti E, Spartà G, Vondrak K, Jager KJ, Oh J, Bonthuis M. Disparities in treatment and outcome of kidney replacement therapy in children with comorbidities: an ESPN/ERA Registry study. Clin Kidney J 2023; 16:745-755. [PMID: 37007701 PMCID: PMC10061422 DOI: 10.1093/ckj/sfad008] [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: 04/07/2022] [Indexed: 01/15/2023] Open
Abstract
Abstract
Background
Data on comorbidities in children on kidney replacement therapy (KRT) is scarce. Considering their high relevance for prognosis and treatment, this study aims to analyse the prevalence and implications of comorbidities in European children on KRT.
Methods
We included data from patients aged < 20 years when commencing KRT from 2007 to 2017 from 22 European countries within the ESPN/ERA Registry. Differences between patients with or without comorbidities in access to kidney transplantation (KT), patient and graft survival were estimated using Cox regression.
Results
Comorbidities were present in 33% of the 4127 children commencing KRT, and the prevalence steadily increased by 5% annually since 2007. Comorbidities were most frequent in high-income countries (43% vs. 24% in low-income and 33% in middle-income countries). Patients with comorbidities had a lower access to transplantation (aHR 0.67, 95% CI: 0.61–0.74), and a higher risk of death (aHR 1.79; 95% CI: 1.38–2.32). The increased mortality was only seen in dialysis patients (aHR 1.60; 95% CI: 1.21–2.13), and not after KT. For both outcomes, the impact of comorbidities was stronger in low-income countries. Graft survival was not affected by presence of comorbidities (aHR for 5-year graft failure: 1.18, 95% CI: 0.84–1.65).
Conclusions
Comorbidities have become more frequent in children on KRT and reduce their access to transplantation and survival, especially when remaining on dialysis. KT should be considered as an option in all paediatric KRT patients and efforts should be made to identify modifiable barriers to KT for children with comorbidities.
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Affiliation(s)
- Raphael Schild
- Division of Pediatric Nephrology, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Simeon Dupont
- Division of Pediatric Nephrology, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Jérôme Harambat
- Department of Pediatrics, Bordeaux University Hospital, Bordeaux Population Health Research Center UMR 1219, University of Bordeaux , Bordeaux , France
| | - Enrico Vidal
- Division of Pediatrics, Department of Medicine, University of Udine , Udine , Italy
| | - Ayşe Balat
- Department of Pediatric Nephrology, Gaziantep University Medical Faculty , Gaziantep , Turkey
| | - Csaba Bereczki
- Department of Pediatrics, University of Szeged , Hungary
| | - Beata Bieniaś
- Department of Paediatric Nephrology, Medical University of Lublin , Lublin , Poland
| | - Per Brandström
- The Pediatric Uro Nephrology Center, The Queen Silvia Children's Hospital, The Sahlgrenska Academy at the University of Gothenburg , Gothenburg , Sweden
| | - Francoise Broux
- Department of Pediatrics, Rouen University Hospital , Rouen , France
| | - Silvia Consolo
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCSS Ca’ Grande Ospedale Maggiore Policlinico , Milan , Italy
| | - Ivana Gojkovic
- Department of Nephrology, University Children's Hospital, University of Belgrade , Belgrade , Serbia
| | - Jaap W Groothoff
- Department of Pediatric Nephrology, Emma Children's Hospital, Amsterdam University Medical Center, University of Amsterdam , Amsterdam , The Netherlands
| | | | - Holger Hubmann
- Department of Pediatrics, Medical University Graz , Graz , Austria
| | | | - Tatiana E Pankratenko
- Moscow Regional Research and Clinical Institute named after M.F. Vladimirskiy , Moscow , Russia
| | - Fotios Papachristou
- Pediatric Nephrology Unit, 1st Department of Pediatrics, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Lucy A Plumb
- Population Health Sciences, University of Bristol Medical School , Bristol , United Kingdom
| | - Ludmila Podracka
- Pediatric Department, National Institute of Children's Health, Comenius University , Bratislava , Slovakia
| | - Sylwester Prokurat
- Department of Nephrology & Kidney Transplantation, The Children's Memorial Health Institute , Warsaw , Poland
| | - Anna Bjerre
- Division of Paediatric and Adolescent Medicine, Department of Specialised Medicine and Transplantation, Oslo University Hospital , Rikshospitalet, Oslo , Norway
| | - Carolina Cordinhã
- Pediatric Nephrology Unit, Hospital Pediátrico - Centro Hospitalar Universitário de Coimbra , Coimbra , Portugal
| | - Juuso Tainio
- Department of Pediatric Nephrology and Transplantation, New Children's Hospital, University of Helsinki and Helsinki University Hospital , Helsinki Finland
| | | | - Giuseppina Spartà
- Pediatric Nephrology Unit, University Children's Hospital Zurich , Zurich , Switzerland
| | - Karel Vondrak
- Department of Pediatric Nephrology, University Hospital Motol , Prague , Czech Republic
| | - Kitty J Jager
- ESPN/ERA Registry, Amsterdam UMC, University of Amsterdam, Department of Medical Informatics, Amsterdam Public Health Research Institute , Amsterdam , The Netherlands
| | - Jun Oh
- Division of Pediatric Nephrology, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Marjolein Bonthuis
- ESPN/ERA Registry, Amsterdam UMC, University of Amsterdam, Department of Medical Informatics, Amsterdam Public Health Research Institute , Amsterdam , The Netherlands
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5
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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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6
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Schytz PA, Blanche P, Nissen AB, Torp-Pedersen C, Gislason GH, Nelveg-Kristensen KE, Hommel K, Carlson N. Acute kidney injury and risk of cardiovascular outcomes: A nationwide cohort study. Nefrologia 2022; 42:338-346. [PMID: 36210122 DOI: 10.1016/j.nefroe.2022.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 06/29/2021] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Acute kidney injury (AKI) has been associated with cardiovascular disease, but this is sparsely studied in non-selected populations and with little attention to the effect in age and renal function. Using nationwide administrative data, we investigated the hypothesis of increased one-year risk of cardiovascular event or death associated with AKI. METHODS In a cohort study, we identified all admissions in Denmark between 2008 and 2018. AKI was defined as ≥1.5 times increase from baseline to peak creatinine during admission, or dialysis. We excluded patients with age <50 years, estimated glomerular filtration rate (eGFR) <15ml/min/1.73m2, renal transplantation, index-admission due to cardiovascular disease or death during index-admission. The primary outcome was cardiovascular risk within one year from discharge, which was a composite of the secondary outcomes ischemic heart disease, heart failure or stroke. To estimate risks, we applied multiple logistic regression fitted by inverse probability of censoring weighting and stratified estimations by eGFR and age. We adjusted for proteinuria in the subcohort with measurements available. RESULTS Among 565,056 hospital admissions, 39,569 (7.0%) cases of AKI were present. In total, 18,642 patients sustained a cardiovascular outcome. AKI was significantly associated with cardiovascular outcome with an adjusted OR [CI] of 1.33 [1.16-1.53], 1.43 [1.33-1.54], 1.23 [1.14-1.34], 1.38 [1.18-1.62] for eGFR ≥90, 60-89, 30-59 and 15-29ml/min/1.73m2, respectively. When omitting the outcome heart failure, these results were 1.24 [1.06-1.45], 1.22 [1.11-1.33], 1.05 [0.95-1.16], 1.25 [1.02-1.54]. Results did not change substantially in strata of age groups, in AKI stages and in the subcohort adjusted for proteinuria. CONCLUSION Non-selected patients aged 50 years or above with AKI during admission had significantly higher one-year risk of cardiovascular event or death, especially, but not only due to heart failure, independent of age and eGFR.
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Affiliation(s)
| | - Paul Blanche
- Department of Public Health, Section of Biostatistics, Copenhagen University, Denmark
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7
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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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8
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Boenink R, Astley ME, Huijben JA, Stel VS, Kerschbaum J, Rosenberg-Ots M, Åsberg AA, Lopot F, Golan E, Castro de la Nuez P, Rodríguez Camblor M, Trujillo-Alemán S, Ruiz San Millan JC, Ucio Mingo P, Díaz JM, Bouzas-Caamaño ME, Artamendi M, Aparicio Madre MI, Santiuste de Pablos C, Slon Roblero MF, Zurriaga O, Stendahl ME, Bell S, Idrizi A, Ioannou K, Debska-Slizien A, Galvão AA, De Meester JM, Resić H, Hommel K, Radunovic D, Pálsson R, Lassalle M, Finne P, De los Ángeles-Garcia Bazaga M, Gjorgjievski N, Seyahi N, Bonthuis M, Ortiz A, Jager KJ, Kramer A. The ERA Registry Annual Report 2019: summary and age comparisons. Clin Kidney J 2021; 15:452-472. [PMID: 35211303 PMCID: PMC8862051 DOI: 10.1093/ckj/sfab273] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Indexed: 11/24/2022] Open
Abstract
Background Data on renal replacement therapy (RRT) for end-stage renal disease were collected by
the European Renal Association (ERA) Registry via national and regional renal registries
in Europe and countries bordering the Mediterranean Sea. This article provides a summary
of the 2019 ERA Registry Annual Report, including data from 34 countries and additional
age comparisons. Methods Individual patient data for 2019 were provided by 35 registries and aggregated data by
17 registries. Using these data, the incidence and prevalence of RRT, the kidney
transplantation activity and the survival probabilities were calculated. Results In 2019, a general population of 680.8 million people was covered by the ERA Registry.
Overall, the incidence of RRT was 132 per million population (p.m.p.). Of these
patients, 62% were men, 54% were ≥65 years of age and 21% had diabetes mellitus as
primary renal disease (PRD), and 84% had haemodialysis (HD), 11% had peritoneal dialysis
(PD) and 5% had pre-emptive kidney transplantation as an initial treatment modality. The
overall prevalence of RRT on 31 December 2019 was 893 p.m.p., with 58% of patients on
HD, 5% on PD and 37% living with a kidney transplant. The overall kidney transplant rate
was 35 p.m.p. and 29% of the kidney grafts were from a living donor. The unadjusted
5-year survival probability was 42.3% for patients commencing dialysis, 86.6% for
recipients of deceased donor grafts and 94.4% for recipients of living donor grafts in
the period 2010–14. When comparing age categories, there were substantial differences in
the distribution of PRD, treatment modality and kidney donor type, and in the survival
probabilities.
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Affiliation(s)
- Rianne Boenink
- ERA Registry, Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Megan E Astley
- ERA Registry, Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Jilske A Huijben
- ERA Registry, Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Vianda S Stel
- ERA Registry, Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, 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, Innsbruck, Austria
| | - Mai Rosenberg-Ots
- Department of Internal Medicine of Tartu University and Tartu University Hospital, Tartu, Estonia
| | - Anders A Åsberg
- The Norwegian Renal Registry, Oslo University Hospital - Rikshospitalet, Oslo, Norway
- Department of Transplantation Medicine, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Frantisek Lopot
- Department of Medicine, General University Hospital, Prague – Strahov, Czech Republic
| | | | - Pablo Castro de la Nuez
- SICATA: Information System of the Autonomous Coordination of Transplants of Andalusia, Seville, Andalucia, Spain
| | | | - Sara Trujillo-Alemán
- Health Quality Assessment and Information System Service, Dirección General de Programas Asistenciales, Servicio Canario de la Salud, Canary Islands, Spain
| | | | - Pablo Ucio Mingo
- Coordinación Autonómica de Trasplantes de Castilla y León, Dirección General de Planificación y Asistencia Sanitaria, Valladolid, Castilla y León, Spain
| | - Joan Manuel Díaz
- Servei Nefrologia, Fundació Puigvert, Barcelona, Catalonia, Spain
| | | | - Marta Artamendi
- Nephrology Department, Hospital San Pedro, Logroño, La Rioja, Spain
| | | | - Carmen Santiuste de Pablos
- Murcia Renal Registry, Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
- CIBERESP (Spanish Consortium for Biomedical Research in Epidemiology and Public Health), Madrid, Spain
| | | | - Oscar Zurriaga
- CIBERESP (Spanish Consortium for Biomedical Research in Epidemiology and Public Health), Madrid, Spain
- Valencian Region Renal Registry, Valencia Regional Health Authority, Generalitat Valenciana, Spain
- Universitat de Valencia, Valencia, Spain
| | - Maria E Stendahl
- Swedish Renal Registry, Department of Internal Medicine, Jonkoping Regional Hospital, Jonkoping, Sweden
| | - Samira Bell
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
- The Scottish Renal Registry, Scottish Health Audits, Public Health Scotland, Meridian Court, Glasgow, UK
| | - Alma Idrizi
- Service of Nephrology, UHC Mother Teresa, Tirana, Albania
| | - Kyriakos Ioannou
- Cyprus Renal Registry, Nicosia, Cyprus
- Nephrology Department, American Medical Center, Nicosia, Cyprus
| | - Alicja Debska-Slizien
- Department of Nephrology, Transplantology and Internal Medicine, Gdansk Medical University, Gdansk, Poland
| | - Ana A Galvão
- Portuguese Society of Nephrology, Coimbra, Portugal
| | - Johan M De Meester
- Department of Nephrology, Dialysis and Hypertension, Dutch-speaking Belgian Renal Registry (NBVN), Sint-Niklaas, Belgium
| | - Halima Resić
- Society of nephrology and dialysis of Bosnia and Herzegovina, Sarajevo, Bosnia and Herzegovina
| | | | - Danilo Radunovic
- Clinical Center of Montenegro, Clinic for Nephrology, Podgorica, Montenegro
| | - Runolfur 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
| | - Mathilde Lassalle
- REIN Registry, Agence de la Biomédecine, Saint-Denis La Plaine, France
| | - Patrik Finne
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Finnish Registry for Kidney Diseases, Helsinki, Finland
| | - Maria De los Ángeles-Garcia Bazaga
- Dirección General de Salud Pública, Servicio Extremeño de Salud, Consejería de Sanidad y Políticas Sociales, Junta de Extremadura, Spain
| | - Nikola Gjorgjievski
- University Hospital of Nephrology, Skopje, North Macedonia
- Faculty of Medicine, University SS“ Cyril and Methodius”, Skopje, North Macedonia
| | - Nurhan Seyahi
- Department of nephrology, Cerrahpaşa medical faculty, Istanbul university-Cerrahpaşa, Istanbul, Turkey
| | - Marjolein Bonthuis
- ERA Registry, Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
- ESPN/ERA Registry, Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health research institute, 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, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Anneke Kramer
- ERA Registry, Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
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9
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Hauge SC, Abrahamsen B, Gislason G, Olesen JB, Hommel K, Hansen D. Diabetes increases the risk of bone fractures in patients on kidney replacement therapy: A Danish national cohort study. Bone 2021; 153:116158. [PMID: 34461286 DOI: 10.1016/j.bone.2021.116158] [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: 04/26/2021] [Revised: 08/10/2021] [Accepted: 08/19/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients treated with dialysis or living with a kidney transplant (kidney replacement therapy, KRT) have an increased risk of bone fracture. Patients with diabetes also have an increased risk of fracture. The aim of this study was to investigate whether the presence of diabetes in patients on KRT aggravates the risk of fracture. METHODS Nationwide Danish registries were used in this retrospective cohort study. All prevalent adult patients on hemodialysis (HD) or peritoneal dialysis (PD) on 1st of January 2000 and all incident patients starting KRT (HD, PD, kidney transplanted (KTX)) until 31st of December 2011 were included in the KRT group. Adult persons not on KRT and without diabetes on 1st of January 2000 were used as a reference group. Patients were separated in groups with and without (+/-) diabetes. They were followed until first fracture, emigration, death, or end-of-study on 31st of December 2016. RESULTS A total of 4,074,085 not on KRT +/- diabetes and 9053 patients on KRT +/- diabetes were included. Comparing the different groups with diabetes to the corresponding group without diabetes, the unadjusted HR (95% CI) for any first fracture were 1.2 (1.0-1.3) in the HD population, 1.4 (1.1-1.7) in the PD population, and 1.7 (1.4-2.2) in the KTX population. Further adjustments for age, sex, prior fractures, comorbidity and medication did not change these results significantly. CONCLUSIONS Diabetes increases the risk of fracture in patients on KRT.
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Affiliation(s)
- Sabina Chaudhary Hauge
- Department of Nephrology, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730 Herlev, Denmark.
| | - Bo Abrahamsen
- Department of Medicine, Holbæk Hospital, Smedelundsgade 60, 4300 Holbæk, Denmark.; Institute of Clinical Research, University of Southern Denmark, Winsløwparken 19, 3. Floor, 5000 Odense C, Copenhagen, Denmark; NDORMS, Botnar Centre, Oxford University, Windmill Road, Oxford, OX3 7LD, United Kingdom
| | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark; The Danish Heart Foundation, Vognmagergade 7, 3. Floor, 1120 Copenhagen K, Denmark
| | - Jonas Bjerring Olesen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
| | - Kristine Hommel
- Department of Medicine, Holbæk Hospital, Smedelundsgade 60, 4300 Holbæk, Denmark.; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
| | - Ditte Hansen
- Department of Nephrology, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730 Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
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10
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Derner O, Kramer A, Hruskova Z, Arici M, Collart F, Finne P, Fuentes Sánchez L, Harambat J, Hemmelder MH, Hommel K, Kerschbaum J, De Meester J, Palsson R, Segelmark M, Skrunes R, Traynor JP, Zurriaga O, Massy ZA, Jager KJ, Stel VS, Tesar V. Incidence of Kidney Replacement Therapy and Subsequent Outcomes Among Patients With Systemic Lupus Erythematosus: Findings From the ERA Registry. Am J Kidney Dis 2021; 79:635-645. [PMID: 34752912 DOI: 10.1053/j.ajkd.2021.09.016] [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: 11/24/2020] [Accepted: 09/18/2021] [Indexed: 01/10/2023]
Abstract
RATIONALE AND OBJECTIVE There is a dearth of data characterizing patients requiring kidney replacement therapy (KRT) for kidney failure due to systemic lupus erythematosus (SLE) and their clinical outcomes. The aim of this study was to describe trends in incidence and prevalence of KRT among these patients as well as to compare their outcomes to patients treated with KRT for diseases other than SLE. STUDY DESIGN Retrospective cohort study based on kidney registry data. SETTING & PARTICIPANTS Patients recorded in 14 registries of patients receiving kidney replacement therapy that provided data to the European Renal Association (ERA) Registry between 1992 and 2016. PREDICTOR SLE as cause of kidney failure. OUTCOMES Incidence and prevalence of KRT, patient survival while receiving KRT, patient and graft survival after kidney transplantation, and specific causes of death. ANALYTICAL APPROACH Kaplan-Meier methods and Cox regression models were fit to compare patient survival between the SLE and non-SLE groups, overall KRT, dialysis and patient and graft survival after kidney transplantation. RESULTS In total, 1826 patients commenced KRT for kidney failure due to SLE, representing an incidence of 0.80 per million population (pmp) per year. The incidence remained stable during the study period (annual percent change=0.1 [95%CI: -0.6 ; 0.8]). Patient survival among patients with SLE receiving KRT was similar to survival within the comparator group (HR=1.11 [95%CI: 0.99-1.23]). After kidney transplantation, the risk of death was greater among patients with SLE than among patients within the comparator group (HR=1.25 [95%CI: 1.02-1.53]), while the risk of all-cause graft failure was similar (HR=1.09 [95%CI: 0.95-1.27]). Ten-year patient overall survival on KRT, and patient and graft survival after kidney transplantation improved over the study period (HR=0.71 [95%CI: 0.56-0.91], 0.43 [0.27-0.69] and 0.60 [0.43-0.84], respectively). Patients with SLE receiving KRT were significantly more likely to die from infections (24.8%) than patients in the comparator group (16.9%, p<0.001). LIMITATIONS No data were available on extrarenal manifestations of SLE, drug treatments, comorbidities, kidney transplant characteristics, or relapses of SLE. CONCLUSION The prognosis of patients with SLE receiving KRT has improved over time. Survival of patients with SLE requiring KRT was similar when compared to patients requiring KRT due to other causes of kidney failure. Survival following kidney transplantation was worse among patients with SLE.
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Affiliation(s)
- Ondrej Derner
- Department of Nephrology, 1st Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Anneke Kramer
- ERA Registry, Amsterdam UMC, University of Amsterdam, Department of Medical Informatics, Amsterdam Public Health research institute, Amsterdam, the Netherlands.
| | - Zdenka Hruskova
- Department of Nephrology, 1st Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Mustafa Arici
- Department of Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | | | - Patrik Finne
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Finnish Registry for Kidney Diseases, Helsinki, Finland
| | | | - Jérôme Harambat
- Université de Bordeaux, Inserm U1219, Unité de Néphrologie, Service de Pédiatrie, CHU de Bordeaux, Bordeaux, France
| | - Marc H Hemmelder
- Dutch Renal Registry Renine, Nefrovisie foundation, Utrecht, the Netherlands; Department of internal medicine, Division of nephrology, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Julia Kerschbaum
- Austrian Dialysis and Transplant Registry, Department of Internal Medicine IV - Nephrology and Hypertension, Medical University Innsbruck, Innsbruck, Austria
| | - Johan De Meester
- Department of Nephrology, Dialysis and Hypertension, Dutch-speaking Belgian Renal Registry (NBVN), Sint-Niklaas, Belgium
| | - 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
| | - Mårten Segelmark
- Department of Clinical Sciences, Division of Nephrology, Lund University and Skane University Hospital, Lund, Sweden
| | - Rannveig Skrunes
- Department of Medicine, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Jamie P Traynor
- Scottish Renal Registry, Meridian Court, ISD Scotland, Glasgow G2 6QE, United Kingdom
| | - Oscar Zurriaga
- Valencia Region Renal Registry. Direccio General de Salut Publica i Adiccions, Valencia, Spain; Department of Preventive Medicine and Public Health. Universitat de Valencia, Valencia, Spain; Rare Diseases Joint Research Unit Universitat de Valencia-Foundation for the Promotion of Health and Biomedical Research in the Valencian Region, FISABIO, Valencia, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, 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 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
- ERA Registry, Amsterdam UMC, University of Amsterdam, Department of Medical Informatics, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Vianda S Stel
- ERA Registry, Amsterdam UMC, University of Amsterdam, Department of Medical Informatics, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Vladimir Tesar
- Department of Nephrology, 1st Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
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11
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Schytz PA, Blanche P, Nissen AB, Torp-Pedersen C, Gislason GH, Nelveg-Kristensen KE, Hommel K, Carlson N. Acute kidney injury and risk of cardiovascular outcomes: A nationwide cohort study. Nefrologia 2021; 42:S0211-6995(21)00140-5. [PMID: 34489123 DOI: 10.1016/j.nefro.2021.06.007] [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: 02/07/2021] [Revised: 06/19/2021] [Accepted: 06/29/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) has been associated with cardiovascular disease, but this is sparsely studied in non-selected populations and with little attention to the effect in age and renal function. Using nationwide administrative data, we investigated the hypothesis of increased one-year risk of cardiovascular event or death associated with AKI. METHODS In a cohort study, we identified all admissions in Denmark between 2008 and 2018. AKI was defined as ≥1.5 times increase from baseline to peak creatinine during admission, or dialysis. We excluded patients with age <50 years, estimated glomerular filtration rate (eGFR) <15ml/min/1.73m2, renal transplantation, index-admission due to cardiovascular disease or death during index-admission. The primary outcome was cardiovascular risk within one year from discharge, which was a composite of the secondary outcomes ischemic heart disease, heart failure or stroke. To estimate risks, we applied multiple logistic regression fitted by inverse probability of censoring weighting and stratified estimations by eGFR and age. We adjusted for proteinuria in the subcohort with measurements available. RESULTS Among 565,056 hospital admissions, 39,569 (7.0%) cases of AKI were present. In total, 18,642 patients sustained a cardiovascular outcome. AKI was significantly associated with cardiovascular outcome with an adjusted OR [CI] of 1.33 [1.16-1.53], 1.43 [1.33-1.54], 1.23 [1.14-1.34], 1.38 [1.18-1.62] for eGFR ≥90, 60-89, 30-59 and 15-29ml/min/1.73m2, respectively. When omitting the outcome heart failure, these results were 1.24 [1.06-1.45], 1.22 [1.11-1.33], 1.05 [0.95-1.16], 1.25 [1.02-1.54]. Results did not change substantially in strata of age groups, in AKI stages and in the subcohort adjusted for proteinuria. CONCLUSION Non-selected patients aged 50 years or above with AKI during admission had significantly higher one-year risk of cardiovascular event or death, especially, but not only due to heart failure, independent of age and eGFR.
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Affiliation(s)
| | - Paul Blanche
- Department of Public Health, Section of Biostatistics, Copenhagen University, Denmark
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12
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Kramer A, Boenink R, Stel VS, Santiuste de Pablos C, Tomović F, Golan E, Kerschbaum J, Seyahi N, Ioanou K, Beltrán P, Zurriaga O, Magaz Á, Slon Roblero MF, Gjorgjievski N, Garneata L, Arribas F, Galvão AA, Bell S, Ots-Rosenberg M, Muñoz-Terol JM, Winzeler R, Hommel K, Åsberg A, Spustova V, Palencia García MÁ, Vazelov E, Finne P, Ten Dam MAGJ, Lopot F, Trujillo-Alemán S, Lassalle M, Kolesnyk MO, Santhakumaran S, Idrizi A, Andrusev A, Comas Farnés J, Komissarov K, Resić H, Palsson R, Kuzema V, Garcia Bazaga MA, Ziginskiene E, Stendahl M, Bonthuis M, Massy ZA, Jager KJ. The ERA-EDTA Registry Annual Report 2018: a summary. Clin Kidney J 2020; 14:107-123. [PMID: 33564410 PMCID: PMC7857839 DOI: 10.1093/ckj/sfaa271] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [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: 12/07/2020] [Accepted: 12/18/2020] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Anneke Kramer
- Department of Medical Informatics, ERA-EDTA Registry, UMC, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Rianne Boenink
- Department of Medical Informatics, ERA-EDTA Registry, UMC, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Vianda S Stel
- Department of Medical Informatics, ERA-EDTA Registry, UMC, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Carmen Santiuste de Pablos
- Department of Epidemiology, Murcia Renal Registry, Murcia Regional Health Authority, IMIB-Arrixaca, Murcia, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Filip Tomović
- Clinical Center of Montenegro, Clinic for Nephrology, Podgorica, Montenegro
| | - Eliezer Golan
- Israel Renal Registry, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Julia Kerschbaum
- Department of Internal Medicine IV-Nephrology and Hypertension, Austrian Dialysis and Transplant Registry, Medical University Innsbruck, Innsbruck, Austria
| | - Nurhan Seyahi
- Department of Nephrology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Kyriakos Ioanou
- Cyprus Renal Registry, Nicosia, Cyprus.,Department of Nephrology, American Medical Center, Nicosia, Cyprus
| | | | - Oscar Zurriaga
- Valencia Region Renal Registry, Direccio General de Salut Publica i Adiccions, Valencia, Spain.,Department of Preventive Medicine and Public Health, Universitat de Valencia, Valencia, Spain.,Rare Diseases Joint Research Unit Universitat de Valencia-Foundation for the Promotion of Health and Biomedical Research in the Valencian Region, FISABIO, Valencia, Spain.,Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Ángela Magaz
- Unidad de Información de Pacientes Renales-UNIPAR, Basque Country, Spain
| | | | - Nikola Gjorgjievski
- University Hospital of Nephrology, Skopje, N. Macedonia.,Faculty of Medicine, University Ss "Cyril and Methodius" Skopje, Skopje, N. Macedonia
| | - Liliana Garneata
- Department of Internal Medicine and Nephrology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Federico Arribas
- Department of Aragon Health, General Direction of Health Care, Zaragoza, Spain
| | | | - Samira Bell
- Scottish Renal Registry, Meridian Court, Information Services Division Scotland, Glasgow, UK.,Division of Population Health and Genomics, University of Dundee, Dundee, UK
| | - Mai Ots-Rosenberg
- Department of Internal Medicine, University of Tartu, Tartu University Hospital, Tartu, Estonia
| | - José M Muñoz-Terol
- Department of Nephrology, Hospital University Virgen del Rocio, Seville, Spain
| | - Rebecca Winzeler
- Institute of Nephrology, City Hospital Waid and Triemli, Zurich, Switzerland
| | | | - Anders Åsberg
- Department of Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Viera Spustova
- Department of experimental and clinical pharmacotherapy, Slovak Medical University, Bratislava, Slovakia
| | - María Ángeles Palencia García
- Coordinación Autonómica de Trasplantes de Castilla y León, Dirección General de Planificación y Asistencia Sanitaria, Regional de Salud, Valladolid, Spain
| | - Evgueniy Vazelov
- Dialysis clinic, "Alexandrovska" University Hospital, Sofia Medical University, Sofia, Bulgaria
| | - Patrik Finne
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Finnish Registry for Kidney Diseases, Helsinki, Finland
| | | | - František Lopot
- Department of Medicine, General University Hospital Prague, Strahov, Czech Republic
| | - Sara Trujillo-Alemán
- Health Quality Assessment and Information System Service, Dirección General de Programas Asistenciales, Servicio Canario de la Salud, Canary Islands, Spain
| | - Mathilde Lassalle
- REIN Registry, Agence de la Biomédecine, Saint-Denis La Plaine, France
| | - Mykola O Kolesnyk
- State Institute of Nephrology, National Academy of Medical Sciences of Ukraine, Kiev, Ukraine
| | | | - Alma Idrizi
- Service of Nephrology, UHC Mother Teresa, Tirana, Albania
| | - Anton Andrusev
- Chronic Dialysis, Russia & CIS Medical Department, Company "Baxter" AO, Moscow, Russia.,Renal Replacement Registry, Russian Dialysis Society, Moscow, Russia
| | - Jordi Comas Farnés
- Health Department, Catalan Renal Registry, Catalan Transplant Organization, Generalitat of Catalonia, Barcelona, Spain
| | - Kirill Komissarov
- Minsk Scientific and Practical Center of Surgery, Transplantation and Hematology, Minsk, Belarus
| | - Halima Resić
- Clinic of Nephrology, Clinical Center, University of Sarajevo, Sarajevo, Bosnia-Herzegovina
| | - 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
| | - 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
| | - Maria Angeles Garcia Bazaga
- Dirección General de Salud Pública, Servicio Extremeño de Salud, Consejería de Sanidad y Políticas Sociales, Junta de Extremadura, Mérida, Spain
| | - Edita Ziginskiene
- Lithuanian Nephrology, Dialysis and Transplantation Association, Kaunas, Lithuania.,Department of Nephrology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Maria Stendahl
- Department of Internal Medicine, Swedish Renal Registry, Jonkoping Regional Hospital, Jonkoping, Sweden
| | - Marjolein Bonthuis
- Department of Medical Informatics, ERA-EDTA Registry, UMC, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands.,Department of Medical Informatics, SPN/ERA-EDTA Registry, UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - 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
- Department of Medical Informatics, ERA-EDTA Registry, UMC, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
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Schytz PA, Nissen AB, Hommel K, Schou M, Nelveg-Kristensen KE, Torp-Pedersen C, Gislason GH, Gerds TA, Carlson N. Correction to: Is metformin associated with acute kidney injury? A case-control study of patients with type 2 diabetes admitted with acute infection. J Nephrol 2020; 34:1381. [PMID: 33058039 DOI: 10.1007/s40620-020-00884-0] [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: 11/25/2022]
Affiliation(s)
- Philip Andreas Schytz
- Department of Cardiology, Herlev and Gentofte Hospital, Kildegaardsvej 28, 2900, Hellerup, Copenhagen, Denmark.
| | - Anders Bonde Nissen
- Department of Cardiology, Herlev and Gentofte Hospital, Kildegaardsvej 28, 2900, Hellerup, Copenhagen, Denmark
| | - Kristine Hommel
- Department of Medicine, Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Morten Schou
- Department of Cardiology, Herlev and Gentofte Hospital, Kildegaardsvej 28, 2900, Hellerup, Copenhagen, Denmark
| | | | | | - Gunnar H Gislason
- Department of Cardiology, Herlev and Gentofte Hospital, Kildegaardsvej 28, 2900, Hellerup, Copenhagen, Denmark
| | - Thomas A Gerds
- Department of Biostatistics, Copenhagen University, Copenhagen, Denmark
| | - Nicholas Carlson
- Department of Nephrology, The Danish Heart Foundation and Specialist Registrar, Rigshospitalet, Copenhagen, Denmark
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14
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Schytz PA, Nissen AB, Hommel K, Schou M, Nelveg-Kristensen KE, Torp-Pedersen C, Gislason GH, Gerds TA, Carlson N. Is metformin associated with acute kidney injury? A case-control study of patients with type 2 diabetes admitted with acute infection. J Nephrol 2020; 34:709-717. [PMID: 33001414 DOI: 10.1007/s40620-020-00863-5] [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: 07/21/2020] [Accepted: 09/14/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Despite the long-term renoprotective effects of Metformin, a recent study on data from the U.S. Food and Drug Administration reported a possible nephrotoxic effect, contributing to the development of acute kidney injury (AKI). We investigated the association between metformin and AKI in patients admitted with the AKI-prone condition of acute infection and compared results with corresponding results of other antidiabetics. METHODS In a nationwide register-based case-control study, we identified Danish patients with type 2 diabetes hospitalized with acute infection between 2008 and 2018. Cases of AKI had an increase in plasma creatinine ≥ × 1.5 during admission, controls did not. Antidiabetics were identified up to 6 months before admission. Odds ratio (OR) of each antidiabetic was computed in separate multiple logistic regression models adjusted for relevant medication and comorbidities and results compared. RESULTS We included 46,811 patients, hereof 9454 AKIs (20%) and 2186 (4.7%) severe AKIs. Overall, 56% were males, median age (IQR) was 73 (65-81). Sixty percent received metformin, 13% sulfonylurea, 31% insulin and 8% dipeptidyl peptidase-4 inhibitors (DPP-4i), with equal distribution between cases and controls. Metformin was associated with increased OR (CI) for AKI, 1.07 (1.02-1.12), equally to sulfonylurea, 1.10 (1.03-1.18) and DPP-4i, 1.11 (1.02-1.20), but not insulin, 0.99 (0.93-1.05). In severe AKI, results for metformin were 1.27 (1.25-1.40) but increased equivalently to other antidiabetics. CONCLUSIONS In patients with type 2 diabetes hospitalized with acute infection, metformin was not independently associated with AKI, since other antidiabetics were also significantly associated, indicating confounding by indication.
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Affiliation(s)
- Philip Andreas Schytz
- Department of Cardiology, Herlev and Gentofte Hospital, Kildegaardsvej 28, 2900, Hellerup, Copenhagen, Denmark.
| | - Anders Bonde Nissen
- Department of Cardiology, Herlev and Gentofte Hospital, Kildegaardsvej 28, 2900, Hellerup, Copenhagen, Denmark
| | - Kristine Hommel
- Department of Medicine, Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Morten Schou
- Department of Cardiology, Herlev and Gentofte Hospital, Kildegaardsvej 28, 2900, Hellerup, Copenhagen, Denmark
| | | | | | - Gunnar H Gislason
- Department of Cardiology, Herlev and Gentofte Hospital, Kildegaardsvej 28, 2900, Hellerup, Copenhagen, Denmark
| | - Thomas A Gerds
- Department of Biostatistics, Copenhagen University, Copenhagen, Denmark
| | - Nicholas Carlson
- Department of Nephrology, The Danish Heart Foundation and Specialist Registrar, Rigshospitalet, Copenhagen, Denmark
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15
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Schytz PA, Nissen AB, Torp-Pedersen C, Gislason GH, Nelveg-Kristensen KE, Hommel K, Gerds TA, Carlson N. Creatinine increase following initiation of antihypertensives is associated with cardiovascular risk: a nationwide cohort study. J Hypertens 2020; 38:2519-2526. [PMID: 32694338 DOI: 10.1097/hjh.0000000000002573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Abrupt decline in renal function following initiation of renin-angiotensin system inhibitor is associated with increased risk of cardiovascular disease, but studies of other antihypertensive drugs are sparse. We investigated the risk of cardiovascular event associated with increased plasma creatinine after initiating first-line antihypertensive treatment. METHODS In a nationwide cohort study, we identified adult Danish primary care patients initiating either renin-angiotensin system inhibitor, calcium channel blocker or thiazide, between 2008 and mid-2018. Patients with prior end-stage renal disease, renal transplantation, or cardiovascular disease were excluded. Percentual plasma creatinine increase was calculated between the nearest creatinine measurement up to 1 year before redeeming the prescription (baseline), and the nearest measurement 90 days or less after (index). Multiple logistic regression and restricted cubic splines were applied to estimate the 6-month absolute risk of cardiovascular event (ischemic heart disease, heart failure or stroke) associated with this creatinine increase. RESULTS We included 20 789 patients. Within the first 6 months of follow-up, 283 (1.4%) cardiovascular events and 93 (0.4%) all-cause deaths were registered. With a creatinine increase of 0 and 30%, 6-month absolute risk [CI] of cardiovascular event was 1.4% [1.1-1.9] and 3.5% [2.4-5.2], respectively (in men aged 50-79 years with estimated glomerular filtration rate at least 60 ml/min per 1.73 m and no diabetes). Higher age and reduced renal function, but not the type of antihypertensive treatment, were associated with higher cardiovascular risk. CONCLUSION In primary care, patients initiating first-line antihypertensive treatment, an increase in plasma creatinine above 30% was associated with increased absolute 6-month risk of cardiovascular event.
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Affiliation(s)
| | | | | | - Gunnar H Gislason
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen.,The Danish Heart Foundation, Copenhagen
| | | | | | - Thomas A Gerds
- Department of Biostatistics, Copenhagen University, Copenhagen, Denmark
| | - Nicholas Carlson
- The Danish Heart Foundation, Copenhagen.,Department of Nephrology, Rigshospitalet Copenhagen
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16
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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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Hauge SC, Abrahamsen B, Gislason G, Bjerring Olesen J, Hommel K, Hansen D. SaO028BONE FRACTURES IN PATIENTS ON RENAL REPLACEMENT THERAPY: DOES DIABETES INCREASE THE RISK? Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz101.sao028] [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: 11/12/2022] Open
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Schytz PA, Torp-Pedersen C, Gislason G, Nelveg-Kristensen KE, Hommel K, Carlson N. FP242MORTALITY AND RELATIVE CHANGES IN PLASMA CREATININE IN NON-HOSPITALIZED GENERAL POPULATIONS. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.fp242] [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: 11/12/2022] Open
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Boesby L, Hommel K, Olesen J, Hansen P. FP643RISK OF PERIPHERALISCHEMIA IN DANISH DIABETES PATIENTS AND PATIENTS ON DIALYSIS: A DANISH COHORT STUDY. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.fp643] [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)
- Lene Boesby
- Dept. of Internal Medicine, SUH Roskilde, Roskilde, Denmark
| | - Kristine Hommel
- Dept. of Cardiology, Gentofte University Hospital, Gentofte, Denmark
- Dept. of Internal Medicine, Holbaek Hospital, Holbaek, Denmark
| | - Jonas Olesen
- Dept. of Cardiology, Gentofte University Hospital, Gentofte, Denmark
- Dept. of Cardiology, Nephrology, Endocrinology, North Zealand Hospital Hilleroed, Hilleroed, Denmark
| | - Pernille Hansen
- Dept. of Nephrology, Herlev University Hospital, Herlev, Denmark
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Carlson N, Hommel K, Olesen JB, Gerds TA, Soja AM, Vilsbøll T, Kamper AL, Torp-Pedersen C, Gislason G. Metformin-associated risk of acute dialysis in patients with type 2 diabetes: A nationwide cohort study. Diabetes Obes Metab 2016; 18:1283-1287. [PMID: 27534835 DOI: 10.1111/dom.12764] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 07/15/2016] [Revised: 08/12/2016] [Accepted: 08/15/2016] [Indexed: 11/28/2022]
Abstract
Recent guidelines governing anti-diabetic medications increasingly advocate metformin as first-line therapy in all patients with type 2 diabetes. However, metformin could be associated with increased risk of acute kidney injury (AKI), acute dialysis and lactate acidosis in marginal patients. In a retrospective nationwide cohort study, a total of 168 443 drug-naïve patients with type 2 diabetes ≥50 years, initiating treatment with either metformin or sulphonyl in Denmark between 2000 and 2012 were included in this study (70.7% initiated treatment with metformin); calculation of 1-year risk of acute dialysis was based on g-standardization of cause-specific Cox regression models for acute dialysis, end-stage renal disease and death. One-year risks of acute dialysis were 92.4 per 100 000 (95% CI, 67.1-121.3) and 142.7 per 100 000 (95% CI, 118.3-168.0) for sulphonylurea and metformin, respectively. The metformin-associated 1-year risk of acute dialysis was increased by 50.3 per 100 000 (95% CI, 7.9-88.6), corresponding to a risk ratio of 1.53 (95% CI, 1.06-2.23), and a number needed to harm of 1988, thus providing evidence of potential concerns pertaining to the increasing use of metformin.
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Affiliation(s)
- Nicholas Carlson
- Department of Cardiology, Gentofte Hospital, Copenhagen University, Hellerup, Denmark
- Department of Nephrology, Herlev Hospital, Copenhagen University, Herlev, Denmark
| | - Kristine Hommel
- Department of Nephrology, Herlev Hospital, Copenhagen University, Herlev, Denmark
| | - Jonas B Olesen
- Department of Cardiology, Gentofte Hospital, Copenhagen University, Hellerup, Denmark
| | - Thomas A Gerds
- Department of Biostatistics, Copenhagen University, Copenhagen, Denmark
| | - Anne-Merete Soja
- Department of Cardiology, Hvidovre Hospital, Copenhagen University, Hvidovre, Denmark
| | - Tina Vilsbøll
- Center for Diabetes Research, Gentofte Hospital, Copenhagen University, Hellerup, Denmark
| | - Anne-Lise Kamper
- Department of Nephrology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | | | - Gunnar Gislason
- Department of Cardiology, Gentofte Hospital, Copenhagen University, Hellerup, Denmark
- The Danish Heart Foundation, Copenhagen, Denmark
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21
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Feist M, Smith J, Enkelmann S, Hommel K, Brandl A, Rau B. Intraoperative Chemotherapie. Onkologe 2016; 22:651-658. [DOI: 10.1007/s00761-016-0061-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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22
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Carlson N, Hommel K, Olesen JB, Soja AM, Vilsbøll T, Kamper AL, Torp-Pedersen C, Gislason G. Trends in One-Year Outcomes of Dialysis-Requiring Acute Kidney Injury in Denmark 2005-2012: A Population-Based Nationwide Study. PLoS One 2016; 11:e0159944. [PMID: 27459297 PMCID: PMC4961397 DOI: 10.1371/journal.pone.0159944] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 07/11/2016] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Dialysis-requiring acute kidney injury (AKI) is associated with substantial mortality and risk of end-stage renal disease (ESRD). Despite considerable growth in incidence of severe AKI, information pertaining to trends in outcomes remains limited. We evaluated time trends in one year risks of ESRD and death in patients with dialysis-requiring AKI over an eight year period in Denmark. METHODS In a retrospective nationwide study based on national registers, all adults requiring acute renal replacement therapy between 2005 and 2012 were identified. Patients with preceding ESRD were excluded. Through individual-level cross-referencing of administrative registries, information pertaining to comorbidity, preceding surgical interventions, and concurrent other organ failure and sepsis was ascertained. Comparisons of period-specific one year odds ratios for ESRD and death were calculated in a multiple logistic regression model. RESULTS A total of 13,819 patients with dialysis-requiring AKI were included in the study. Within one year, 1,017 (7.4%) patients were registered with ESRD, and 7,908 (57.2%) patients died. The one-year rate of ESRD decreased from 9.0% between 2005 and 2006 to 6.1% between 2011 and 2012. Simultaneously, the one-year mortality rate decreased from 58.2% between 2005 and 2006 to 57.5% between 2011 and 2012. Consequently, the adjusted odds ratios for the period 2011-2012 (with the period 2005-2006 as reference) were 0.75 (0.60-0.95, p = 0.015) and 0.87 (95% CI 0.78-0.97, p = 0.010) for ESRD and death, respectively. CONCLUSIONS In a nationwide retrospective study on time trends in one year outcomes following dialysis-requiring AKI, risk of all-cause mortality and ESRD decreased over a period of 8 years.
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Affiliation(s)
- Nicholas Carlson
- Department of Cardiology, Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
- Department of Nephrology, Herlev Hospital, University of Copenhagen, Herlev, Denmark
- * E-mail:
| | - Kristine Hommel
- Department of Nephrology, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Jonas Bjerring Olesen
- Department of Cardiology, Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
| | - Anne-Merete Soja
- Department of Cardiology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - Tina Vilsbøll
- Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
| | - Anne-Lise Kamper
- Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Gunnar Gislason
- Department of Cardiology, Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
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Hansen D, Olesen JB, Gislason GH, Abrahamsen B, Hommel K. Risk of fracture in adults on renal replacement therapy: a Danish national cohort study. Nephrol Dial Transplant 2016; 31:1654-62. [DOI: 10.1093/ndt/gfw073] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 02/22/2016] [Indexed: 11/13/2022] Open
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Carlson N, Hommel K, Olesen JB, Soja AM, Vilsbøll T, Kamper AL, Torp-Pedersen C, Gislason G. Dialysis-Requiring Acute Kidney Injury in Denmark 2000-2012: Time Trends of Incidence and Prevalence of Risk Factors-A Nationwide Study. PLoS One 2016; 11:e0148809. [PMID: 26863015 PMCID: PMC4749171 DOI: 10.1371/journal.pone.0148809] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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: 10/31/2015] [Accepted: 01/22/2016] [Indexed: 01/26/2023] Open
Abstract
Introduction Dialysis-requiring acute kidney injury is a severe illness associated with poor prognosis. However, information pertaining to incidence rates and prevalence of risk factors remains limited in spite of increasing focus. We evaluate time trends of incidence rates and changing patterns in prevalence of comorbidities, concurrent medication, and other risk factors in nationwide retrospective cohort study. Materials and Methods All patients with dialysis-requiring acute kidney injury were identified between January 1st 2000 and December 31st 2012. By cross-referencing data from national administrative registries, the association of changing patterns in dialysis treatment, comorbidity, concurrent medication and demographics with incidence of dialysis-requiring acute kidney injury was evaluated. Results A total of 18,561 adult patients with dialysis-requiring AKI were identified between 2000 and 2012. Crude incidence rate of dialysis-requiring AKI increased from 143 per million (95% confidence interval, 137–144) in 2000 to 366 per million (357–375) in 2006, and remained stable hereafter. Notably, incidence of continuous veno-venous hemodialysis (CRRT) and use of acute renal replacement therapy in elderly >75 years increased substantially from 23 per million (20–26) and 328 per million (300–355) in 2000, to 213 per million (206–220) and 1124 per million (1076–1172) in 2012, respectively. Simultaneously, patient characteristics and demographics shifted towards increased age and comorbidity. Conclusions Although growth in crude incidence rate of dialysis-requiring AKI stabilized in 2006, continuous growth in use of CRRT, and acute renal replacement therapy of elderly patients >75 years, was observed. Our results indicate an underlying shift in clinical paradigm, as opposed to unadulterated growth in incidence of dialysis-requiring AKI.
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Affiliation(s)
- Nicholas Carlson
- Department of Cardiology, Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
- Department of Nephrology, Herlev Hospital, University of Copenhagen, Herlev, Denmark
- * E-mail:
| | - Kristine Hommel
- Department of Nephrology, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Jonas Bjerring Olesen
- Department of Cardiology, Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
| | - Anne-Merete Soja
- Department of Cardiology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - Tina Vilsbøll
- Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
| | - Anne-Lise Kamper
- Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Gunnar Gislason
- Department of Cardiology, Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
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van den Beukel TO, Hommel K, Kamper AL, Heaf JG, Siegert CEH, Honig A, Jager KJ, Dekker FW, Norredam M. Differences in survival on chronic dialysis treatment between ethnic groups in Denmark: a population-wide, national cohort study. Nephrol Dial Transplant 2015; 31:1160-7. [PMID: 26492925 DOI: 10.1093/ndt/gfv359] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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: 03/04/2015] [Accepted: 09/15/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In Western countries, black and Asian dialysis patients experience better survival compared with white patients. The aim of this study is to compare the survival of native Danish dialysis patients with that of dialysis patients originating from other countries and to explore the association between the duration of residence in Denmark before the start of dialysis and the mortality on dialysis. METHODS We performed a population-wide national cohort study of incident chronic dialysis patients in Denmark (≥18 years old) who started dialysis between 1995 and 2010. RESULTS In total, 8459 patients were native Danes, 344 originated from other Western countries, 79 from North Africa or West Asia, 173 from South or South-East Asia and 54 from sub-Saharan Africa. Native Danes were more likely to die on dialysis compared with the other groups (crude incidence rates for mortality: 234, 166, 96, 110 and 53 per 1000 person-years, respectively). Native Danes had greater hazard ratios (HRs) for mortality compared with the other groups {HRs for mortality adjusted for sociodemographic and clinical characteristics: 1.32 [95% confidence interval (CI) 1.14-1.54]; 2.22 [95% CI 1.51-3.23]; 1.79 [95% CI 1.41-2.27]; 2.00 [95% CI 1.10-3.57], respectively}. Compared with native Danes, adjusted HRs for mortality for Western immigrants living in Denmark for ≤10 years, >10 to ≤20 years and >20 years were 0.44 (95% CI 0.27-0.71), 0.56 (95% CI 0.39-0.82) and 0.86 (95% CI 0.70-1.04), respectively. For non-Western immigrants, these HRs were 0.42 (95% CI 0.27-0.67), 0.52 (95% CI 0.33-0.80) and 0.48 (95% CI 0.35-0.66), respectively. CONCLUSIONS Incident chronic dialysis patients in Denmark originating from countries other than Denmark have a better survival compared with native Danes. For Western immigrants, this survival benefit declines among those who have lived in Denmark longer. For non-Western immigrants, the survival benefit largely remains over time.
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Affiliation(s)
- Tessa O van den Beukel
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands Department of Nephrology, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands
| | - Kristine Hommel
- Department of Nephrology, Rigshospitalet, Copenhagen, Denmark
| | | | - James G Heaf
- Department of Medicine, Roskilde Hospital, University of Copenhagen, Roskilde, Denmark
| | - Carl E H Siegert
- Department of Nephrology, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands
| | - Adriaan Honig
- Department of Psychiatry, Sint Lucas Andreas Hospital and VU University Medical Center, Amsterdam, The Netherlands
| | - Kitty J Jager
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marie Norredam
- Danish Research Centre for Migration, Ethnicity and Health, Section of Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Bonde AN, Lip GY, Kamper AL, Hansen PR, Lamberts M, Hommel K, Hansen ML, Gislason GH, Torp-Pedersen C, Olesen JB. Net Clinical Benefit of Antithrombotic Therapy in Patients With Atrial Fibrillation and Chronic Kidney Disease. J Am Coll Cardiol 2014; 64:2471-82. [DOI: 10.1016/j.jacc.2014.09.051] [Citation(s) in RCA: 216] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 08/19/2014] [Accepted: 09/16/2014] [Indexed: 11/26/2022]
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Blicher TM, Hommel K, Kristensen SL, Torp-Pedersen C, Madsen M, Kamper AL, Olesen JB. Benefit of clopidogrel therapy in patients with myocardial infarction and chronic kidney disease-a Danish nation-wide cohort study. J Am Heart Assoc 2014; 3:jah3644. [PMID: 25146707 PMCID: PMC4310409 DOI: 10.1161/jaha.114.001116] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background The aim of the present study was to evaluate clopidogrel treatment after incident myocardial infarction (MI) in patients with and without chronic kidney disease (CKD). Methods and Results By linking nation‐wide registries, information about patients admitted with incident MI was found. Primary endpoints were all‐cause and cardiovascular (CV) mortality, a composite of all‐cause mortality and recurrent MI, and a composite of fatal and nonfatal bleedings. Effect of clopidogrel use versus clopidogrel nonuse was estimated using an adjusted Cox's regression model stratified according to percutaneous coronary intervention (PCI) treatment. A total of 69 082 incident MI patients in the period 2002–2011 were included. Clopidogrel treatment was associated with hazard ratios (HRs) for the combined endpoint of all‐cause mortality and recurrent MI in PCI‐treated patients of 0.90 (95% confidence interval [CI], 0.47 to 1.72) in renal replacement therapy (RRT) patients, 0.59 (95% CI: 0.40 to 0.88) in non‐end‐stage CKD patients and 0.69 (95% CI, 0.61 to 0.77) in patients without kidney disease (P for interaction=0.60). In patients not treated with PCI, HRs were 0.90 (95% CI, 0.68 to 1.21) in RRT patients, 0.86 (95% CI, 0.75 to 0.99) in non‐end‐stage CKD patients, and 0.91 (95% CI, 0.87 to 0.95) in patients without kidney disease (P for interaction=0.74). An increase in bleeding events (not significant) was noted for clopidogrel‐treated patients not undergoing PCI and for non‐end‐stage CKD patients undergoing PCI, whereas clopidogrel was associated with less bleedings in PCI‐treated RRT patients and patients without kidney disease. Conclusions During a 1‐year follow‐up, after MI, clopidogrel was associated with improved outcomes in patients with non‐end‐stage CKD. Even though no effect difference, compared to patients without CKD, was observed, the benefit associated with the use of clopidogrel after MI in patients requiring RRT is less clear.
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Affiliation(s)
- Thalia Marie Blicher
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark (T.M.B., L.K., J.B.O.)
| | - Kristine Hommel
- Department of Nephrology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark (K.H., A.L.K.)
| | - Søren Lund Kristensen
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark (T.M.B., L.K., J.B.O.)
| | | | - Mette Madsen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark (M.M.)
| | - Anne-Lise Kamper
- Department of Nephrology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark (K.H., A.L.K.)
| | - Jonas Bjerring Olesen
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark (T.M.B., L.K., J.B.O.)
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Blicher TM, Hommel K, Olesen JB, Torp-Pedersen C, Madsen M, Kamper AL. Less use of standard guideline-based treatment of myocardial infarction in patients with chronic kidney disease: a Danish nation-wide cohort study. Eur Heart J 2013; 34:2916-23. [DOI: 10.1093/eurheartj/eht220] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Hommel K, Madsen M, Kamper AL. The importance of early referral for the treatment of chronic kidney disease: a Danish nationwide cohort study. BMC Nephrol 2012; 13:108. [PMID: 22963236 PMCID: PMC3469388 DOI: 10.1186/1471-2369-13-108] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Accepted: 08/31/2012] [Indexed: 11/10/2022] Open
Abstract
Background Many patients with advanced chronic kidney disease are referred late to renal units. This is associated with negative aspects. The purpose of the present study was to characterize late versus early referrals for renal replacement therapy including their renal disease, health care contacts and medical treatment before renal replacement therapy (RRT) and the consequences for RRT modality and mortality. Methods Nationwide cohort study including 4495 RRT patients identified in the Danish Nephrology Registry 1999–2006. The cohort was followed to end 2007 by linkage to other national registries. Late referral: follow-up ≤16 weeks in renal unit before RRT start. Cox proportional hazards models were used to estimate the relative risk of mortality or waiting list status within 365 days in late referrals versus early referrals. Results A total of 1727 (38%) incident RRT patients were referred late. Among these, 72% were treated in non-nephrology hospital departments and 91% in general practice 2 years to 16 weeks before RRT start. Fewer late referrals received recommended pre-RRT treatment as judged by renin-angiotensin-system blockade: 32% versus 57% or the D-vitamin analogue alfacalcidol: 5% versus 30% (P < .001). Primary RRT modality was peritoneal dialysis: 18% in late versus 32% in early referrals (P < .001), 7% versus 30%, respectively, had an arteriovenous dialysis-fistula (P < .001) and 0.2% versus 6% were on the waiting-list for renal transplantation (P < .001) before RRT start. One-year-mortality was higher in late referrals: hazard ratio 1.55 (CI 95% 1.35–1.78). In a subgroup, 30% (CI 95% 25–35%) late and 9% (CI 95% 6–12%) early referrals had plasma creatinine ≤150% of upper reference limit within 1 to 2 years before RRT start (P < .001). Conclusions Late nephrology referrals were well-known to the healthcare system before referral for RRT start and more often had near normal plasma creatinine levels within 2 years before RRT start. They infrequently received available treatment or optimal first RRT modality. An increased effort to identify these patients in the healthcare system in time for proper pre-dialysis care including preparation for RRT is needed.
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Affiliation(s)
- Kristine Hommel
- Department of Nephrology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen East, 2100, Denmark
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Olesen JB, Lip GYH, Kamper AL, Hommel K, Køber L, Lane DA, Lindhardsen J, Gislason GH, Torp-Pedersen C. Stroke and bleeding in atrial fibrillation with chronic kidney disease. N Engl J Med 2012; 367:625-35. [PMID: 22894575 DOI: 10.1056/nejmoa1105594] [Citation(s) in RCA: 657] [Impact Index Per Article: 54.8] [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: 11/19/2022]
Abstract
BACKGROUND Both atrial fibrillation and chronic kidney disease increase the risk of stroke and systemic thromboembolism. However, these risks, and the effects of antithrombotic treatment, have not been thoroughly investigated in patients with both conditions. METHODS Using Danish national registries, we identified all patients discharged from the hospital with a diagnosis of nonvalvular atrial fibrillation between 1997 and 2008. The risk of stroke or systemic thromboembolism and bleeding associated with non-end-stage chronic kidney disease and with end-stage chronic kidney disease (i.e., disease requiring renal-replacement therapy) was estimated with the use of time-dependent Cox regression analyses. In addition, the effects of treatment with warfarin, aspirin, or both in patients with chronic kidney disease were compared with the effects in patients with no renal disease. RESULTS Of 132,372 patients included in the analysis, 3587 (2.7%) had non-end-stage chronic kidney disease and 901 (0.7%) required renal-replacement therapy at the time of inclusion. As compared with patients who did not have renal disease, patients with non-end-stage chronic kidney disease had an increased risk of stroke or systemic thromboembolism (hazard ratio, 1.49; 95% confidence interval [CI], 1.38 to 1.59; P<0.001), as did those requiring renal-replacement therapy (hazard ratio, 1.83; 95% CI, 1.57 to 2.14; P<0.001); this risk was significantly decreased for both groups of patients with warfarin but not with aspirin. The risk of bleeding was also increased among patients who had non-end-stage chronic kidney disease or required renal-replacement therapy and was further increased with warfarin, aspirin, or both. CONCLUSIONS Chronic kidney disease was associated with an increased risk of stroke or systemic thromboembolism and bleeding among patients with atrial fibrillation. Warfarin treatment was associated with a decreased risk of stroke or systemic thromboembolism among patients with chronic kidney disease, whereas warfarin and aspirin were associated with an increased risk of bleeding. (Funded by the Lundbeck Foundation.).
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Affiliation(s)
- Jonas Bjerring Olesen
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark.
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Kristensen SL, Fosbøl EL, Kamper AL, Køber L, Hommel K, Lamberts M, Abildstrøm SZ, Blicher TM, Torp-Pedersen C, Gislason GH. Use of nonsteroidal anti-inflammatory drugs prior to chronic renal replacement therapy initiation: a nationwide study. Pharmacoepidemiol Drug Saf 2012; 21:428-34. [DOI: 10.1002/pds.3227] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Revised: 12/14/2011] [Accepted: 01/10/2012] [Indexed: 02/06/2023]
Affiliation(s)
- Søren Lund Kristensen
- Department of Cardiology; Copenhagen University Hospital; Gentofte; Hellerup; Denmark
| | | | - Anne-Lise Kamper
- Department of Nephrology; Copenhagen University Hospital; Rigshospitalet; Copenhagen; Denmark
| | - Lars Køber
- Department of Cardiology; Copenhagen University Hospital; Rigshospitalet; Copenhagen; Denmark
| | - Kristine Hommel
- Department of Nephrology; Copenhagen University Hospital; Rigshospitalet; Copenhagen; Denmark
| | - Morten Lamberts
- Department of Cardiology; Copenhagen University Hospital; Gentofte; Hellerup; Denmark
| | - Steen Z. Abildstrøm
- Department of Cardiology; Copenhagen University Hospital; Bispebjerg; Copenhagen; Denmark
| | - Thalia M. Blicher
- Department of Clinical Pharmacology; Copenhagen University Hospital; Bispebjerg; Copenhagen; Denmark
| | | | - Gunnar H. Gislason
- Department of Cardiology; Copenhagen University Hospital; Gentofte; Hellerup; Denmark
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Winkelmayer W, Liu J, Brookhart A, Wang HY, Kan WC, Chien CC, Fang TC, Lin HF, Li YH, Wang CH, Chou CL, Yazawa M, Shibagaki Y, Kimura K, Ohira S, Ryo K, Hasegawa T, Hanafusa N, Tsubakihara Y, Iseki K, Chen HY, Cheng IC, Pan YJ, Chiu YL, Hsu SP, Pai MF, Yang JY, Peng YS, Tsai TJ, Wu KD, Dzekova-Vidimliski P, Severova-Andreevska G, Pavlevska S, Trajceska L, Selim G, Gelev S, Sikole A, Hecking M, Karaboyas A, Saran R, Sen A, Inaba M, Horl WH, Pisoni R, Robinson B, Sunder-Plassmann G, Port FK, Chiroli S, Perrault L, Mitchell D, Mattin C, Krause R, Roth HJ, Schober-Halstenberg HJ, Edenharter G, Frei U, Wilson R, Adena M, Hodgkins P, Keith M, Smyth M, Couchoud C, Galland R, Man NK, Chanliau J, Lemaitre V, Traeger J, von Gersdorff G, Vega O, Schaller M, Usvyat L, Levin N, Barth C, Kotanko P, Vega O, Usvyat L, Rosales L, Thijssen S, Levin N, Kotanko P, Schmid H, Schiffl H, Romanos A, Lederer S, Chu KH, Lam B, Tang C, Wong S, Cheuk A, Yim KF, Tang HL, Lee W, Fung KS, Chan H, Ng TK, Tong KL, Doyle M, Severn A, Traynor J, Metcalfe W, Boyd J, Cairns S, Reilly J, Henderson A, Simpson K, Tovbin D, Douvdevani A, Novack V, Abd Elkadir A, Zlotnik M, Djuric Z, Dimkovic N, Popovic J, Furumatsu Y, Yamazaki S, Hayashino Y, Takegami M, Yamamoto Y, Kakudate N, Wakita T, Akizawa T, Akiba T, Saito A, Kurokawa K, Fukuhara S, Voronovitsky G, Pinelli L, Paganti L, Silva J, Garofalo R, Reiss E, Gimenez Torrado J, Lafroscia P, Lugo M, Laplante S, Vanovertveld P, Nordio M, Limido A, Maggiore U, Nichelatti M, Postorino M, Quintaliani G, Ebah L, Kanigicherla D, Nikam M, Dutton G, Mitra S, Attipoe L, Baharani J, Pinelli L, Voronovitsky G, Magrini G, Martorell A, Lugo M, Mashima Y, Konta T, Kudo K, Suzuki K, Ikeda A, Takasaki S, Kubota I, Chudek J, Wieczorowska-Tobis K, Wiecek A, Members of the "PolSenior" Study Group, des Grottes JM, Collart F, Lemaitre V, Maheut H, Couchoud C, Goodkin DA, Bieber B, Robinson BM, Jadoul M, Djogan M, Dudar I, Sergeyeva T, Hanafusa N, Yamagata K, Nishi H, Nishi S, Iseki K, Tsubakihara Y, Hommel K, Madsen M, Blicher TM, Kamper AL, Masakane I, Ito S, Seino M, Ito M, Nagasawa J, Rayner HC, Fuller DS, Gillespie BW, Hasegawa T, Morgenstern H, Robinson BM, Saran R, Tentori F, Pisoni RL, Chien CC, Wang JJ, Hwang JC, Wang HY, Kan WC, Trajceska L, Mladenovska D, Severova G, Amitov V, Selim G, Gelev S, Dzekova-Vidimliski P, Sikole A, Yadav P, Baharani J, Attipoe L, Baharani J, Carrero JJ, Jager DJ, Verduijn M, Ravani P, De Meester J, Heaf JG, Finne P, Hoitsma AJ, Pascual J, Jarraya F, Reisaeter AV, Collart F, Dekker FW, Jager KJ, Trajceska L, Mladenovska D, Severova G, Gelev S, Selim G, Amitov V, Sikole A, Sammut H, Ahmed MSA, Sheppard J, Attwood N, Cserep G, Sinnamon K, Pinelli L, Voronovitsky G, Lugo M, Reiss E, Katsipi I, Tatsiopoulos A, Doulgerakis C, Papanikolaou P, Kardouli E, Lamprinoudis G, Kintzoglanakis K, Gennadiou M, Kyriazis J, Granger Vallee A, Covic E, Morena M, Fournier A, Canaud B, Bolignano D, Rastelli S, Curatola G, Caridi G, Tripepi R, Tripepi G, Politi R, Catalano F, Delfino D, Ciccarelli M, Mallamaci F, Zoccali C. Epidemiology & outcome in CKD 5D (1). Clin Kidney J 2011. [DOI: 10.1093/ndtplus/4.s2.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Ferrieres J, Berkenboom G, Coufal Z, James S, Mohacsi A, Pavlides G, Norrbacka K, Sartral M, Paget MA, Tomlin M, Zeymer U, Hoffmann P, Keller F, Blicher TM, Hommel K, Abildstrom SZ, Madsen M, Kamper AL, Rogacev K, Pinsdorf T, Weingartner O, Gerhart M, Welzel E, van Bentum K, Menzner A, Fliser D, Lutjohann D, Heine G, Di Benedetto A, Marcelli D, Giordana G, Cerino F, Gatti E, Otero A, Dominguez-Sardina M, Castineira MC, Crespo JJ, Ferreras A, Mojon A, Ayala DE, Fernandez JR, Hermida RC, Investigadores Proyecto Hygia, Doi Y, Yoshihara F, Iwashima Y, Takata H, Fujii T, Horio T, Nakamura S, Kawano Y, Onofriescu M, Cepoi V, Segall L, Covic A, Kurnatowska I, Grzelak P, Kaczmarska M, Masajtis-Zagajewska A, Rutkowska-Majewska E, Stefanczyk L, Nowicki M, Gozhenko A, Susla O, Shved M, Mysula I, Susla H, Cordeiro Silva Junior AC, Smanio P, Amparo FC, Oliveira MAC, Gonzaga CC, Sousa MG, Passarelli Jr O, Borelli F, Lotaif LD, Sousa AGMR, Amodeo C, Inaguma D, Ando R, Ikeda M, Joki N, Koiwa F, Komatsu Y, Sakaguchi T, Shinoda T, Yamaka T, Shigematsu T, Pizzarelli F, Rossi C, Dattolo P, Tripepi G, Mieth M, Bandinelli S, Zoccali C, Mass R, Ferrucci L, Gifford F, Methven S, Boag DE, Spalding EM, MacGregor MS, Kirsch M, Dorhofer L, Bruning J, Banas B, Kramer BK, Schubert M, Boger CA, Dorhofer L, Kirsch M, Bruning J, Banas B, Kramer BK, Schubert M, Boger CA, Atapour A, Kalantari E, Shahidi S, Mortazavi M, Marron B, Quiros P, Vega N, Garcia-Canton C, Moreno F, Prieto M, Ahijado F, Salgueira M, Paez C, Castellano I, Lerma JL, De Arriba G, Martinez-Ocana JC, Morales A, Ramirez de Orellana M, Ramos A, Duarte V, Ruiz C, Gallego S, Ortiz A, Furuhashi T, Moroi M, Joki N, Hase H, Masai H, Kunimasa T, Nakazato R, Fukuda H, Sugi K, Valluri A, Severn A, Chakraverty S, Palma R, Polo A, Espigares MJ, Manjon M, Cerezo S, Garcia-Agudo R, Aoufi S, Ruiz-Carrillo F, Gonzalez-Carro P, Perez-Roldan F, Tenias JM, Santiago da Silva P, Cunha C, Coelho L, Viana A, Moreira R, Wagner S, Friedman R, Veloso V, Suassuna J, Grinsztejn B, Iimuro S, Imai E, Matsuo S, Watanabe T, Nitta K, Akizawa T, Makino H, Ohashi Y, Hishida A, Fujimoto S, Yano Y, Sato Y, Konta T, Iseki K, Moriyama T, Yamagata K, Tsuruya K, Yoshida H, Asahi K, Watanabe T, Bellasi A, Mandreoli M, Baldrati L, Rigotti A, Corradini M, Russo G, David S, Malmusi G, Di Nicolo P, Orsi C, Poisetti P, Zanbianchi L, Caruso F, Fabbri A, Santoro A, Moranne O, Couchoud C, Pradier C, Esnault V, Vigneau C, Skapinakis P, Ikonomou M, Kyroglou E, Chondrogiannis P, Sygelakis M, Varvara C, Kyriklidou P, Balafa O, Mavreas V, Tsakiris D, Goumenos D, Siamopoulos K, Ikonomou M, Skapinakis P, Eleftheroudi M, Chardalias A, Kyroglou E, Banioti A, Vakianos I, Sygelakis M, Kalaitzidis R, Asimakopoulos K, Tsakiris D, Goumenos D, Siamopoulos K, Methven S, Jardine A, MacGregor M, van der Tol A, Van Biesen W, De Groote G, Verbeke P, Eeckhaut K, Vanholder R, Ivkovic V, Karanovic S, Vukovic Lela I, Juric D, Fistrek M, Kos J, Kovac-Peic A, Pecin I, Premuzic V, Miletic-Medved M, Cvitkovic A, Fodor L, Jelakovic B. General & clinical epidemiology CKD 1-5 (1). Clin Kidney J 2011. [DOI: 10.1093/ndtplus/4.s2.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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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Hommel K, Rasmussen S, Kamper AL, Madsen M. Regional and social inequalities in chronic renal replacement therapy in Denmark. Nephrol Dial Transplant 2010; 25:2624-32. [PMID: 20207710 DOI: 10.1093/ndt/gfq110] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The incidence of chronic renal replacement therapy (RRT) varies markedly between Danish nephrology centres. The aim of the present study was to establish if there is regional and social variation in the incidence of chronic RRT in Denmark when analysed according to patient residence. The importance of diabetic nephropathy and patients aged 70 years or older was also studied. METHODS Incident patients on chronic RRT in the period 1995-2006 were identified in the Danish National Registry on Regular Dialysis and Transplantation. Information on residence, income, educational status and ethnic origin was obtained from Statistics Denmark. Rates of incident RRT patients were standardized for regional differences of sex and age as well as income, educational status and ethnic origin. Poisson regression was used when comparing rates. RESULTS Age- and sex-standardized incident chronic RRT rates among individuals with low income or short educational level were higher (P < 0.0001) compared to other groups. Also, standardized rates of patients in total and patients aged 70 years or older were higher in the catchment areas of the nephrology centres located in the two largest cities than for patients with residence in other areas of the country (P < 0.0001). Standardizing for regional differences of ethnic origin did not change the rates. The incident chronic RRT rate caused by diabetic nephropathy was higher for patients with residence in the catchment area of the nephrology centre in the largest city [49 per million people (p.m.p.) (95% CI = 40-57 p.m.p.)] compared to the catchment area of the nephrology centre located in the second largest city [31 (95% CI = 26-37 p.m.p.)] and other areas [29 p.m.p. (95% CI = 26-31 p.m.p.)] in 2001-06. When standardizing for differences in income among the 30-69-year-old persons, the rate of patients with residence in the catchment area of the nephrology centre located in the largest city decreased but was still higher than in other regions (P = 0.0003). CONCLUSIONS There are marked socio-economic and regional differences in rates of incident RRT patients. The rates of incident RRT patients are highest in the catchment areas of the two largest nephrology centres and this may be partly explained by a higher frequency of end-stage diabetic nephropathy and a new treatment programme targeting frail, mainly elderly, patients.
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Affiliation(s)
- Kristine Hommel
- Department of Nephrology, Rigshospitalet, Copenhagen, Denmark.
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Hommel K, Rasmussen S, Madsen M, Kamper AL. The Danish Registry on Regular Dialysis and Transplantation: completeness and validity of incident patient registration. Nephrol Dial Transplant 2009; 25:947-51. [PMID: 19861312 DOI: 10.1093/ndt/gfp571] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The Danish National Registry on Regular Dialysis and Transplantation (NRDT) provides systematic information on the epidemiology and treatment of end-stage chronic kidney disease in Denmark. It is therefore of major importance that the registry is valid and complete. The aim of the present study was to evaluate the registration of incident patients on chronic renal replacement therapy (RRT). METHODS Incident patients on chronic RRT in the period 2001-2004 were identified in NRDT and in the National Patient Registry, which contains information on hospital admissions and treatments. In the National Patient Registry, identification of patients was as follows: patients receiving the procedure of dialysis during a minimum of 90 days and for a minimum of 12 times or the procedure of renal transplantation. Only patients with at least 2 years of dialysis-free interval before and never being transplanted were included. The completeness of NRDT was calculated as the percentage of new patients on chronic RRT registered in the National Patient Registry also found in NRDT. Validity of data in NRDT was assessed by information from medical records and analysed using kappa statistics. RESULTS Completeness of NRDT: Of 3020 patients registered in the National Patient Registry as incident chronic RRT patients, 97.2% were found in NRDT but 22.5% with another year of entry. There were no differences in completeness between hospitals or regions. Validity of NRDT: Validity of common renal diagnoses and RRT modality was high: diabetic nephropathy (kappa = 0.98), adult polycystic kidney disease (kappa = 0.95), chronic glomerulonephritis (kappa = 0.78) and RRT modality (kappa = 0.94). The diagnosis CKD of unknown aetiology and type of diabetes were less valid (kappa = 0.62, 0.60 and 0.73, respectively). The date of RRT start had also high validity. CONCLUSIONS Completeness of incident patient registration in NRDT was highly acceptable. Validity of incident patient data was also good, except for type of diabetes.
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Affiliation(s)
- Kristine Hommel
- Department of Nephrology, Rigshospitalet, Copenhagen, Denmark.
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Abstract
Nociceptin-immunoreactive cellbodies were detected in the human trigeminal ganglion, while no such fibers were identified in the temporal artery or in dermal tissue from the neck region. In four healthy subjects receiving nociceptin into the temporal muscle in an open labeled design no pain was detected. In 10 healthy subjects who received 200pmol of nociceptin into tender non-dominant trapezius muscles in a placebo-controlled, randomized, balanced, and double-blinded design local tenderness increased (P=0.025) while no pain was noted. Thus, the action of nociceptin should be searched for in the trigeminal ganglion and/or in the central nervous system (CNS).
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Affiliation(s)
- Hanne Mørk
- Copenhagen Headache Center, Department of Neurology, Glostrup Hospital, University of Copenhagen, DK-2600 Glostrup, Copenhagen, Denmark.
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Westphal K, Strouhal U, Byhahn C, Hommel K, Behne M. [Inhalation of nitric oxide in severe lung failure]. Anaesthesiol Reanim 1999; 23:144-8. [PMID: 10036793] [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] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Despite intensive therapeutic efforts, adult respiratory distress syndrome (ARDS) is still associated with a lethality ranging from 50 to 80%. Besides hypoxemia, fatal outcome is caused by myocardial insufficiency due to a progressive decrease in pulmonary vascular conductance. Inhalation of NO can selectively dilate pulmonary vessels in ventilated lung regions, thus increasing mean pulmonary artery conductance and decreasing venous admixture. This study determines the effects of NO inhalation in patients with severe ARDS on pulmonary gas exchange, haemodynamics and mortality. Twenty surgical patients (mean age 50.3 +/- 9.25 years) with severe ARDS (Murray score 3.4 +/- 0.3) were treated with variable concentrations of NO during mechanical ventilation with continuous positive pressure. Pulmonary artery catheters were used to measure pressures, flow and venous admixture. Mortality with NO inhalation was compared with that of previous ARDS patients (n = 20) who had not received NO. Mean duration of NO inhalation was 120.1 +/- 33.12 hours (n = 20) (range 40 to 254 hours). Mean NO concentration during the first hour of delivery was 18.5 +/- 3.88 ppm. Sixteen patients had FiO2 of 1.0 when NO was started. Within the first hour of NO inhalation, the PaO2/FiO2 ratio increased from 82.1 +/- 10.28 to 124.6 +/- 28.18. Eighteen patients were responders. Mean ventilatory pressure was lowered. Oxygenation improvement was most marked during the first 36 hours and then gradually declined. Despite the significant increase in NO related oxygenation, pulmonary artery pressures did not consistently decrease. Sixteen patients in the NO group died. In the group without NO 15 patients died. Compared with ARDS patients of similar severity not receiving NO, the NO-treated patients had the same lethality. In severe ARDS, oxygenation significantly improves with the initiation of NO inhalation, but this effect declines over time. With NO, FiO2 and ventilatory pressures can be lowered. Whether the theoretically reduced oxygen toxicity and the reduced invasiveness of mechanical ventilation with NO reduces patient mortality must be determined in larger patient groups.
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Affiliation(s)
- K Westphal
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Johann Wolfgang Goethe-Universität Frankfurt/Main
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Westphal K, Martens S, Strouhal U, Matheis G, Hommel K, Kessler P. Nitric oxide inhalation in acute pulmonary hypertension after cardiac surgery reduces oxygen concentration and improves mechanical ventilation but not mortality. Thorac Cardiovasc Surg 1998; 46:70-3. [PMID: 9618806 DOI: 10.1055/s-2007-1010192] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Impaired right-ventricular function may benefit from afterload reduction. Inhalation of nitric oxide (NO) reduces pulmonary hypertension without systemic circulatory depression. Influence of NO inhalation on oxygenation, ventilation, and hemodynamic parameters in 10 patients with acute pulmonary hypertension after cardiac surgery was examined in this study. Ten patients without NO treatment served as a control group. NO patients showed significantly improved oxygenation and recovery of right-ventricular function. Pulmonary artery pressure (12.8%), inspiratory oxygen demand (34.7%), PEEP (13.2%), and inspiration time (18.8%) decreased significantly during inhalation of nitric oxide. Mortality in both groups was identical. We therefore conclude that NO, by improving oxygenation and right-ventricular function, temporarily reduces invasiveness of mechanical ventilation. Reduction of invasiveness of ventilation did not influence mortality as compared with patients who did not receive NO. To finally estimate the benefit of NO inhalation, larger patient groups need to be examined.
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Affiliation(s)
- K Westphal
- Department of Anaesthesiology and Resuscitation, J. W. Goethe University, Frankfurt am Main, Germany
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Ehrenberger F, Gorbach S, Hommel K. Schnellbestimmung von Halogen und Schwefel in organischen Substanzen mit einer modifizierten Wickbold-Apparatur. ACTA ACUST UNITED AC 1965. [DOI: 10.1007/bf00521356] [Citation(s) in RCA: 8] [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: 11/25/2022]
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