Abstract
The aim of this study was to investigate the epidemiology of kidney replacement treatment (KRT) in Italy with a focus on gender and residence. As a population-based study using administrative databases from the Campania region of Italy between 2015 and 2018, the study outcomes included diagnoses of haemodialysis, peritoneal dialysis, kidney transplant, and mortality. A total of 11,713 residents in Campania were on KRT from 2015 to 2018. The annual prevalence ranged between 1000 and 1015 patients per million population (pmp) for haemodialysis, between 115 and 133 pmp for peritoneal dialysis, and between 2081 and 2245 pmp for kidney transplant. The annual incidence ranged between 160 and 185 pmp for de novo haemodialysis and between 59 and 191 pmp for kidney transplant. Annual mortality ranged between 12.8% and 14.2% in haemodialysis, between 5.2% and 13.8% in peritoneal dialysis, and between 2.4% and 3.3% in kidney transplant. In Cox regression targeting mortality, significant HRs were found for age (95%CI = 1.05/1.05), kidney transplant (compared to haemodialysis: 0.37/0.47), residence in suburban areas (1.03/1.24), and de novo dialysis incidence in years 2015–2018 (1.01/1.17). The annual rate of kidney transplant was 2.6%. In regression targeting kidney transplant rate, significant HRs were found for female gender (0.67/0.92), age (0.93/0.94), residence in suburban areas (0.65/0.98), and de novo incidence of dialysis in 2015–2018 (0.49/0.71). The existence of socioeconomic inequities in KRT is suggested by the evidence that gender and suburban residence predicted mortality and/or access to kidney transplant.
Highlights
The prevalence of kidney replacement treatment (KRT) is increasing worldwide in parallel with the prevalence of end-stage kidney disease [1,2,3]
Chronic haemodialysis can be provided as out-patient treatment by hospitals and/or private ambulatory specialty clinics accredited by the health authority and part of state-run health care
More than 98% of prevalent haemodialysis patients were treated in private outpatient clinics
Summary
The prevalence of kidney replacement treatment (KRT) is increasing worldwide in parallel with the prevalence of end-stage kidney disease [1,2,3]. In Italy, the KRT Registry has been managed by the Italian Society of Nephrology (Società Italiana di Nefrologia) for the past 25 years [6]. Data collection for this Registry is based on yearly reports from regional sections of the society and is still largely incomplete because only a minority of sections report complete data [7]. Administrative databases have been successfully used to build up registries for various diseases including chronic kidney disease (CKD) [8,9]. The present study analysed administrative databases of the Campania region, southern Italy, to investigate the epidemiology of KRT and, in particular, the possibility that gender and residence could be determinants of health care inequality in the field of kidney diseases [12,13,14,15,16]
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