Per Million Population Research Articles

Temporal Trends and Mortality Patterns in Peripheral Arterial Disease: A Comprehensive Analysis of Hospitalized Patients in Kazakhstan between 2014 and 2021.

Peripheral artery disease (PAD) is a global health concern associated with arterial narrowing or blockage, leading to significant morbidity and mortality. The aim of this study is to assess the disease burden and trends in mortality utilizing nationwide administrative health data. This retrospective study utilized data from the Unified National Electronic Healthcare System (UNEHS) from 2014 to 2021. Patients meeting PAD criteria were included, with demographic and clinical data analyzed. Cox regression and Competing Risk Analysis assessed mortality risks. Between 2014 and 2021, 19,507 individuals were hospitalized due to PAD, with 8,332 (43%) being women and 11,175 (57%) men. The incidence of PAD increased markedly over the observation period, rising from 79 individuals per million population (PMP) in 2014 to 309 PMP in 2021. Concurrent heart failure (HF), acute myocardial infarction (AMI), diabetes, and essential hypertension were prevalent in 50%, 27%, 27%, and 26% of the PAD patients, respectively. Competing Risk Analysis showed a subdistribution hazard ratio (SHR) of 6.53 [95% CI: 4.65-9.19] for individuals over 80 years. Heart failure was associated with lower all-cause HR [0.80, 95% CI: 0.76-0.86, p < 0.001] but higher SHR [1.30, 95% CI: 1.18-1.44, p < 0.001]. Comorbidities such as heart failure, stroke, and acute myocardial infarction significantly increased mortality risks, while essential hypertension was associated with lower risk of death. The significant rise in the incidence rate of PAD underscores the growing burden of the disease, highlighting the urgent need for targeted preventive and management strategies in Kazakhstan.

COVID-19 in the Arab countries: Three-year study

Background Twenty-two Arab countries share a common language, history, and culture. Nevertheless, governmental policies, healthcare systems, and resources differ from one Arab country to another. We have been following Coronavirus (COVID-19) from the beginning in each Arab country. In the present study, we aimed to assess the prevalence of COVID-19 in the Arab world and to compare these findings with other significantly affected countries. Methods Websites of the World Health Organization, World COVID-vaccinations tracker, Worldometer, and Ministries of Health were used to extract COVID-19 data in all Arab countries between the period January 2020 to December 2022. Results All Arab countries had 14,218,042 total confirmed COVID-19 cases, 13,384,924 total recovered cases and 173,544 total related deaths. The trend demonstrated that the third quarter of 2021 recorded the highest death toll and the first quarter of 2022 recorded the highest number of confirmed and recovered cases. Compared to the top 15 affected countries, the Arab world ranked last as it had the lowest overall incidence per million population (PMP) of 31,609. The data on total deaths PMP showed that India had the lowest number of deaths with only 377 cases followed by the Arab world with 386 cases. Conclusions Although the number of confirmed, death, and recovered cases of COVID-19 have greatly reduced in the last quarter of 2022 in most Arab countries, many Arab countries still need to re-campaign about COVID-19 vaccines and raise awareness programs about boosters. COVID-19 has had a relatively smaller impact on Arab countries than on other countries that have been significantly affected.

COVID-19 in the Arab countries: Three-year review

Background Twenty-two Arab countries share a common language, history, and culture. Nevertheless, governmental policies, healthcare systems, and resources differ from one Arab country to another. We have been following Coronavirus (COVID-19) from the beginning in each Arab country. In the present study, we aimed to assess the prevalence of COVID-19 in the Arab world and to compare these findings with other significantly affected countries. Methods Websites of the World Health Organization, World COVID-vaccinations tracker, Worldometer, and Ministries of Health were used to extract COVID-19 data in all Arab countries between the period January 2020 to December 2022. Results All Arab countries had 14,218,042 total confirmed COVID-19 cases, 13,384,924 total recovered cases and 173,544 total related deaths. The trend demonstrated that the third quarter of 2021 recorded the highest death toll and the first quarter of 2022 recorded the highest number of confirmed and recovered cases. Compared to the top 15 affected countries, the Arab world ranked last as it had the lowest overall incidence per million population (PMP) of 31,609. The data on total deaths PMP showed that India had the lowest number of deaths with only 377 cases followed by the Arab world with 386 cases. Conclusions Although the number of confirmed, death, and subsequently recovered cases of COVID-19 have greatly reduced in the last quarter of 2022 in most Arab countries, many Arab countries still need to re-campaign about COVID-19 vaccines and raise awareness programs about boosters. COVID-19 has had a relatively smaller impact on Arab countries than on other countries that have been significantly affected.

COVID-19 in the Arab countries: Three-year review

Background Twenty-two Arab countries share a common language, history, and culture. Nevertheless, governmental policies, healthcare systems, and resources differ from one Arab country to another. We have been following Coronavirus (COVID-19) from the beginning in each Arab country. In the present study, we aimed to assess the prevalence of COVID-19 in the Arab world and to compare these findings with other significantly affected countries. Methods Websites of the World Health Organization, World COVID-vaccinations tracker, Worldometer, and Ministries of Health were used to extract COVID-19 data in all Arab countries between the period January 2020 to December 2022. Results All Arab countries had 14,218,042 total confirmed COVID-19 cases, 13,384,924 total recovered cases and 173,544 total related deaths. The trend demonstrated that the third quarter of 2021 recorded the highest death toll and the first quarter of 2022 recorded the highest number of confirmed and recovered cases. Compared to the top 15 affected countries, the Arab world ranked last as it had the lowest overall incidence per million population (PMP) of 31,609. The data on total deaths PMP showed that India had the lowest number of deaths with only 377 cases followed by the Arab world with 386 cases. Conclusions Although the number of confirmed, death, and subsequently recovered cases of COVID-19 have greatly reduced in the last quarter of 2022 in most Arab countries, many Arab countries still need to re-campaign about COVID-19 vaccines and raise awareness programs about boosters. COVID-19 has had a relatively smaller impact on Arab countries than on other countries that have been significantly affected.

Income inequality and its association with COVID-19 cases and deaths: a cross-country analysis in the Eastern Mediterranean region

IntroductionThere is limited evidence on the associations between economic and social disparities in the Eastern Mediterranean region (EMR) with COVID-19 infections and deaths. This study aims to investigate the relationship...

P11.12: Global and Country-Level Growth in Deceased Organ Donation Over Two Decades

Background: Organ shortage remains the main challenge to organ donation and transplantation worldwide. Given the limited number of deceased donors (DD), consolidated efforts were made in the past two decades to legislate and facilitate brain death donation and further increase its public acceptance. To better understand the impact of these strategies, we describe the global and country-level change in deceased organ donation activities between 2000-2019. Methods: Using data from the Global Observatory of Donation and Transplantation (GODT) for the years (2000 to 2019), we screened all WHO countries (n=194) and included 75 countries with available data on deceased donation activities (DD data for ≥ 5 years). We obtained the annual number of DD in each country, including donors after brain death (DBD) and donors after circulatory death (DCD), and reported in absolute numbers in addition to the adjusted per million population (PMP) numbers. The average annual percentage change (AAPC) in the number of donors PMP was calculated using the JoinPoint Software of the National Cancer Institute. Results: In a sample of 75/194 countries with available data on deceased donation activities, the absolute number of DD increased by 265.3% (from 11181 in 2000 to 40841 in 2019), or 0.11 to 0.4 DD, PMP with an AAPC of 7% (95% CI [4, 10.1]). This increase was predominantly driven by the rise in DBD, which increased by 228.2% (from 9703 in 2000 to 31842 in 2019), or 0.1 to 0.32 DBD, PMP with an AAPC of 6% (95% CI [4.6, 7.4]). However, temporal trends in the number of DD adjusted for the population varied considerably among countries (Figure 1), such that significant growth in DD was seen in 60 (80%) of the nations (AAPC 7.5%; 95% CI [5.6, 9.5]), while the remaining 15 countries were more likely to feature a decline over time (AAPC -1.6%; 95% CI [-3.1, -0.1]). Conclusion: In this global sample, the number of DD increased by four folds between 2000-2019, mainly driven by donations after brain death. However, only 4 in 5 countries maintained growth in their deceased donation activities over time. Future research is needed to understand the variation in donation activities worldwide.

Abstract 32: Temporal Trends And Drivers Of Growth In Heart Transplantation Volumes In A Globally Representative Sample

Background: The need to handle a growing number of advanced heart failure (HF) patients has fueled growth in heart transplantation (HT) activities and development of effective strategies to increase the availability of donors in the last two decades. The impact of these changes on global HT volumes has not been previously described. Methods: Using data from the Global Observatory of Donation and Transplantation (GODT) for the years (2000-2019), we obtained the annual number of HT performed in each country per million population (PMP), number of brain-dead donors, and number of officially registered HT centers. We also identified WHO countries with sustained HT activities (HT data in ≥ 5 years). Data on health expenditures and on the prevalence of severe HF were collected from the World Health Expenditure and Global Burden of Disease (GBD) databases, respectively. Average annual percentage change (AAPC) in number of HT PMP was calculated using JoinPoint software. The contribution of the above-mentioned variables on change in HT volumes over time was determined using a linear mixed-effects regression model. Results: In a sample of 55/194 countries with sustained HT activities, the absolute number of HT increased by 92% (from 4504 in 2000 to 8646 in 2019), or 0.05 to 0.09 HT PMP with an AAPC of 3.6% (95% CI [2.7, 4.5]) in HT/PMP. Temporal trends in HT volumes varied considerably among countries, such that as significant growth in HT was seen in 41 (74.5%) countries (AAPC 5.6%; 95% CI [5, 6.2]), while the remaining 14 countries experienced a decline (AAPC -0.7%; 95% CI [-1.1, -0.2]) ( Figure A ). In an adjusted model, donor availability, HF prevalence, and health expenditure, but not the number of HT centers, significantly predicted an increase in HT over time ( Figure B ). Conclusion: Despite near doubling of HT worldwide in the last two decades, there remain unmet needs to face the growing burden of HF, specifically maximizing organ utilization in brain-dead donors.

Global and Country-Level Impact of COVID-19 on Heart Transplant Volumes

PurposeShifting healthcare resources to deal with the COVID-19 has hampered heart transplant programs around the world, making orthotopic heart transplant (OHT) less feasible. We aim to describe the global impact of COVID-19 on OHT volumes one year after the pandemic.MethodsUsing data from the Global Observatory on Donation and Transplantation (GODT), the world's most comprehensive source of data on organ donation and transplantation, we determined the number of OHT procedures performed in the years 2019 (pre-COVID-19 era) and 2020 (COVID-19 era). Countries with reported data on OHT volumes in both years (n=51 countries) were included. OHT volumes were reported for each country per million population (PMP), and change in the COVID-19 era was expressed as a percentage of the pre-COVID-19 rates of OHT PMP.ResultsAmong countries included in this analysis, the number of OHT decreased by 9.3% during the COVID-19 era (a decrease from 1.82 to 1.65 OHT PMP). However, significant variability existed among included countries, such that 76.5% (39/51) of countries experienced a reduction in OHT volumes during the COVID-19 era (median OHT of 2.56 PMP in 2019 vs. 1.84 in 2020, median difference -0.53 OHT PMP, IQR [-0.83, -0.2], p<0.001) while the rest experienced an increase in OHT volumes (median OHT of 4.1 PMP in 2019 vs. 5 in 2020, median difference 0.47 OHT PMP, IQR [0.12, 0.95], p=0.002). Figure.1 features changes in OHT volumes after COVID-19 around the world.ConclusionIn a representative sample of countries around the world, OHT volumes decreased significantly during the early phase of COVID-19 pandemic in most, but not all countries around the world. Understanding the causes leading to heterogeneity in change in OHT volumes during COVID-19 pandemic may help uncover essential strategies to maintain organ transplantation activities during similar circumstances in the future.

Early impact of COVID-19 pandemic on heart transplant volumes in Asia and Oceania: results from the Global Observatory on Donation and Transplantation (GODT)

Funding AcknowledgementsType of funding sources: None.IntroductionMassive demand for healthcare services worldwide following the emergence of coronavirus disease 2019 (COVID-19) has limited the availability of healthcare resources needed for certain high-complexity procedures, including orthotopic heart transplantation (OHT). Whereas the negative impact of COVID-19 pandemic on several elective procedures has been well-documented, data on regional changes in OHT volumes after COVID-19 are limited. Therefore, we aimed to quantify the impact of COVID-19 pandemic on OHT volumes in Asia and Oceania.MethodsUsing data from the Global Observatory on Donation and Transplantation (GODT), the world"s most comprehensive source of data on organ donation and transplantation, we recorded the number of OHT procedures performed in years 2019 (pre-COVID-19 era) and 2020 (COVID-19 era). The analysis was limited to countries with reported OHT data within Asia and Oceania (Australia, China, India, Iran, Israel, Japan, New Zealand, Russian Federation, Saudi Arabia, Thailand, Turkey, and the United Arab Emirates). OHT rates were reported for each country per million population (PMP), and change in the COVID-19 era was reported as percentage of the pre-COVID-19 rates. The association of total COVID-19 cases with relative reduction in OHT was evaluated using linear regression.ResultsAcross the Asia/Oceania region, number of OHT in COVID-19 era (median 0.64 procedures PMP, IQR 0.28, 2.15) was significantly lower compared with the pre-COVID-19 era (median 1.18 procedures PMP, IQR 0.49, 2.50), with a median change of -0.29 (IQR -0.70, -0.08; P = 0.04). The impact of COVID-19 on OHT was most pronounced in Turkey, United Arab Emirates, and India, where OHT volumes decreased by 75.4%, 60.8%, and 53%, respectively. Country-level reduction in OHT volumes was not associated with total number of COVID-19 cases during the year 2020 in that country (r = 0.31; P-value = 0.3).ConclusionThe number of heart transplants during the early phase of COVID-19 pandemic significantly decreased in ­­­most countries of the Asia/Oceania region. Furthermore, the change in OHT volumes did not correlate with the total number of recorded COVID-19 cases, suggesting the pandemic’s impact on OHT numbers extended beyond limiting availability of resources. Identifying factors leading to OHT deferral during COVID-19 pandemic will advance our understanding of the pandemic’s true impact on the care of advanced heart failure patients in the region. Figure.

POS-677 COMPARISON BETWEEN SINGLE AND DOUBLE CUFFED TENCKHOFF CATHETER IN EARLY ONSET EXIT SITE INFECTION AND PERITONITIS - SINGLE CENTER EXPERIENCE

In Malaysia, the overall prevalence of Chronic Kidney Disease (CKD) is 15.48%1. The incidence of patients with end-stage renal disease (ESRD) requiring dialysis has been growing rapidly in Malaysia from 18 per million population (PMP) in 1993 to 231 PMP in 20132. From 2007 to 2016, the acceptance rate for both hemodialysis and peritoneal dialysis nearly doubled while the prevalence rate had increased by more than two-fold.3Early observational studies reported lower peritonitis rates with double versus single-cuffed catheters.

The Determinants of Non-COVID-19 Excess Deaths During the COVID-19 Pandemic: A Cross-country Panel Study

This paper examines the determinants of non-COVID excess deaths during the COVID pandemic between January and June 2020. These are the extra deaths occurring during the pandemic which are not directly attributable to COVID. While emerging literature examines the determinants of COVID deaths, few look at non-COVID excess deaths, though early estimates suggest they are enough to be seen as a pandemic in their own count. We investigate the impact of factors including COVID deaths and cases, lockdown stringency, economic support and search intensity for non-COVID conditions on excess deaths, using Fixed Effects and GMM estimations. We also use quantile regression to assess the differential impacts of the variables at different stages of the excess death distribution. First, we find that excess deaths are increasing and concave in COVID deaths, and that the rate of growth, as well as the level, of COVID deaths has a significant and positive impact. Second, we find some evidence that stringency of lockdown increases excess deaths by a maximum of 16 extra per-million population. Third, we find a reduction in search intensity for other conditions significantly increases excess deaths, implying that policymakers should ensure public health messaging for other conditions during a pandemic.JEL Classifications: I12, I18, I11

Twenty-year temporal and regional trends in heart transplantation in Europe: results from the Global Observatory on Donation and Transplantation (GODT)

Abstract Introduction Heart transplant (HT) remains the only cure for patients with advanced heart failure. However, limited supply of donors continues to be the main obstacle to growing transplant programs around the world. Since population changes are not uniform, describing temporal trends in availability of donors and in number of transplanted hearts will provide better understanding of regional variations in organ availability and allocation. Purpose We aim to evaluate temporal and regional trends in number of brain-dead donors (BDDs) and its association with the number of heart transplants (HTs) in Europe between 2000 and 2019. Methods Global Observatory on Donation and Transplantation (GODT) represents the world's most comprehensive source of data on organ donation and transplantation. Available data were collected for all European countries for the years (2000–2019) except for the year 2005. Geographical classification (north, west, central, south) was made according to EuroVoc definition. Trends of HTs and BDDs were assessed using Joinpoint Software of the National Cancer Institute to calculate the annual percentage change (APC) and reported as per million population (PMP). The linear correlation coefficient was assessed using R studio. Results Over the past two decades, there was a 35% increase in HTs PMP rate in Europe from the year 2000 to 2019 with an APC of 1.4% (95% CI [1.1–1.7], P&amp;lt;.0001). This change was more pronounced in Central Europe, where HTs PMP rate increased from 0.65 in 2000 to 2.93 in 2019 (APC 9.9% (95% CI [8.1–11.8], P&amp;lt;.0001)) and in Northern Europe, where HTs PMP rate increased from 2.97 in 2000 to 5.18 in 2019 (APC 2.7% (95% CI [1.8–3.7], P&amp;lt;.0001)) (Figure 1). Despite the increase in BDDs in Europe between 2000–2019 (from 3.62 to 12.25 donors PMP) (Figure 2), the association between increased BDDs and HTs varied between regions, with a very strong association in Central Europe (r=0.95, P&amp;lt;0.0001) and strong correlation in Northern Europe (r=0.64, P=0.003). However, positive correlation between BDDs and HTs was not seen in Southern or Western Europe (r=−0.52, p-value=0.02, r=0.02, p-value=0.94, respectively). Conclusion The number of BDDs has increased in Europe in the past two decades with a concomitant increase in HT volumes. A regional variation in the relationship between the number of BDDs and HTs was observed among European subregions, such that it was most pronounced in Central Europe. Understanding the reasons underlying these disparities can potentially inform improvement in organ allocation systems throughout Europe. Funding Acknowledgement Type of funding sources: None.

1481Epidemiology of membranous nephropathy in thirteen Asia-Pacific nations using an incidence-to-prevalence model

Abstract Background Primary membranous nephropathy (PMN) is the leading cause of nephrotic syndrome. Several studies conducted in Asia-Pacific region report the incidence of PMN. However, there is a paucity of peer-reviewed published prevalence data for this condition. Methods A literature review was conducted using PubMed and Clarivate’s Cortellis database from 1/1/1980 to 1/11/2019) to identify country-specific, age- and gender-specific diagnosed incidence rates and observed survival data-point inputs for use in our incidence- prevalence model. For countries lacking published incidence data, logical extrapolations were made, applying the incidence from countries based on comparable geography and healthcare access. Results The diagnosed prevalence of PMN varies substantially between the countries under study, from 15 per million population (PMP), in the Philippines to 277 PMP in China in 2021. The number of diagnosed prevalent cases of PMN in the countries under study will increase by 21% over 2021-2031 with highest growth in Vietnam (34%) and lowest in Australia (9%). Conclusions The prevalence of PMN is expected to increase over the next ten years due to population aging, changes in population size, and improvements in survival in the countries under study. Limited registry and published prevalence data for these countries is highlighting the need for increasing awareness and research for this rare disease. Key messages This study provides the insights into the current and future trends in the prevalence of PMN in next 10-years (2021-2031) which was otherwise not reported in the published literature

POS-685 STRUCTURE OF RENAL REPLACEMENT THERAPY IN THE KINGDOM OF SAUDI ARABIA

Renal replacement therapy (RRT) is the mainstay in the clinical management and treatment of patients with chronic renal disease and end-stage renal disease (ESRD) aimed to support, maintain and improved the quality of life and may even decreased the mortality of patients having the disease, and with the increasing demand on renal replacement therapy in Kingdom it is imperative to improve the facilities, patient quality care and even types of RRT in the Kingdom. A review of renal replacement therapy in the Kingdom of Saudi Arabia published by Saudi Center for Organ Transplantation (SCOT) data in 2019; based on the cross-sectional study of annual questionnaires from all the dialysis centers in the Kingdom and annual post-transplantation follow-up from the accredited renal transplant centers in KSA. Renal replacement therapy (RRT) in the Kingdom were composed of 3 modalities: hemodialysis (HD), peritoneal dialysis (PD), and kidney transplantation (KTx). In 2019, a total of 28,256 patients were on RRT with 19,522 patients on HD, 1,546 on PD and, 7,188 patients with post-renal transplant follow-up. The prevalence and incidence rate of patients on dialysis were 631 and 142 per million population (PMP) respectively. Mortality rate on patients on dialysis were 8.2% this year. Kidney transplantation from deceased and living donors was the highest kidney transplants performed with a total of 1,121 kidneys transplanted, 140 (12%) from deceased and 981 (88%) kidneys from living donation making the Saudi Arabia the 2nd highest kidney transplant from living donor rate worldwide 29.37 pmp and 3rd highest living organ donors rate worldwide with 36.59 pmp (IRODAT: 2019). Graft loss and mortality rate on the same year were also recorded on living kidney recipients with 6 (0.6%) recipients loss their graft and 2 (0.2%) recipients died on the same year, while recipients from deceased donors, graft loss were 4 (2.8%) and a mortality rate were 2 (1.4%). Renal replacement therapy is the cornerstone in clinical management of patients with end-stage renal disease. Hemodialysis is the most common modality of renal replacement therapy providing greater convenience and accessibility, followed by peritoneal dialysis which needs to be encouraged, other modality such as home hemodialysis should be explored and considered. While, the Kingdom has reached a milestone in kidney transplantation making it one of the highest living organ donors rate worldwide, Saudi Arabia is still working on to improve its deceased organ donation which has a great potential in buffering the increasing demand of kidney transplant. Mortality rate post-renal transplant at one year was also considerably low with 4 deaths (0.3%) from both living and deceased kidney transplant at the same year.

Epidemiology of dialysis-treated end-stage renal disease patients in Kazakhstan: data from nationwide large-scale registry 2014\u20132018

BackgroundThe epidemiology of dialysis patients has been little studied in developing countries and economies in transition. We examined the prevalence, incidence and mortality rate of dialysis patients in Kazakhstan, via aggregation and utilization of large-scale administrative healthcare data.MethodsThe registry data of 8898 patients receiving dialysis therapy between 2014 and 2018 years were extracted from the Unified National Electronic Health System (UNEHS) and linked with the national population registry of Kazakhstan. We provide descriptive statistics of demographic, comorbidity and dialysis-related characteristics.ResultsAmong all patients undergoing maintenance dialysis for end-stage renal disease (ESRD), there were 3941 (44%) females and 4957 (56%) males. 98.7% of patients received hemodialysis and 1.3% peritoneal dialysis. The majority of the patients (63%) were ethnic Kazakhs, 18% were Russians and 19% were of other ethnicities. The prevalence and incidence rate in 2014 were 135.2 and 68.9 per million population (PMP), respectively, which were different in 2018 [350.2 and 94.9 PMP, respectively]. Overall mortality rate among dialysis patients reduced from 1667/1000 patient-years [95%Confidence Interval (CI): 1473–1886] (PY) in 2014 to 710/1000PY [95%CI: 658–767] in 2018. We observed 13% lower crude survival probability in females compared to males and in older patients compared to younger ones. Russian ethnicity had 58% higher risk of death, while other ethnicities had 34% higher risk of death compared to in those of Kazakh ethnicity.ConclusionWe describe for the first time in Kazakhstan an increase in the prevalence and incidence of ESRD on dialysis, while mortality rate decreased over time, during 2014–2018. We observed statistically significant lower survival probability in female dialysis patients compared to males, in older patients compared to younger ones, and in patients of Russian ethnicity compared to Kazakh.

Epidemiological Characteristics and Causes of End-stage Renal Disease in Hemodialysis Patients

Background and aims: Hemodialysis (HD) is considered as the main method of renal replacement therapy (RRT) for end-stage renal disease (ESRD) patients in many countries including Iran. Given the limited number of epidemiological studies in this regard at the provincial level across the country, the present study aimed to describe the demographic and clinical characteristics of ESRD patients and determine the most important causes of ESRD in Hamadan Province. Methods: This cross-sectional study was conducted on 508 HD patients in Hamadan province in January 2017. The checklist used to gather information comprised of the patient’s demographic and clinical information. The analysis was carried out using descriptive analysis including frequency tables and charts and the chi-square statistic test was used to compare the groups using Stata software, version 12. Results: The prevalence rate of HD treatment was 288.9 per million population (PMP). Further, most under HD patients were married, illiterate, and urban residents. The mean age of patients at the diagnosis was 47.64 ± 15.17 years. Hypertension (37.4%), diabetes (28.74%), and glomerulonephritis (10.63%) were the common causes of ESRD. Eventually, there was a significant difference between ESRD causes according to gender and residency (P&lt;0.05). Conclusion: In general, the prevalence rate of HD in Hamadan was relatively similar to that of developing countries although it was lower than the national average. Furthermore, hypertension and diabetes were the common causes of ESRD in Hamadan Province. Therefore, preventive strategies should be taken to modify their risk factors.

P0439THE RELATIONSHIP BETWEEN SOCIO-ECONOMIC STATUS AND RENAL VASCULITIS IN SCOTLAND

Abstract Background and Aims Individuals living in areas of multiple socioeconomic deprivation have reduced life expectancy and experience health inequalities. Chronic kidney disease is more common in areas of social deprivation and these patients are more likely to develop end stage kidney disease. Vasculitis is a rare but significant cause of kidney disease. The impact of socioeconomic status on disease activity or outcomes in patients with ANCA Associated Vasculitis (AAV) is yet to be fully explored. The aim of this study was to establish whether there is an association between the incidence of biopsy-proven renal vasculitis and socioeconomic status, as measured by the Scottish Index of Multiple Deprivation (SIMD). Method Using the Scottish renal biopsy registry, we identified all adult native renal biopsies performed across Scotland between 2014 and 2018 with a diagnosis of AAV. Patient’s postcode and SIMD (2016) rank were recorded. Patients were separated into quintiles of SIMD rank. Baseline demographics were recorded. We derived the denominator population from the 2016 SIMD census. Data were calculated per million population (PMP) served. Results 339 biopsy proven cases of AAV were identified. 6 cases were excluded as postcode was unavailable. Overall, mean age was 65.9 (±13.0) years and 45% of patients were male. At time of diagnosis, mean estimated glomerular filtration rate (eGFR) was 61.7 (±25.7) ml/min/1.73m2 and median urinary protein creatinine ratio (uPCR) was 134mg/mmol (IQR 64-21). Microscopic Polyangiits n=205(65%) was more common than Granulomatosis with Polyangiits n=128(35%). The incidences of kidney biopsy proven AAV were similar across all quintiles of deprivation. In the most deprived 20% of population, incidence rate of kidney biopsy proven AAV was 11.2 per million person-years vs 13.0 per million person-years in least deprived 20% of population. Patients in areas of greatest relative deprivation were younger (64.0 (±12.3) vs. 68.1 (±12.7) years) and had slightly less proteinuria at diagnosis (99mg/mmol (IQR 35-211) vs. 138mg/mmol (IQR 78-281)) when compared to patients living in least deprived areas. However, there was no difference in level of renal function at diagnosis (33.8 (±29.6) ml/min/1.73m2 vs 31.5 (±23.2) ml/min/1.73m2). Conclusion Our complete national dataset shows that there is no significant difference in incidence of renal AAV across the spectrum of socioeconomic deprivation. The analysis of renal function at presentation suggests no evidence of an association between deprivation and delay in diagnosis in a healthcare system free at the point of access.

Does established vascular kidney disease exist?

Does established vascular kidney disease exist?

Global Dialysis Perspective: Korea.

According to the Korean ESKD registry (1), in 2018 there were 17,621 incident ESKD patients in Korea. The unadjusted incidence rate was 340.0 per million population (PMP) (Table 1). The number of patients with incident ESKD continued to increase until 2006, plateaued between 2007 and 2009, and rose again from 2010 (Figure 1A). This trend in rising ESKD incidence rate implies increasing burden of CKD, which is attributable to the aging Korean population and high rate of diabetes mellitus (DM) and hypertension. View this table: Table 1. Trends in annual number of patients with incident ESKD and incidence rates of ESKD in the Korean population, 2000–2018 Figure 1. Trends in the annual number of patients (A) with incident ESKD or (B) with prevalent ESKD by modality in the Korean population, 2000-2018. The number of patients with incident and prevalent HD has steadily increased. The number of patients with incident and prevalent PD continuously declined since 2006. The number of kidney transplants has gradually increased and plateaued since 2016. On December 31, 2018, there were 103,984 patients with prevalent ESKD in Korea, representing a 271% increase since 2000. The unadjusted prevalence rate was 2006.4 PMP (Table 1), which ranked high globally (2). Prevalence rate of ESKD has steadily increased year after year (Figure 1B). Hemodialysis (HD) was the predominant form of ESKD treatment modality in all years in both patients with incident and prevalent ESKD. The number of patients with incident peritoneal dialysis (PD) rapidly increased from the late 1990s and peaked in 2006 ( n =2568), then declined every year until 2018 ( n =735, a decrease of 71%) (Figure1A, Table 1). The ratio of HD to PD gradually changed from 68.9:31.1 in 2006 to 95.3:4.7 in 2018 in patients with incident ESKD, and from 78.4:21.6 in 2006 to 92.5:7.5 in 2018 in patients with prevalent ESKD …

Estimating the prevalence of undocumented immigrants with end-stage renal disease in the United States.

In the current political environment, the plight of undocumented immigrants in the United States (U.S.) remains perilous and uncertain, and this precarious situation is magnified for undocumented immigrants with end-stage renal disease (ESRD). For this population, access to hemodialysis varies dramatically from standard-of-care thrice-weekly hemodialysis, to the other extreme of emergency-only hemodialysis which is the practice of offering hemodialysis only after a patient meets "critically ill criteria." Due to the exclusion from Medicare, undocumented immigrants are not included in the United States Renal Data System (USRDS), and therefore the prevalence of undocumented immigrants with ESRD in the U.S. remains unknown. In this review, we assemble the published literature, press reports, and other data sources to arrive at an estimated crude prevalence of undocumented immigrants with ESRD. In 2015, USRDS data reported an adjusted ESRD prevalence of 2,988 per million population (PMP) among documented U.S. Hispanics and 1,902 PMP among documented U.S. non-Hispanics, adjusted for age, sex, and race. Although 77.8% of undocumented immigrants in the U.S. are from Latin America, simply applying USRDS-adjusted prevalence estimates for U.S. Hispanics with Medicare to undocumented immigrants would likely overestimate the undocumented immigrant population with ESRD given the younger age of the immigrant population. Applying the estimates from the states with the largest population of undocumented immigrants, the range for California and Texas is 500-798 PMP which results in an estimate of 5,500-8,857 undocumented immigrants with ESRD living in the U.S.