Prevalence Of Renal Replacement Therapy Research Articles

Renal Replacement Therapy Modalities in Critically Ill Children.

The objective of this study is to describe the relative frequency of use of continuous renal replacement therapy, intermittent hemodialysis, and peritoneal dialysis and to analyze characteristics and outcomes of critically ill children receiving renal replacement therapies admitted to PICUs that participate in the Virtual PICU (VPS LLC, Los Angeles, CA) registry. Retrospective, database analysis. PICUs that participate in the Virtual PICU (VPS LLC) registry. Critically ill children admitted to PICUs that participate in the Virtual PICU (VPS LLC) registry and received renal replacement therapy from January 1, 2009, to December 31, 2015. None. A total of 7,109 cases (53% males) received renal replacement therapy during the study period. The median age was 72.3 months (interquartile range, 8.4-170 mo) and median length of stay was 8.7 days (interquartile range, 3.3-21.2 d). Caucasians comprised 42% of the cohort and blacks and Hispanics were 16% each. Continuous renal replacement therapy was used in 46.5%, hemodialysis in 35.5% and peritoneal dialysis in 18%. Of the 7,109 cases, 1,852 (26%) were postoperative cases (68% cardiac surgical) and 981 (14%) had a diagnosis of cancer. Conventional mechanical ventilation was used in 64%, high-frequency oscillatory ventilation in 12%, noninvasive ventilation in 24%, and extracorporeal membrane oxygenation in 5.8%. The overall mortality was 22.3%. Patients who died were younger 40.8 months (interquartile range, 1.5-159.4 mo) versus 79.9 months (interquartile range, 12.6-171.7 mo), had a longer length of stay 15 days (interquartile range, 7-33 d) versus 7 days (interquartile range, 3-18 d) and higher Pediatric Index of Mortality 2 score -2.84 (interquartile range, -3.5 to -1.7) versus -4.2 (interquartile range, -4.7 to -3.0) (p < 0.05). On multivariate logistic regression analysis, higher mortality was associated with the presence of cancer (32.7%), previous ICU admission (32%), requiring mechanical ventilation (33.7%), receiving high-frequency oscillatory ventilation (67%), or extracorporeal membrane oxygenation (58.4%), admission following cardiac surgical procedure (29.4%), and receiving continuous renal replacement therapy (38.8%), and lower mortality was associated with hemodialysis (9.8%), and peritoneal dialysis (12.3%) (p < 0.0001). Continuous renal replacement therapy is an increasingly prevalent renal replacement therapy modality used in critically ill children admitted to an ICU. Higher mortality rate with the use of continuous renal replacement therapy should be interpreted with caution.

Renal Replacement Therapy in Children in Lithuania: Challenges, Trends, and Outcomes.

Background and Objectives: Pediatric renal replacement therapy (RRT) in Lithuania resumed in 1994 after a 12-year pause in renal transplantation. Management of end stage renal disease (ESRD) has changed, and outcomes have improved over decades. Our aim was to evaluate the dynamics of RRT in Lithuania in the period 1994–2015, describe its distinctive features, and compare our results with other countries. Materials and Methods: Data between 1994 and 2015 were collected from patients under the age of 18 years with ESRD receiving RRT. The data included: Hemodialysis (HD), peritoneal dialysis (PD), transplantation incidence and prevalence, transplant waiting time, dialysis modalities before transplantation, causes of ESRD and gender distribution in transplanted patients, and patient and graft survival. Results: RRT incidence and prevalence maintained an increase up until 2009. Sixty-four transplantations were performed. Juvenile nephronophthisis (25.9%) was the primary cause of ESRD in transplanted children. The transplant waiting time median was 8.0 months. The male to female ratio post-transplantation was 1.02. Patient survival after transplantation at 10 years was 90.0%, while graft survival for living (related) was 77.0% and 51.1% for deceased. Twelve patients died while on RRT. Conclusions: RRT numbers are increasing in Lithuania. HD is the primary treatment of choice before transplantation, with continued low numbers of preemptive transplantation. Patient survival post-transplantation is favorable, though graft survival is less satisfactory.

Chronic kidney disease and kidney health care status: the healthy life in Suriname (HeliSur) study

The high cardiovascular risk burden in low- and middle-income countries is expected to lead to an explosive increase in chronic kidney disease (CKD). However, population data on CKD from these countries are scarce. Therefore, we assessed kidney health in Suriname. In the Healthy Life in Suriname (HeliSur) study, a random sample of the adult population, we collected data with standardized questionnaires, physical examination, and blood and urine samples analysed in a central laboratory. Prevalent CKD was graded with KDIGO guidelines. In addition, we assessed national data on prevalent renal replacement therapy (RRT), estimated the future need for RRT, and evaluated national kidney health work force and policies. We include 1117 participants (2.0‰ of the population), 63% women, 40% of African ancestry and 43% of Asian ancestry, with a mean age of 42.2 (SE 0.4) years. Blood pressure is elevated in 72% of the participants, 26% have diabetes or prediabetes, and 78% are obese or overweight. The prevalence of CKD is 5.4%, and around 0.3% have kidney failure, translating to approximately 1500 patients nationally (2690 per million population, pmp), with currently 516 patients (920 pmp) on dialysis. Based on the participants from the random population sample in CKD stage G3 or G4, we estimate that 6750–10,750 pmp may develop kidney failure within the next 10 years. However, specialized kidney health workforce is currently very limited, and specific national or local policies for CKD management are lacking. Since the large majority of the general population has one or more risk factors for CKD including elevated blood pressure, urgent action is needed to strengthen kidney health care and prevent a catastrophic rise in need for RRT in the coming years.

Is the Rise in the Prevalence of Renal Replacement Therapy at Older Ages the Price for Living Longer?

Renal replacement therapy (RRT) is one of the most expensive in renal medicine. Cross-sectional studies suggest that life expectancy increases in the general population are associated with a higher burden of RRT. This study tests this hypothesis in a prospective setting among people aged 75+ living in Western Europe. We gathered sex-specific data for 11 Western European countries in 2005-2014. RRT prevalence on country level was extracted from the ERA-EDTA registry, while data on population size and life expectancy for the 75+ age group came from the Eurostat database. GDP per capita was extracted from the OECD database. To measure the association between RRT prevalence and life expectancy, we performed Poisson regression models separately for each country and for all countries combined. To adjust for confounding, GDP per capita as well as time and country-fixed effects were included. Our analysis revealed that living longer coincides with rising RRT prevalence at ages 75+ in Western Europe between 2005 and 2014. On average, a 1-year increase in life expectancy was associated with a roughly 20% increase in RRT prevalence [(95% CI) 21-23% in men and 19-22% in women]. However, after adjustments for confounding were made, the association became insignificant among women and became weaker among men, falling to a level of 11% [(95% CI) 6-17%]. Living longer was not necessarily associated with a higher burden of RRT in Western European countries.

Severe mental illness and chronic kidney disease: a cross-sectional study in the United Kingdom.

ObjectiveWe investigated the burden of chronic kidney disease (CKD) among patients with severe mental illness (SMI).MethodsWe identified patients with SMI among all those aged 25–74 registered in the UK Clinical Practice Research Datalink as on March 31, 2014. We compared the prevalence of CKD (two measurements of estimated glomerular filtration rate <60 mL/min/1.73 m2 for ≥3 months) and renal replacement therapy between patients with and without SMI. For patients with and without a history of lithium prescription separately, we used logistic regression to examine the association between SMI and CKD, adjusting for demographics, lifestyle characteristics, and known CKD risk factors.ResultsThe CKD prevalence was 14.6% among patients with SMI and a history of lithium prescription (n = 4,295), 3.3% among patients with SMI and no history of lithium prescription (n = 24,101), and 2.1% among patients without SMI (n = 2,387,988; P < 0.001). The prevalence of renal replacement therapy was 0.23%, 0.15%, and 0.11%, respectively (P = 0.012). Compared to patients without SMI, the fully adjusted odds ratio for CKD was 6.49 (95% CI 5.84–7.21) for patients with SMI and a history of lithium prescription and 1.45 (95% CI 1.34–1.58) for patients with SMI and no history of lithium prescription. The higher prevalence of CKD in patients with SMI may, in part, be explained by more frequent blood testing as compared to the general population.ConclusionCKD is identified more commonly among patients with SMI than in the general population.

South African Renal Registry Annual Report 2016

The fifth annual report of the South African Renal Registry summarises the 2016 data on renal replacement therapy (RRT) for patients with end-stage renal disease (ESRD) in South Africa. In December 2016, the number of patients with ESRD who were treated with chronic dialysis or transplantation stood at 10 257, a prevalence of 183 per million population (pmp). The growing prevalence observed since the registry was established is due mainly to the increasing numbers of patients accessing haemodialysis in the private sector. In the public sector, which serves 84% of the South African population, the prevalence of RRT (68 pmp) has dipped below the level reported for 1994, so that the disparity in access continues to increase. The disparities between provinces remain, with Limpopo and Mpumalanga the most under-served, as do the disparities between ethnic groups, with Blacks being the most under-served group.

The epidemiology of renal replacement therapy in two different parts of the world: the Latin American Dialysis and Transplant Registry versus the European Renal Association-European Dialysis and Transplant Association Registry.

ABSTRACTObjectiveTo compare the epidemiology of renal replacement therapy (RRT) for end-stage renal disease (ESRD) in Latin America and Europe, as well as to study differences in macroeconomic indicators, demographic and clinical patient characteristics, mortality rates, and causes of death between these two populations.MethodsWe used data from 20 Latin American and 49 European national and subnational renal registries that had provided data to the Latin American Dialysis and Renal Transplant Registry (RLADTR) and the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) Registry, respectively. The incidence and prevalence of RRT in 2013 were calculated per million population (pmp), overall and by subcategories of age, sex, primary renal disease, and treatment modality. The correlation between gross domestic product and the prevalence of RRT was analyzed using linear regression. Trends in the prevalence of RRT between 2004 and 2013 were assessed using Joinpoint regression analysis.ResultsIn 2013, the overall incidence at day 91 after the onset of RRT was 181 pmp for Latin American countries and 130 pmp for European countries. The overall prevalence was 660 pmp for Latin America and 782 pmp for Europe. In the Latin American countries, the annual increase in the prevalence averaged 4.0% (95% confidence interval (CI): 2.5%-5.6%) from 2004 to 2013, while the European countries showed an average annual increase of 2.2% (95% CI: 2.0%-2.4%) for the same time period. The crude mortality rate was higher in Latin America than in Europe (112 versus 100 deaths per 1 000 patient-years), and cardiovascular disease was the main cause of death in both of those regions.ConclusionsThere are considerable differences between Latin America and Europe in the epidemiology of RRT for ESRD. Further research is needed to explore the reasons for these differences.

Projecting demands for renal replacement therapy in the Northern Territory: a stochastic Markov model.

Objective The aim of the present study was to evaluate the potential effects of different health intervention strategies on demand for renal replacement therapy (RRT) services in the Northern Territory (NT). Methods A Markov chain simulation model was developed to estimate demand for haemodialysis (HD) and kidney transplantation (Tx) over the next 10 years, based on RRT registry data between 2002 and 2013. Four policy-relevant scenarios were evaluated: (1) increased Tx; (2) increased self-care dialysis; (3) reduced incidence of end-stage kidney disease (ESKD); and (4) reduced mortality. Results There were 957 new cases of ESKD during the study period, with most patients being Indigenous people (85%). The median age was 50 years at onset and 57 years at death, 12 and 13 years younger respectively than Australian medians. The prevalence of RRT increased 5.6% annually, 20% higher than the national rate (4.7%). If current trends continue (baseline scenario), the demand for facility-based HD (FHD) would approach 100000 treatments (95% confidence interval 75000-121000) in 2023, a 5% annual increase. Increasing Tx (0.3%), increasing self-care (5%) and reducing incidence (5%) each attenuate demand for FHD to ~70000 annually by 2023. Conclusions The present study demonstrates the effects of changing service patterns to increase Tx, self-care and prevention, all of which will substantially attenuate the growth in FHD requirements in the NT. What is known about the topic? The burden of ESKD is projected to increase in the NT, with demand for FHD doubling every 15 years. Little is known about the potential effect of changes in health policy and clinical practice on demand. What does this paper add? This study assessed the usefulness of a stochastic Markov model to evaluate the effects of potential policy changes on FHD demand. What are the implications for practitioners? The scenarios simulated by the stochastic Markov models suggest that changes in current ESKD management practices would have a large effect on future demand for FHD.

South African Renal Registry Annual Report 2015

The fourth annual report of the South African Renal Registry summarises the 2015 data on renal replacement therapy (RRT) for patients with end-stage renal disease (ESRD) in South Africa. The South African population increased to 54.96 million in 2015, from 54.00 million in 2014. In December 2015, the number of patients with ESRD who were treated with chronic dialysis or transplantation stood at 10 360, a prevalence of 189 per million population (pmp). The prevalence was 167 pmp in 2013 and 178 pmp in 2014. The increasing prevalence observed is due mainly to the increased numbers of patients accessing haemodialysis in the private sector. In the public sector, which serves 84% of the South African population, the prevalence of RRT (71.9 pmp in 2015) remains at levels close to those reported in 1994 so that the disparity in access continues to increase. The disparities between provinces remain, with Limpopo and Mpumalanga the most under-served, as do the disparities between ethnic groups, with Blacks being the most under-served group.

Validity of estimated prevalence of decreased kidney function and renal replacement therapy from primary care electronic health records compared with national survey and registry data in the United Kingdom.

BackgroundAnonymous primary care records are an important resource for observational studies. However, their external validity is unknown in identifying the prevalence of decreased kidney function and renal replacement therapy (RRT). We thus compared the prevalence of decreased kidney function and RRT in the Clinical Practice Research Datalink (CPRD) with a nationally representative survey and national registry.MethodsAmong all people ≥25 years of age registered in the CPRD for ≥1 year on 31 March 2014, we identified patients with an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, according to their most recent serum creatinine in the past 5 years using the Chronic Kidney Disease Epidemiology Collaboration equation and patients with recorded diagnoses of RRT. Denominators were the entire population in each age–sex band irrespective of creatinine measurement. The prevalence of eGFR <60 mL/min/1.73 m2 was compared with that in the Health Survey for England (HSE) 2009/2010 and the prevalence of RRT was compared with that in the UK Renal Registry (UKRR) 2014.ResultsWe analysed 2 761 755 people in CPRD [mean age 53 (SD 17) years, men 49%], of whom 189 581 (6.86%) had an eGFR <60 mL/min/1.73 m2 and 3293 (0.12%) were on RRT. The prevalence of eGFR <60 mL/min/1.73 m2 in CPRD was similar to that in the HSE and the prevalence of RRT was close to that in the UKRR across all age groups in men and women, although the small number of younger patients with an eGFR <60 mL/min/1.73 m2 in the HSE might have hampered precise comparison.ConclusionsUK primary care data have good external validity for the prevalence of decreased kidney function and RRT.

Ten-years trends in renal replacement therapy for end-stage renal disease in mainland France: Lessons from the French Renal Epidemiology and Information Network (REIN) registry

BackgroundThe incidence rate of renal replacement therapy (RRT) for end-stage renal disease (ESRD) is decreasing in several countries, but not in France. We studied the RRT trends in mainland France from 2005 to 2014 to understand the reasons for this discrepancy and determine the effects of ESRD management changes. MethodsData were extracted from the French Renal Epidemiology and Information Network registry. Time trends of RRT incidence and prevalence rates, patients’ clinical and treatment characteristics were analysed using the Joinpoint regression program and annual percentage changes. Survival within the first year of RRT was analysed using Kaplan-Meier estimates for 4 periods of time. ResultsThe overall age- and gender-adjusted RRT incidence rate increased from 144 to 159 individuals per million inhabitants (pmi) (+0.8% per year; 95% CI: 0.5–1.2) and the prevalence from 903 to 1141 pmi (+2.4% per year; 95% CI: 2.2–2.7). This increase concerned exclusively ESRD associated with type 2 diabetes (+4.0%; 3.4–4.6) and mostly elderly men. Despite patient aging and increasing comorbidity burden and a persistent 30% rate of emergency dialysis start, the one-year survival rate slightly improved from 82.1% (81.4–82.8) to 83.8% (83.3–84.4). Pre-emptive wait listing for renal transplantation and the percentage of wait-listed patients within one year after dialysis start strongly increased (from 5.6% to 15.5% and from 29% to 39%, respectively). ConclusionKidney transplantation and survival significantly improved despite the heavier patient burden. However, the rise in type 2 diabetes-related ESRD and the stable high rate of emergency dialysis start remain major issues.

Inception and utility of a renal replacement registry using administrative health data in North-East Italy.

Disease registries are useful tools for public health planning, evaluating clinical practice and providing information on cohorts of patients. The administrative databases of the regional health information system of Friuli Venezia Giulia, Italy were used to build a regional registry of the resident population in renal replacement therapy (including dialysis and renal transplantation), through an algorithm taking into account hospital discharge and outpatient ambulatory care data. The registry includes an anonymous univocal identifier, the start date for the replacement therapy and changes of status (haemodialysis, peritoneal dialysis, renal transplantation). Data from the registry were used to estimate incidence rate, prevalence and mortality of patients receiving renal replacement therapy in 2014. In addition, we described an example of how the registry can be used to assess the prevalence of selected comorbidities. In Friuli Venezia Giulia in 2014, we estimated an incidence rate of renal replacement therapy of 166 per million inhabitants and a prevalence of 1,400 per million inhabitants. A total of 10% of the patients died in the study year. Hypertension, heart disease and diabetes mellitus were common co-morbidities. The registry allows us to estimate the incidence rate and prevalence of renal replacement therapy and also to investigate specific issues regarding these patients through record linkage with other administrative health databases.

Prevalence of patients receiving renal replacement therapy in El Salvador in 2014

El Salvador has the highest renal failure mortality rate in the Americas. Five healthcare providers offer renal replacement therapy (RRT) in the country. The national RRT prevalence has never been reported. AimsTo determine the RRT prevalence in El Salvador and some basic characteristics. MethodsThe association of nephrology coordinated a nationwide cross-sectional survey during the third quarter of 2014. 31 renal centres participated in the survey, covering 99.5% of patients. ResultsNational RRT prevalence: 595 per million population (pmp), N=3807, average age 50.4 years old, 67.5% male. By modality: peritoneal dialysis (PD) 289pmp, haemodialysis (HD) 233pmp, with functioning kidney transplantation 74pmp (living donor only). Social security covers 25% of the population but treats 49.7% of RRT patients. Generally, higher prevalence was observed in municipalities with renal centres or located on the coast or lowlands. Ninety-five per cent of HD patients receive fewer than 3 weekly sessions. Of PD patients, 59% do not belong to a continuous outpatient or automated programme, and 25% still use rigid catheter. Aetiology of chronic kidney disease: unavailable/undetermined 50%, hypertension 21.1%, diabetes 18.9%, glomerulonephritis 6.7%, obstructive causes 1.2%, tubulointerstitial 0.9%, polycystic 0.4% and other 0.7%. DiscussionDespite the increase in RRT services, the prevalence is lower than the Latin American average (660pmp). Three quarters of HD and PD patients are under-dialysed. Obsolete RRT techniques are still used. The presence of Mesoamerican nephropathy influences the demographic characteristics (many young patients, two-thirds male, high prevalence in lowlands and coastlands).

Prevalencia de pacientes con tratamiento sustitutivo renal en El Salvador en 2014

El Salvador has the highest renal failure mortality rate in the Americas. Five healthcare providers offer renal replacement therapy (RRT) in the country. The national RRT prevalence has never been reported. AimsTo determine the RRT prevalence in El Salvador and some basic characteristics. MethodsThe association of nephrology coordinated a nationwide cross-sectional survey during the third quarter of 2014. 31 renal centres participated in the survey, covering 99.5% of patients. ResultsNational RRT prevalence: 595 per million population (pmp), N=3807, average age 50.4 years, 67.5% male. By modality: peritoneal dialysis (PD) 289 pmp, haemodialysis (HD) 233 pmp, with functioning kidney transplantation 74 pmp (living donor only). Social security covers 25% of the population but treats 49.7% of RRT patients. Generally, higher prevalence was observed in municipalities with renal centres or located on the coast or lowlands. Ninety-five percent of HD patients receive fewer than 3 weekly sessions. Of PD patients, 59% do not belong to a continuous outpatient or automated programme, and 25% still use rigid catheter. Aetiology of chronic kidney disease: unavailable/undetermined 50%, hypertension 21.1%, diabetes 18.9%, glomerulonephritis 6.7%, obstructive causes 1.2%, tubulointerstitial 0.9%, polycystic 0.4% and other 0.7%. DiscussionDespite the increase in RRT services, the prevalence is lower than the Latin American average (660 pmp). Three quarters of HD and PD patients are under-dialysed. Obsolete RRT techniques are still used. The presence of Mesoamerican nephropathy influences the demographic characteristics (many young patients, two-thirds male, high prevalence in lowlands and coastlands).

Symptomatic fracture risk in the renal replacement therapy population.

Bone fractures are an important cause of morbidity and mortality in patients on renal replacement therapy (RRT). The aim of this multicentre observational study was to quantify the incidence of radiologically proven bone fracture by anatomical site in prevalent RRT groups and study its relationship to potential risk factors. We performed a retrospective analysis of electronic records of all 2096 adults prevalent on RRT in the West of Scotland on 7 July 2010 across all hospitals (except one where inception was 1 August 2011) to identify all subsequent radiologically proven fractures during a median 3-year follow-up. There were 340 fractures, with an incidence of 62.8 per 1000 patient-years. The incidences were 37.6, 99.2 and 57.6 per 1000 patient-years in the transplant, haemodialysis (HD) and peritoneal dialysis (PD) groups, respectively (P < 0.05). In the multivariable model, age and HD (relative to transplant or PD) were independently associated with increased risk of fractures, while primary glomerular disease, increasing serum albumin and taking alfacalcidol or lanthanum were associated with decreased risk. In a multivariable model of only HD patients, age was independently associated with an increased risk of fractures, while glomerular disease, high serum albumin and being on alfacalcidol and lanthanum were associated with decreased risk. In a multivariable model in transplant patients, there were no significant independent predictors of fracture. The risk of symptomatic bone fracture is high in RRT patients and is ∼2.5 times higher in HD than in renal transplant patients, with the increased risk being independent of baseline factors. Fracture risk increases with age and lower serum albumin and is reduced if the primary renal diagnosis is glomerular disease. The possible protective role of alfacalcidol and lanthanum in HD patients deserves further exploration.

Diabetes mellitus as a cause of end-stage renal disease in Europe: signs of improvement.

Diabetes mellitus as a cause of end-stage renal disease in Europe: signs of improvement.

Risk factors for bleeding complications after percutaneous dilatational tracheostomy: a ten-year institutional analysis.

Bleeding complications after percutaneous dilatational tracheostomy (PDT) are infrequent but may have a tremendous impact on a patient's further clinical course. Therefore, it seems necessary to perform risk stratification for patients scheduled for PDT. We retrospectively reviewed the records of 1001 patients (46% male, mean age 68.1 years) undergoing PDT (using the Ciaglia Blue Rhino® technique with direct bronchoscopic guidance) in our cardiothoracic ICU between January 2003 and February 2013. Patients were stratified into two groups: patients suffering acute moderate, severe, or major bleeding (Group A) and patients who had no or only mild bleeding (Group B). In the majority of patients, no or only mild bleeding during PDT occurred (none: 425 [42.5%], mild: 488 [48.8%]). In 84 patients (8.4%), bleeding was classified as moderate. Three patients suffered from severe bleeding; only one major bleed with need for emergency surgery occured. Patients in Group A had a significantly higher Simplified Acute Physiology Score on the day of PDT (P=0.042), higher prevalence of renal replacement therapy on the day of PDT (P=0.026), higher incidence of coagulopathy (P=0.043), lower platelet counts (P=0.037), lower fibrinogen levels (P=0.012), higher proportion of PDTs performed by residents (P=0.034) and higher difficulty grading of PDT (P=0.001). Using logistic regression analyses, difficult PDT, less experienced operator, Simplified Acute Physiology Score>40 and low fibrinogen levels were independent predictors of clinically significant bleeding after PDT. Low fibrinogen levels, as well as difficult PDT, less experienced operator and Simplified Acute Physiology Score>40 are associated with an increased risk for bleeding during PDT.

Renal replacement therapy in Europe: a summary of the 2013 ERA-EDTA Registry Annual Report with a focus on diabetes mellitus.

BackgroundThis article provides a summary of the 2013 European Renal Association–European Dialysis and Transplant Association (ERA-EDTA) Registry Annual Report (available at http://www.era-edta-reg.org), with a focus on patients with diabetes mellitus (DM) as the cause of end-stage renal disease (ESRD).MethodsIn 2015, the ERA-EDTA Registry received data on renal replacement therapy (RRT) for ESRD from 49 national or regional renal registries in 34 countries in Europe and bordering the Mediterranean Sea. Individual patient data were provided by 31 registries, while 18 registries provided aggregated data. The total population covered by the participating registries comprised 650 million people.ResultsIn total, 72 933 patients started RRT for ESRD within the countries and regions reporting to the ERA-EDTA Registry, resulting in an overall incidence of 112 per million population (pmp). The overall prevalence on 31 December 2013 was 738 pmp (n = 478 990). Patients with DM as the cause of ESRD comprised 24% of the incident RRT patients (26 pmp) and 17% of the prevalent RRT patients (122 pmp). When compared with the USA, the incidence of patients starting RRT pmp secondary to DM in Europe was five times lower and the incidence of RRT due to other causes of ESRD was two times lower. Overall, 19 426 kidney transplants were performed (30 pmp). The 5-year adjusted survival for all RRT patients was 60.9% [95% confidence interval (CI) 60.5–61.3] and 50.6% (95% CI 49.9–51.2) for patients with DM as the cause of ESRD.

2012 ERA-EDTA Registry Annual Report: cautious optimism on outcomes, concern about persistent inequalities and data black-outs

The 2012 ERA-EDTA Registry Annual Report contains both good news and bad news. On the bright side, the 2-year survival of patients starting renal replacement therapy (RRT) for chronic kidney disease (CKD), on dialysis or receiving a living-related kidney transplantation, has progressively increased to 82.2, 79.7 and 98.3%, respectively, whereas for cadaveric kidney transplantation it remains stable (96.0–96.1%). On the dark side, inequalities persist between European citizens in access to renal transplantation and in incidence and prevalence of RRT. Living in Greece, Belgium (French- or Dutch-speaking) or Portugal (the GBP countries) is associated with higher chances of initiating RRT than living in other European countries. The adjusted RRT incidence for GBP countries was 188, 201-174 and 220* (* unadjusted) pmp in 2012, respectively (versus 122, 114 and 97 pmp in the Netherlands or two Spanish regions bordering Portugal). In lower income countries, a low RRT incidence may represent lack of access to needed healthcare (e.g. Montenegro 26 pmp). However, how can the high incidence and prevalence of RRT in the GBP countries be explained? Do GBP citizens have access to RRT that is denied, rejected or considered unnecessary in other high income countries? Does the GBP healthcare system fail to prevent progression of CKD? Do local genetic or environmental factors favour CKD progression? Unravelling the underlying reasons is an urgent research need: only an understanding of the causes will allow correction of the problem. Unavailability of data from some large countries (e.g. Germany and Italy) is not helpful.

EVALUATIONOFRENAL REPLACEMENT THERAPYQUALITY IN UKRAINE: TIME FOR ACTIONS

Background. Little is known about the status of renal replacement therapy (RRT) in the post-Soviet period of Ukraine. We therefore investigated the epidemiology and treatment outcomes of RRT in Ukrainian patients and put the results into an international perspective.&#x0D; Methods. Data from the Ukrainian National Renal Registry for patients on RRT between 1 January 2010 and 31 December 2012 were selected. We calculated the incidence and prevalence of RRT per million population (pmp) and the 3-, 12- and 24-month patient survival using the Kaplan— Meier method and Cox regression&#x0D; Results. There were 5985prevalent patients on RRT on 31 December 2012 (131,2 pmp). Mean age was 46,5 ± 13,8 years, 56% were men and 74% received haemodialysis (HD), while peritoneal dialysis and kidney transplantation both represented 13%. The most common cause of end-stage renal disease was glomerulonephritis (51%), while only 12% had diabetes. In 2012, 1129 patients started dialysis (incidence 24,8 pmp), with 80% on HD. Mean age was 48 ± 14 years, 58% were men and 20% had diabetes. Three, 12- and 24-month patient survival on dialysis was 95,1%, 86,0% and 76,4%, respectively. The transplant rate in 2012 was 2,1 pmp.&#x0D; Conclusions. The incidence and prevalence of RRT and the transplantation rate in Ukraine are among the lowest in Europe, suggesting that the need for RRT is not being met. Strategies to reduce the RRT deficit include the development and improvement of transplantation and home-based dialysis programs. Further evaluation of the quality of Ukrainian RRT care is needed.