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Noordzij M, Jager KJ, van der Veer SN, Kramar R, Collart F, Heaf JG, Stojceva-Taneva O, Leivestad T, Buturovic-Ponikvar J, Benítez Sánchez M, Moreso F, Prütz KG, Severn A, Wanner C, Vanholder R, Ravani P. Use of vascular access for haemodialysis in Europe: a report from the ERA-EDTA Registry. Nephrol Dial Transplant 2014; 29:1956-64. [PMID: 25061126 DOI: 10.1093/ndt/gfu253] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Although arteriovenous fistulas (AVFs) are actively promoted, their use at the start of haemodialysis (HD) seems to be decreasing worldwide. In this paper, we describe recent trends in incidence and prevalence of vascular access types in Europe from 2005 to 2009 and their relationship with patient characteristics and survival. METHODS Ten European renal registries participating in the ERA-EDTA Registry provided data on incidence (n = 13,044) and/or prevalence (n = 75,715) of vascular access types. We used logistic regression to assess which factors influence the likelihood to be treated with an AVF rather than another type. RESULTS The use of AVFs at the start of HD showed a significant decreasing trend from 42% in 2005 to 32% in 2009 (P < 0.0001), while the use of central venous catheters (CVCs) increased from 58 to 68% (P < 0.0001). A similar evolution pattern was observed for the prevalence; use of AVFs decreased from 66 to 62% and use of CVCs increased from 28 to 32%. There was a large international variation in the use of the different vascular access types. Female patients [adjusted odds ratio: 0.84, 95% confidence interval (CI): 0.78-0.90] and those ≥80 years (0.77, 95% CI: 0.67-0.90) were least likely to start HD with an AVF. CONCLUSION In Europe, there is a decreasing trend in the use of AVFs and an increasing trend in the use of CVCs at the start and after the start of HD. We cannot explain all between-country variations we found, and more research is needed to clarify how healthcare around vascular access is organized in Europe.
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Fusaro M, Giannini S, Miozzo D, Noale M, Tripepi G, Plebani M, Zaninotto M, Piccoli A, Vilei MT, Cristofaro R, Gallieni M, Hamamoto K, Inaba M, Okuno S, Imanishi Y, Ishimura E, Yamakawa T, Shoji S, Rothe HM, Eller P, Mayer G, Ketteler M, Kramar R, Shaheen F, Al Rukhaimi M, Alsahow A, Al-Ali F, Al Salmi I, Al Ghareeb S, Wang M, Bieber B, Robinson BM, Pisoni RL, Waniewski J, Debowska M, Wojcik-Zaluska A, Ksiazek A, Zaluska W, De Broe ME, Wilson RJ, Copley JB, Hiramtasu R, Ubara Y, Hoshino J, Takaichi K, Ghalli FG, Ghalli FG, Ibakkanavar R, Chess J, Roberts G, Riley S, Oliveira ASA, Carvalho CJB, Oliveira CBL, Pessoa CTBC, Leao RAS, Gueiros JEB, Gueiros APS, Okano K, Tsuruta Y, Hibi A, Tsukada M, Miwa N, Kimata N, Tsuchiya K, Akiba T, Nitta K, Mizobuchi M, Ogata H, Hosaka N, Sanada D, Arai N, Koiwa F, Kinugasa E, Shibata T, Akizawa T, Delanaye P, Krzesinski JM, Warling X, Moonen M, Smelten N, Medart L, Pottel H, Cavalier E, Delanaye P, Souberbielle JC, Gadisseur R, Dubois BE, Krzesinski JM, Cavalier E, Matias P, Jorge C, Mendes M, Azevedo A, Navarro D, Ferreira C, Amaral T, Aires I, Gil C, Ferreira A, Kikuchi H, Shimada H, Karasawa R, Suzuki M, An WS, Lee SM, Oh YJ, Son YK, De Paola L, Lombardi G, Panzino MT, Lombardi L, Reichel H, Hahn KM, Kohnle M, Guggenberger C, Delanna F, Sasaki N, Tsunoda M, Ikee R, Hashimoto N, Sola L, Leyun MN, Diaz JC, Sehabiague C, Gonzalez S, Alallon W, Bourbeau K, Lajoie C, Macway F, Fujii T, Suzuki S, Shinozaki M, Tanaka H, Klingele M, Seiler S, Poppleton A, Lepper P, Fliser D, Seidel R, Lun L, Liu D, Li X, Wei X, Miao J, Gao Z, Hu R, De Paola L, Lombardi G, Panzino MT, Lombardi L, Gros B, Galan A, Gonzalez-Parra E, Herrero JA, Echave M, Vegter S, Tolley K, Oyaguez I, Gutzwiller FS, Braunhofer PG, Szucs TD, Schwenkglenks M, Yilmaz VT, Ozdem S, Donmez L, Kocak H, Dinckan A, Cetinkaya R, Suleymanlar G, Ersoy FF. DIALYSIS BONE DISEASE. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bornstein J, McCullough K, Combe C, Bieber B, Jadoul M, Pisoni R, Mariani L, Robinson B, Saito A, Sen A, Tentori F, Guinsburg A, Marelli C, Marcelli D, Usvyat L, Maddux D, Canaud B, Kotanko P, Hwang SJ, Hsieh HM, Chen HF, Mau LW, Lin MY, Hsu CC, Yang WC, Pitcher D, Rao A, Phelps R, Canaud B, Barbieri C, Marcelli D, Bellocchio F, Bowry S, Mari F, Amato C, Gatti E, Zitt E, Hafner-Giessauf H, Wimmer B, Herr A, Horn S, Friedl C, Sprenger-Maehr H, Kramar R, Rosenkranz AR, Lhotta K, Ferris M, Marcelli D, Marelli C, Etter M, Xu X, Grassmann A, Von Gersdorff GD, Pecoits-Filho R, Sylvestre L, Kotanko P, Usvyat L, Consortium M, Dzekova-Vidimliski P, Nikolov I, Trajceska L, Selim G, Gelev S, Matevska Geshkovska N, Dimovski A, Sikole A, Suleymanlar G, Utas C, Ecder T, Ates K, Bieber B, Robinson BM, Pisoni RL, Laplante S, Liu FX, Culleton B, Tomilina N, Bikbov B, Andrusev A, Zemchenkov A, Bieber B, Robinson BM, Pisoni RL, Bikbov B, Tomilina N, Kotenko O, Andrusev A, Panaye M, Jolivot A, Lemoine S, Guebre-Egziabher F, Doret M, Juillard L, Filiopoulos V, Hadjiyannakos D, Papakostoula A, Takouli L, Biblaki D, Dounavis A, Vlassopoulos D, Bikbov B, Tomilina N, Al Wakeel J, Bieber B, Al Obaidli AA, Ahmed Almaimani Y, Al-Arrayed S, Alhelal B, Fawzy A, Robinson BM, Pisoni RL, Aucella F, Girotti G, Gesuete A, Cicchella A, Seresin C, Vinci C, Scaparrotta G, Naso A, Pilotto A, Hoffmann TR, Flusser V, Santoro LF, Almeida FA, Aucella F, Girotti G, Gesuete A, Cicchella A, Seresin C, Vinci C, Scaparrotta G, Ganugi S, Gnerre T, Russo GE, Amato M, Naso A, Pilotto A, Trigka K, Douzdampanis P, Chouchoulis K, Mpimpi A, Kaza M, Pipili C, Kyritsis I, Fourtunas C, Ortalda V, Tomei P, Ybarek T, Lupo A, Torreggiani M, Esposito V, Catucci D, Arazzi M, Colucci M, Montagna G, Semeraro L, Efficace E, Piazza V, Picardi L, Esposito C, Hekmat R, Mohebi M, Ahmadzadehhashemi S, Park J, Hwang E, Jang M, Park S, Resende LL, Dantas MA, Martins MTS, Lopes GB, Lopes AA, Engelen W, Elseviers M, Gheuens E, Colson C, Muyshondt I, Daelemans R, He Y, Chen J, Luan S, Wan Q, Cuoghi A, Bellei E, Monari E, Bergamini S, Tomasi A, Atti M, Caiazzo M, Palladino G, Bruni F, Tekce H, Ozturk S, Aktas G, Kin Tekce B, Erdem A, Uyeturk U, Ozyasar M, Taslamacioglu Duman T, Yazici M, Schaubel DE, McCullough KP, Morgenstern H, Gallagher MP, Hasegawa T, Pisoni RL, Robinson BM, Nacak H, Van Diepen M, Suttorp MM, Hoorn EJ, Rotmans JI, Dekker FW, Speyer E, Beauger D, Gentile S, Isnard Bagnis C, Caille Y, Baudelot C, Mercier S, Jacquelinet C, Briancon S, Sosorburam T, Baterdene B, Delger A, Daelemans R, Gheuens E, Engelen W, De Boeck K, Marynissen J, Bouman K, Mann M, Exner DV, Hemmelgarn BR, Hanley D, Ahmed SB. DIALYSIS. EPIDEMIOLOGY, OUTCOME RESEARCH, HEALTH SERVICES 2. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Noordzij M, Kramer A, Abad Diez JM, Alonso de la Torre R, Arcos Fuster E, Bikbov BT, Bonthuis M, Bouzas Caamaño E, Čala S, Caskey FJ, Castro de la Nuez P, Cernevskis H, Collart F, Díaz Tejeiro R, Djukanovic L, Ferrer-Alamar M, Finne P, García Bazaga MDLA, Garneata L, Golan E, Gonzalez Fernández R, Heaf JG, Hoitsma A, Ioannidis GA, Kolesnyk M, Kramar R, Lasalle M, Leivestad T, Lopot F, van de Luijtgaarden MW, Macário F, Magaz Á, Martín Escobar E, de Meester J, Metcalfe W, Ots-Rosenberg M, Palsson R, Piñera C, Pippias M, Prütz KG, Ratkovic M, Resić H, Rodríguez Hernández A, Rutkowski B, Spustová V, Stel VS, Stojceva-Taneva O, Süleymanlar G, Wanner C, Jager KJ. Renal replacement therapy in Europe: a summary of the 2011 ERA-EDTA Registry Annual Report. Clin Kidney J 2014; 7:227-38. [PMID: 25852881 PMCID: PMC4377783 DOI: 10.1093/ckj/sfu007] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 01/22/2014] [Indexed: 11/14/2022] Open
Abstract
Background This article provides a summary of the 2011 ERA–EDTA Registry Annual Report (available at www.era-edta-reg.org). Methods Data on renal replacement therapy (RRT) for end-stage renal disease (ESRD) from national and regional renal registries in 30 countries in Europe and bordering the Mediterranean Sea were used. From 27 registries, individual patient data were received, whereas 17 registries contributed data in aggregated form. We present the incidence and prevalence of RRT, and renal transplant rates in 2011. In addition, survival probabilities and expected remaining lifetimes were calculated for those registries providing individual patient data. Results The overall unadjusted incidence rate of RRT in 2011 among all registries reporting to the ERA–EDTA Registry was 117 per million population (pmp) (n = 71.631). Incidence rates varied from 24 pmp in Ukraine to 238 pmp in Turkey. The overall unadjusted prevalence of RRT for ESRD on 31 December 2011 was 692 pmp (n = 425 824). The highest prevalence was reported by Portugal (1662 pmp) and the lowest by Ukraine (131 pmp). Among all registries, a total of 22 814 renal transplantations were performed (37 pmp). The highest overall transplant rate was reported from Spain, Cantabria (81 pmp), whereas the highest rate of living donor transplants was reported from Turkey (39 pmp). For patients who started RRT between 2002 and 2006, the unadjusted 5-year patient survival on RRT was 46.8% [95% confidence interval (CI) 46.6–47.0], and on dialysis 39.3% (95% CI 39.2–39.4). The unadjusted 5-year patient survival after the first renal transplantation performed between 2002 and 2006 was 86.7% (95% CI 86.2–87.2) for kidneys from deceased donors and 94.3% (95% CI 93.6–95.0) for kidneys from living donors.
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Kainz A, Goliasch G, Wiesbauer F, Binder T, Maurer G, Nesser HJ, Mascherbauer R, Ebner C, Kramar R, Wilflingseder J, Oberbauer R. Left atrial diameter and survival among renal allograft recipients. Clin J Am Soc Nephrol 2013; 8:2100-5. [PMID: 24009216 DOI: 10.2215/cjn.04300413] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND OBJECTIVES Sequential echocardiography is routinely performed in patients with ESRD listed for transplantation. The benefit of this labor- and time-intensive measure, however, remains unclear. Thus, this study elucidated the various obtained routine echocardiography parameters that best predicted mortality and graft survival after renal transplantation. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This study investigated 553 first renal transplant recipients listed in the Austrian Dialysis and Transplant Registry between 1992 and 2011 who had echocardiographic analysis at transplantation and survived at least 1 year. Cox proportional hazards models with the purposeful selection algorithms for covariables were used to identify predictors of mortality and graft loss. A Fine and Gray model was used to evaluate cause-specific death. RESULTS During a median follow-up of 7.14 years, 81 patients died, and 59 patients experienced graft loss after the first year. The Kaplan-Meier analysis showed that 85% of patients with a left atrial diameter below the median of 53 mm were alive 10 years after transplantation, whereas only 70% of those patients with a left atrial diameter equal to or above the median had survived (P<0.001). In the multivariable model, left atrial diameter (per millimeter) independently predicted overall mortality (hazard ratio, 1.06; 95% confidence interval, 1.03 to 1.08; P<0.001) and cause-specific cardiac death (hazard ratio, 1.04; 95% confidence interval, 1.00 to 1.08; P=0.04). Functional graft loss was predicted by the right atrial diameter (hazard ratio, 1.04; 95% confidence interval, 1.02 to 1.07; P=0.001). CONCLUSION The left atrial diameter determined at transplantation predicted overall and cardiac mortality. Patients with widely enlarged left atria exhibit a considerably reduced life expectancy. It remains to be determined, however, whether renal transplantation is futile in these patients.
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Cabezas-Rodriguez I, Carrero JJ, Zoccali C, Qureshi AR, Ketteler M, Floege J, London G, Locatelli F, Gorriz JL, Rutkowski B, Memmos D, Ferreira A, Covic A, Teplan V, Bos WJ, Kramar R, Pavlovic D, Goldsmith D, Nagy J, Benedik M, Verbeelen D, Tielemans C, Wüthrich RP, Martin PY, Martínez-Salgado C, Fernández-Martín JL, Cannata-Andia JB. Influence of body mass index on the association of weight changes with mortality in hemodialysis patients. Clin J Am Soc Nephrol 2013; 8:1725-33. [PMID: 24009217 DOI: 10.2215/cjn.10951012] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND OBJECTIVES A high body mass index (BMI) is associated with lower mortality in patients undergoing hemodialysis. Short-term weight gains and losses are also related to lower and higher mortality risk, respectively. The implications of weight gain or loss may, however, differ between obese individuals and their nonobese counterparts. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS The Current Management of Secondary Hyperparathyroidism: A Multicenter Observational Study (COSMOS) is an observational study including 6797 European hemodialysis patients recruited between February 2005 and July 2007, with prospective data collection every 6 months for 3 years. Time-dependent Cox proportional hazard regressions assessed the effect of BMI and weight changes on mortality. Analyses were performed after patient stratification according to their starting BMI. RESULTS Among 6296 patients with complete data, 1643 died. At study entry, 42% of patients had a normal weight (BMI, 20-25 kg/m(2)), 11% were underweight, 31% were overweight, and 16% were obese (BMI ≥ 30 kg/m(2)). Weight loss or gain (<1% or >1% of body weight) was strongly associated with higher rates of mortality or survival, respectively. After stratification by BMI categories, this was true in nonobese categories and especially in underweight patients. In obese patients, however, the association between weight loss and mortality was attenuated (hazard ratio, 1.28 [95% confidence interval (CI), 0.74 to 2.14]), and no survival benefit of gaining weight was seen (hazard ratio, 0.98 [95% CI, 0.59 to 1.62]). CONCLUSIONS Assuming that these weight changes were unintentional, our study brings attention to rapid weight variations as a clinical sign of health monitoring in hemodialysis patients. In addition, a patient's BMI modifies the strength of the association between weight changes with mortality.
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Cannata-Andía JB, Fernández-Martín JL, Locatelli F, London G, Gorriz JL, Floege J, Ketteler M, Ferreira A, Covic A, Rutkowski B, Memmos D, Bos WJ, Teplan V, Nagy J, Tielemans C, Verbeelen D, Goldsmith D, Kramar R, Martin PY, Wüthrich RP, Pavlovic D, Benedik M, Sánchez JE, Martínez-Camblor P, Naves-Díaz M, Carrero JJ, Zoccali C. Use of phosphate-binding agents is associated with a lower risk of mortality. Kidney Int 2013; 84:998-1008. [PMID: 23823605 DOI: 10.1038/ki.2013.185] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 01/31/2013] [Accepted: 02/14/2013] [Indexed: 11/09/2022]
Abstract
Hyperphosphatemia has been associated with higher mortality risk in CKD 5 patients receiving dialysis. Here, we determined the association between the use of single and combined phosphate-binding agents and survival in 6797 patients of the COSMOS study: a 3-year follow-up, multicenter, open-cohort, observational prospective study carried out in 227 dialysis centers from 20 European countries. Patient phosphate-binding agent prescriptions (time-varying) and the case-mix-adjusted facility percentage of phosphate-binding agent prescriptions (instrumental variable) were used as predictors of the relative all-cause and cardiovascular mortality using Cox proportional hazard regression models. Three different multivariate models that included up to 24 variables were used for adjustments. After multivariate analysis, patients prescribed phosphate-binding agents showed a 29 and 22% lower all-cause and cardiovascular mortality risk, respectively. The survival advantage of phosphate-binding agent prescription remained statistically significant after propensity score matching analysis. A decrease of 8% in the relative risk of mortality was found for every 10% increase in the case-mix-adjusted facility prescription of phosphate-binding agents. All single and combined therapies with phosphate-binding agents, except aluminum salts, showed a beneficial association with survival. The findings made in the present association study need to be confirmed by randomized controlled trials to prove the observed beneficial effect of phosphate-binding agents on mortality.
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Malhotra R, Usyvat L, Raimann J, Thijssen S, Levin N, Kotanko P, Hilderman M, Qureshi AR, Al-Abed Y, Anderstam B, Bruchfeld A, Minco M, Argentino G, Grumetto L, Postiglione L, Memoli B, Riccio E, Striker G, Yubero-Serrano E, Uribarri J, Vlassara H, do Sameiro-Faria M, Ribeiro S, Kohlova M, Rocha-Pereira P, Fernandes J, Nascimento H, Reis F, Miranda V, Bronze-da-Rocha E, Quintanilha A, Costa E, Belo L, Santos-Silva A, Modilca M, Margineanu M, Gluhovschi G, Vernic C, Velciov S, Petrica L, Barzuca E, Gluhovschi C, Balgradean C, Kaycsa A, Stockler-Pinto M, Dornelles S, Cozzolino S, Malm O, Mafra D, Cobo G, Rodriguez I, Oliet A, Hinostroza J, Vigil A, Di Gioia M, Gallar P, Drechsler C, Wanner C, Blouin K, Pilz S, Tomaschitz A, Krane V, Marz W, Ritz E, van der Harst P, de Boer R, Carrero JJ, Cabezas-Rodriguez I, Zoccali C, Qureshi A, Ketteler M, Gorriz J, Rutkowski B, Teplan V, Kramar R, Pavlovic D, Goldsmith D, Benedik M, Fernandez-Martin J, Cannata-Andia J, Guido G, Loiacono E, Serriello I, Camilla R, Coppo R, Amore A, Schiller A, Munteanu M, Schiller O, Mihaescu A, Olariu N, Andrei C, Anton C, Ivacson Z, Roman V, Berca S, Bansal V, Marcelli D, Grassmann A, Bayh I, Scatizzi L, Marelli C, Etter M, Usvyat L, Kooman J, Sande F, Levin N, Kotanko P, Canaud B, Quiroga B, Villaverde M, Abad S, Vega A, Reque J, Yuste C, Barraca D, Perez de Jose A, Lopez-Gomez JM, Castellano Gasch S, Palomares I, Dominguez J, Ramos R, Schmidt J, Hafer C, Clajus C, Hadem J, Schmidt B, Haller H, Kielstein J, Katagiri M, Kamada Y, Kobayashi N, Moriguchi I, Ito Y, Kamekawa D, Akiyama A, Ishii H, Tanaka S, Kamiya K, Hamazaki N, Kato M, Shimizu R, Hotta K, Masuda T, Veronesi M, Mancini E, Valente F, Righetti F, Brunori G, Santoro A, Bal Z, Tutal E, Erkmen Uyar M, Guliyev O, Sayin B, Sezer S, Mikami S, Hamano T, Tanaka T, Iba O, Toki M, Mikami H, Takamitsu Y, Inoue T, Fujii M, Hirayama A, Ueda A, Watanabe R, Matsui H, Nagano Y, Nagase S, Aoyagi K, Owada S, Tutal E, Bal Z, Erkmen Uyar M, Sayin B, Tot U, Sezer S, Onec K, Erten Y, Pasaoglu O, Ebinc F, Uludag K, Okyay G, Inal S, Pasaoglu H, Deger S, Arinsoy T, Arias-Guillen M, Masso E, Perez E, Herrera P, Romano B, Perez N, Maduell F, Jung YS, Kim YN, Shin HS, Rim H, Al Ismaili Z, Hassan M, Dastoor H, Bernieh B, Ismael A, Marcelli D, Richards N, Khil M, Sheiman B, Dudar I, Gonchar Y, Khil V, Kim HL, Ryu HH, Kim SH, Bosch Benitez-Parodi E, Baamonde Laborda E, Perez Suarez G, Ramirez JI, Garcia Canton C, Guerra R, Ramirez Puga A, Toledo A, Lago Alonso MM, Checa Andres MD, Hwang WM, Yun SR, Molsted S, Andersen JL, Eidemak I, Harrison AP, Kose E, Turgutalp K, Kiykim A, Celik F, Gok Oguz E. Protein-energy wasting. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kramer A, Stel VS, Abad Diez JM, Alonso de la Torre R, Bouzas Caamaño E, Čala S, Cao Baduell H, Castro de la Nuez P, Cernevskis H, Collart F, Couchoud C, de Meester J, Djukanovic L, Ferrer-Alamar M, Finne P, Fogarty D, de Los Ángeles García Bazaga M, Garneata L, Golan E, Gonzalez Fernández R, Heaf JG, Hoitsma A, Ioannidis GA, Kolesnyk M, Kramar R, Leivestad T, Limido A, Lopot F, Macario F, Magaz Á, Martín-Escobar E, Metcalfe W, Noordzij M, Ots-Rosenberg M, Palsson R, Piñera C, Postorino M, Prutz KG, Ratkovic M, Resic H, Rodríguez Hernández A, Rutkowski B, Serdengeçti K, Yebenes TS, Spustová V, Stojceva-Taneva O, Tomilina NA, van de Luijtgaarden MWM, van Stralen KJ, Wanner C, Jager KJ. Renal replacement therapy in Europe-a summary of the 2010 ERA-EDTA Registry Annual Report. Clin Kidney J 2013; 6:105-115. [PMID: 27818766 PMCID: PMC5094410 DOI: 10.1093/ckj/sfs164] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background This study provides a summary of the 2010 European Renal Association–European Dialysis and Transplant Association (ERA–EDTA) Registry Annual Report (available at www.era-edta-reg.org). Methods This report includes data on renal replacement therapy (RRT) using data from the national and regional renal registries in 29 countries in Europe and bordering the Mediterranean Sea. Individual patient data were received from 27 registries, whereas 18 registries contributed data in aggregated form. We present incidence and prevalence of RRT, transplant rates, survival probabilities and expected remaining lifetimes. The latter two are solely based on individual patient records. Results In 2010, the overall incidence rate of RRT for end-stage renal disease (ESRD) among all registries reporting to the ERA–EDTA Registry was 123 per million population (pmp) (n = 91 798). The highest incidence rate was reported by Turkey (252pmp) and the lowest reported by Montenegro (21 pmp). The overall prevalence of RRT for ESRD at 31 December 2010 among all registries reporting to the ERA–EDTA Registry was 741 pmp (n = 551 005). The prevalence varied from 124 pmp in Ukraine to 1580 pmp in Portugal. The overall number of renal transplantations performed in 2010 among all registries was 29.2 pmp (n = 21 740). The highest overall transplant rate was reported from Spain, Cantabria (73 pmp), whereas the highest transplant rate for living donor kidneys was reported from the Netherlands (28 pmp). For patients who started RRT between 2001 and 2005, the unadjusted 5-year patient survival on RRT was 46.2% [95% confidence interval (CI) 46.0–46.3], and on dialysis 38.6% (95% CI 38.5–38.8). The unadjusted 5-year patient survival after the first renal transplantation performed between 2001 and 2005 was 86.6% (95% CI 86.1–87.1) for deceased donor kidneys and 94.1% (95% CI 93.4–94.8) for living donor kidneys.
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Venkat-Raman G, Tomson CRV, Gao Y, Cornet R, Stengel B, Gronhagen-Riska C, Reid C, Jacquelinet C, Schaeffner E, Boeschoten E, Casino F, Collart F, De Meester J, Zurriaga O, Kramar R, Jager KJ, Simpson K. New primary renal diagnosis codes for the ERA-EDTA. Nephrol Dial Transplant 2012; 27:4414-9. [PMID: 23175621 PMCID: PMC3520087 DOI: 10.1093/ndt/gfs461] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) Registry has produced a new set of primary renal diagnosis (PRD) codes that are intended for use by affiliated registries. It is designed specifically for use in renal centres and registries but is aligned with international coding standards supported by the WHO (International Classification of Diseases) and the International Health Terminology Standards Development Organization (SNOMED Clinical Terms). It is available as supplementary material to this paper and free on the internet for non-commercial, clinical, quality improvement and research use, and by agreement with the ERA-EDTA Registry for use by commercial organizations. Conversion between the old and the new PRD codes is possible. The new codes are very flexible and will be actively managed to keep them up-to-date and to ensure that renal medicine can remain at the forefront of the electronic revolution in medicine, epidemiology research and the use of decision support systems to improve the care of patients.
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Fernández-Martín JL, Carrero JJ, Benedik M, Bos WJ, Covic A, Ferreira A, Floege J, Goldsmith D, Gorriz JL, Ketteler M, Kramar R, Locatelli F, London G, Martin PY, Memmos D, Nagy J, Naves-Díaz M, Pavlovic D, Rodríguez-García M, Rutkowski B, Teplan V, Tielemans C, Verbeelen D, Wüthrich RP, Martínez-Camblor P, Cabezas-Rodriguez I, Sánchez-Alvarez JE, Cannata-Andia JB. COSMOS: the dialysis scenario of CKD-MBD in Europe. Nephrol Dial Transplant 2012; 28:1922-35. [PMID: 23166310 DOI: 10.1093/ndt/gfs418] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Chronic kidney disease-mineral and bone disorders (CKD-MBD) are important complications of CKD5D patients that are associated with mortality. METHODS COSMOS is a multicentre, open cohort, prospective, observational 3-year study carried out in haemodialysis patients from 20 European countries during 2005-07. The present article describes the main characteristics of the European dialysis population, the current practice for the prevention, diagnosis and treatment of secondary hyperparathyroidism and the differences across different European regions. RESULTS The haemodialysis population in Europe is an aged population (mean age 64.8±14.2 years) with a high prevalence of diabetes (29.5%) and cardiovascular disease (76.0%), and 28.7% of patients have been on haemodialysis more than 5 years. Patients from the former Eastern countries are younger (59.3±14.3 versus 66.0±13.9), having a lower proportion of diabetics (24.1 versus 30.7%). There were relevant differences in the frequency of measurement of the main CKD-MBD biochemical parameters [Ca, P and parathyroid hormone (PTH)] and the Eastern countries showed a poorer control of these biochemical parameters (K/DOQI and K/DIGO targets). Overall, 48.0% of the haemodialysis patients received active vitamin D treatment. Calcitriol use doubled that of alfacalcidiol in the Mediterranean countries, whereas the opposite was found in the non-Mediterranean countries. The criteria followed to perform parathyroidectomy were different across Europe. In the Mediterranean countries, the level of serum PTH considered to perform parathyroidectomy was higher than in non-Mediterranean countries; as a result, in the latter, more parathyroidectomies were performed in the year previous to inclusion to COSMOS. CONCLUSIONS The COSMOS baseline results show important differences across Europe in the management of CKD-MBD.
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Kainz A, Wiesbauer F, Goliasch G, Binder T, Maurer G, Kramar R, Oberbauer R. Echocardiographic Parameters at Transplantation Are Independently Associated with Survival of Renal Allograft Recipients. Transplantation 2012. [DOI: 10.1097/00007890-201211271-01626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Temme J, Kramer A, Jager KJ, Lange K, Peters F, Müller GA, Kramar R, Heaf JG, Finne P, Palsson R, Reisæter AV, Hoitsma AJ, Metcalfe W, Postorino M, Zurriaga O, Santos JP, Ravani P, Jarraya F, Verrina E, Dekker FW, Gross O. Outcomes of male patients with Alport syndrome undergoing renal replacement therapy. Clin J Am Soc Nephrol 2012; 7:1969-76. [PMID: 22997344 DOI: 10.2215/cjn.02190312] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Patients with the hereditary disease Alport syndrome commonly require renal replacement therapy (RRT) in the second or third decade of life. This study compared age at onset of RRT, renal allograft, and patient survival in men with Alport syndrome receiving various forms of RRT (peritoneal dialysis, hemodialysis, or transplantation) with those of men with other renal diseases. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Patients with Alport syndrome receiving RRT identified from 14 registries in Europe were matched to patients with other renal diseases. A linear spline model was used to detect changes in the age at start of RRT over time. Kaplan-Meier method and Cox regression analysis were used to examine patient and graft survival. RESULTS Age at start of RRT among patients with Alport syndrome remained stable during the 1990s but increased by 6 years between 2000-2004 and 2005-2009. Survival of patients with Alport syndrome requiring dialysis or transplantation did not change between 1990 and 2009. However, patients with Alport syndrome had better renal graft and patient survival than matched controls. Numbers of living-donor transplantations were lower in patients with Alport syndrome than in matched controls. CONCLUSIONS These data suggest that kidney failure in patients with Alport syndrome is now being delayed compared with previous decades. These patients appear to have superior patient survival while undergoing dialysis and superior patient and graft survival after deceased-donor kidney transplantation compared with patients receiving RRT because of other causes of kidney failure.
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Kainz A, Wilflingseder J, Függer R, Kramar R, Oberbauer R. Hemoglobin variability after renal transplantation is associated with mortality. Transpl Int 2012; 25:323-7. [PMID: 22313094 DOI: 10.1111/j.1432-2277.2012.01428.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Anemia is a common problem after renal transplantation. Therefore, the patients are treated with erythropoietin stimulating agents (ESAs). The varying response to treatment contributes to hemoglobin variability, which might be associated with mortality. We conducted a retrospective cohort study of first kidney allograft recipients between 1990 and 2008 represented in the Austrian Transplant Registry. We included 1441 patients of whom 683 received ESAs at any time after transplantation. Cox regression with cubic splines and linear estimates and the purposeful selection algorithm of covariables were used. The measure of variability was the moving standard deviation computed at three monthly intervals for the entire graft life. The hazard ratio (HR) of mortality and graft loss in the spline models increased with hemoglobin variability. The linear HR for mortality was 2.35 (95% confidence interval 1.75-3.17, P<0.001) and functional graft loss 2.45 (1.76-3.40, P<0.001). In an adjusted Cox model (ESA use, hemoglobin, age, diabetes, days on dialysis, eGFR, biopsy confirmed acute rejection and year of transplantation), hemoglobin variability was associated with mortality (HR: 2.11; 1.51-2.94; P<0.001). No association with functional graft loss could be detected (HR: 1.34; 0.93-1.93; P=0.121). These findings suggest that hemoglobin variability is associated with mortality of renal allograft recipients.
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Lhotta K, Piret SE, Kramar R, Thakker RV, Sunder-Plassmann G, Kotanko P. Epidemiology of uromodulin-associated kidney disease - results from a nation-wide survey. NEPHRON EXTRA 2012; 2:147-58. [PMID: 22740033 PMCID: PMC3383240 DOI: 10.1159/000339102] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND/AIMS Uromodulin-associated kidney disease (UAKD) is caused by uromodulin mutations and leads to end-stage renal disease. Our objective was to examine the epidemiology of UAKD. METHODS Data from all UAKD families in Austria were collected. Patients included in the Austrian Dialysis and Transplantation Registry (OEDTR) with unclear diagnoses or genetic diseases were asked whether they had (1) a family history of kidney disease or (2) had suffered from gout. Patients with gout and autosomal dominant renal disease underwent mutational analysis. Kaplan-Meier and Cox analysis was employed to estimate time to renal failure. RESULTS Of the 6,210 patients in the OEDTR, 541 were approached with a questionnaire; 353 patients answered the questionnaire. Nineteen of them gave two affirmative answers. In 7 patients, an autosomal dominant renal disease was found; in 1 patient a UMOD mutation was identified. One family was diagnosed through increased awareness as a consequence of the study. At present, 14 UAKD patients from 5 families are living in Austria (1.67 cases per million), and 6 of them require renal replacement therapy (0.73 per 1,000 patients). Progression to renal failure was significantly associated with UMOD genotype. CONCLUSION UAKD patients can be identified by a simple questionnaire. UMOD genotype may affect disease progression.
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Stel VS, Kramar R, Leivestad T, Hoitsma AJ, Metcalfe W, Smits JM, Ravani P, Jager KJ. Time trend in access to the waiting list and renal transplantation: a comparison of four European countries. Nephrol Dial Transplant 2012; 27:3621-31. [PMID: 22555254 DOI: 10.1093/ndt/gfs089] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND To examine the time trend and international differences in access to the waiting list and renal transplantation of patients with end-stage kidney disease. METHODS We included all patients (n = 30 961) from Austria, Norway, the Netherlands and Scotland who started renal replacement therapy (RRT) between 1995 and 2003 with their kidney transplant waiting list data (until 31 December 2005) and follow-up data on RRT and mortality (until 31 December 2007). The outcome measure was access to the waiting list within 2 years and to a first renal transplant within 4 years from the start of RRT, expressed as incidence per million age-related population (p.m.a.r.p.) per year. To estimate trends over time, mean percentage annual change (MPAC) and 95% confidence interval (CI) were calculated. RESULTS In each country, the number of patients starting RRT > 65 years increased significantly over time, whereas the number of renal transplants did not increase to the same extent. Only in Norway were almost all patients on the waiting list transplanted within 4 years of RRT start if they were < 65 years. In patients who started RRT > 65 years, the access to renal transplantation was high in Norway (49 p.m.a.r.p.) and low in Austria ( < 26 p.m.a.r.p.), the Netherlands and Scotland (both < 10 p.m.a.r.p.) but increased significantly in Austria (MPAC = 9.8%; 95% CI = 3.9-16.9) and the Netherlands (MPAC = 9.0%; 95% CI = 3.2-15.0). CONCLUSION Only in Norway, virtually all patients on the waiting list < 65 years received a transplant within 4 years after the start of RRT and, remarkably, also most of those > 65 years of age.
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Beck FX, Kuper C, Neuhofer W, Rodrigues-Diez R, Stark Aroeira LG, Jimenez JA, Rodrigues-Diez R, Rayego-Mateos S, Bajo Rubio A, Ortiz A, Egido J, Lopez-Cabrera M, Selgas R, Ruiz-Ortega M, Pedro Ventura A, Olivia S, Teixeira L, Joana V, Francisco F, Maria Joao C, Antonio C, Rodrigues AS, Vychytil A, Kerschbaum J, Lhotta K, Prischl F, Wiesholzer M, Kopriva-Altfahrt G, Machold-Fabrizii V, Schwarz C, Balcke P, Oberbauer R, Kramar R, Konig P, Rudnicki M, Habib M, Betjes M, Korte M, Vidal E, Edefonti A, Chimenz R, Gianoglio B, Leozappa G, Maringhini S, Mencarelli F, Pecoraro C, Puteo F, Testa S, Cannavo R, Verrina E. Peritoneal dialysis. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kramer A, Stel VS, Geskus RB, Tizard EJ, Verrina E, Schaefer F, Heaf JG, Kramar R, Krischock L, Leivestad T, Pálsson R, Ravani P, Jager KJ. The effect of timing of the first kidney transplantation on survival in children initiating renal replacement therapy. Nephrol Dial Transplant 2011; 27:1256-64. [PMID: 21865215 DOI: 10.1093/ndt/gfr493] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Controversy exists concerning the timing of the first kidney transplantation for children who need to start renal replacement therapy (RRT). Our aim was to estimate the effect of timing of the first transplantation on patient survival in children, for the first time also taking into account the mortality on dialysis before transplantation. METHODS We included 2091 patients who started RRT between the age of 3 and 18 years in the period 1988-2007, from 13 European renal registries. A multistate model was used to simulate patient survival assuming (i) pre-emptive transplantation, (ii) transplantation after 1 or 2 years on dialysis and (iii) remaining on dialysis. RESULTS Over the 20-year period, the highest 8-year survival probabilities were achieved in children transplanted pre-emptively {living donor (LD): 95.9% [95% confidence interval (CI): 93.1-98.8], deceased donor (DD): 95.3% (95% CI: 90.9-99.9)} rather than after 2 years of dialysis [LD: 94.2% (95% CI: 91.6-96.8), DD: 93.4% (95% CI: 91.0-95.9)], although these differences were not statistically significant. CONCLUSIONS Even after taking mortality on dialysis into account, the potentially negative effect of postponing transplantation for 1 or 2 years was relatively small and not statistically significant. Therefore, if pre-emptive transplantation is not possible, starting RRT with a short period of dialysis and receiving a transplant thereafter seems an acceptable alternative from the perspective of patient survival.
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Koopman JJE, Rozing MP, Kramer A, de Jager DJ, Ansell D, De Meester JMJ, Prütz KG, Finne P, Heaf JG, Palsson R, Kramar R, Jager KJ, Dekker FW, Westendorp RGJ. Senescence rates in patients with end-stage renal disease: a critical appraisal of the Gompertz model. Aging Cell 2011; 10:233-8. [PMID: 21108732 DOI: 10.1111/j.1474-9726.2010.00659.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The most frequently used model to describe the exponential increase in mortality rate over age is the Gompertz equation. Logarithmically transformed, the equation conforms to a straight line, of which the slope has been interpreted as the rate of senescence. Earlier, we proposed the derivative function of the Gompertz equation as a superior descriptor of senescence rate. Here, we tested both measures of the rate of senescence in a population of patients with end-stage renal disease. It is clinical dogma that patients on dialysis experience accelerated senescence, whereas those with a functional kidney transplant have mortality rates comparable to the general population. Therefore, we calculated the age-specific mortality rates for European patients on dialysis (n=274 221; follow-up=594 767 person-years), for European patients with a functioning kidney transplant (n=61 286; follow-up=345 024 person-years), and for the general European population. We found higher mortality rates, but a smaller slope of logarithmic mortality curve for patients on dialysis compared with both patients with a functioning kidney transplant and the general population (P<0.001). A classical interpretation of the Gompertz model would imply that the rate of senescence in patients on dialysis is lower than in patients with a functioning transplant and lower than in the general population. In contrast, the derivative function of the Gompertz equation yielded the highest senescence rates for patients on dialysis, whereas the rate was similar in patients with a functioning transplant and the general population. We conclude that the rate of senescence is better described by the derivative function of the Gompertz equation.
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Haller M, Gutjahr G, Kramar R, Harnoncourt F, Oberbauer R. Cost-effectiveness analysis of renal replacement therapy in Austria. Nephrol Dial Transplant 2011; 26:2988-95. [PMID: 21310740 DOI: 10.1093/ndt/gfq780] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Providing renal replacement therapy (RRT) for end-stage renal disease patients is resource intensive. Despite growing financial pressure in health care systems worldwide, cost-effectiveness studies of RRT modalities are scarce. METHODS We developed a Markov model of costs, quality of life and survival to compare three different assignment strategies to chronic RRT in Europe. RESULTS Mean annual treatment costs for haemodialysis were €43,600 during the first 12 months, €40,000 between 13 and 24 months and €40,600 beyond 25 months after initiation of treatment. Mean annual treatment costs for peritoneal dialysis were €25,900 during the first 12 months, €15,300 between 13 and 24 months and €20,500 beyond 25 months. Mean annual therapy costs for a kidney transplantation during the first 12 months were €50,900 from a living donor, €51,000 from a deceased donor, €17,200 between 13 and 24 months and €12,900 beyond 25 months after engraftment. Over the next 10 years in Austria with a population of 8 million people, increased assignment to peritoneal dialysis of 20% incident patients saved €26 million with a discount rate of 3% and gained 839 quality-adjusted life years (QALYs); additionally, increasing renal transplants to 10% from live donations saved €38 million discounted and gained 2242 QALYs. CONCLUSIONS Live donor renal transplantation is cost effective and associated with increase in QALYs. Therefore, preemptive live kidney transplantation should be promoted from a fiscal as well as medical point of view.
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Kainz A, Mayer B, Kramar R, Oberbauer R. Association of ESA hypo-responsiveness and haemoglobin variability with mortality in haemodialysis patients. Nephrol Dial Transplant 2010; 25:3701-6. [PMID: 20507852 DOI: 10.1093/ndt/gfq287] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Anaemia is a common complication in dialysis patients. In most cases, it is treated with erythropoietin-stimulating agents (ESA). It is not entirely clear whether the variability of haemoglobin caused by changing ESA response is associated with increased mortality. Therefore, we conducted a retrospective cohort study to evaluate ESA responsiveness and haemoglobin variability in association with mortality. METHODS We used the Austrian dialysis and transplant registry, and identified 932 patients who were on maintenance haemodialysis in the years 2005-08 with recorded weekly ESA doses and haemoglobin concentrations. ESA response was defined as a positive regression slope over the observation period. Cox regression analysis with spline functions and purposeful variable selection algorithms were used. RESULTS Adjusted Cox regression analysis showed an increased mortality risk in subjects with wide ranges of haemoglobin variability (from <10 to >12 g/dL) (HR = 2.38, 95% CI 1.20-4.71, P = 0.013). Furthermore, patients that never reached haemoglobin levels >10 g/dL despite ESA therapy exhibited the highest risk of mortality (HR = 6.37, 95% CI 2.15-18.82, P < 0.001). ESA hypo-responsiveness was associated with increased risk of mortality in the low as well as high haemoglobin ranges [HR = 2.06, 95% CI 1.49-2.86 at haemoglobin of 9.5 g/dL and HR = 1.64, 95% CI 0.68-3.92 at 13.5 g/dL both vs. 11 g/dL (reference)]. ESA dose equivalents >16,000 units per week were associated with increased mortality in ESA responders (HR = 1.30, 95% CI 1.02-1.64). However, in hypo-responders, mortality is not associated with ESA dose (HR = 1.02, 95% CI 0.87-1.20) [both at weekly ESA dose of 20,000 units vs. 16,000 (reference)]. CONCLUSIONS These findings suggest that the risk of mortality of haemodialysis patients requiring ESA therapy is lowest if the haemoglobin concentration is stably maintained in the range between 10 and 12 g/dL with weekly ESA dose equivalents <16,000 units.
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Prischl FC, Knoll F, Kramar R. Another peritoneal dialysis catheter encapsulated in peritoneal tissue. Perit Dial Int 2009; 29:119-120. [PMID: 19164264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
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Prischl F, Knoll F, Kramar R. Another Peritoneal Dialysis Catheter Encapsulated in Peritoneal Tissue. Perit Dial Int 2009. [DOI: 10.1177/089686080902900119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Kleinert J, Kotanko P, Spada M, Pagliardini S, Paschke E, Paul K, Voigtländer T, Wallner M, Kramar R, Stummvoll HK, Schwarz C, Horn S, Holzer H, Födinger M, Sunder-Plassmann G. Anderson-Fabry disease: a case-finding study among male kidney transplant recipients in Austria. Transpl Int 2008; 22:287-92. [PMID: 18954370 DOI: 10.1111/j.1432-2277.2008.00791.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The diagnosis of Anderson-Fabry disease is often delayed or even missed. As severe renal manifestations are a hallmark of alfa-galactosidase A (AGAL) deficiency, we tested the hypothesis that Anderson-Fabry disease is under-recognized among male kidney transplant recipients. This nation-wide study in Austria enrolled 1306 patients (ca 65% of all kidney transplanted males) from 30 kidney centers. AGAL activity was determined from filter paper dried blood spots by a fluorescence assay. A positive screening test was defined by an AGAL activity below 1.5 nmol/h/ml. In patients with a positive blood spot-screening test, AGAL activity was re-examined in peripheral blood leukocytes. Genetic testing for mutations in the GLA gene was performed by sequencing to confirm the diagnosis of Anderson-Fabry disease. Two previously not recognized cases with Anderson-Fabry disease were identified. Our study is the first showing that a diagnosis of Anderson-Fabry disease can be missed even in patients who undergo kidney transplantation. Case-finding strategies may be considered a useful tool for diagnosis of this rare disease that may be somewhat more prevalent among kidney transplant recipients compared with dialysis populations.
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Couchoud C, Kooman J, Finne P, Leivestad T, Stojceva-Taneva O, Ponikvar JB, Collart F, Kramar R, de Francisco A, Jager KJ. From registry data collection to international comparisons: examples of haemodialysis duration and frequency. Nephrol Dial Transplant 2008; 24:217-24. [PMID: 18678560 DOI: 10.1093/ndt/gfn442] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate haemodialysis (HD) dose practice patterns in different European countries in the light of the European Best Practice Guidelines (EBPG) and to study the associations of patient characteristics and country with weekly dialysis duration. METHODS Renal registries in Europe were asked to contribute to the study with individual patient data on weekly HD duration, number of HD sessions a week and last measured Kt/V. Additional items were age, sex, date of first renal replacement therapy (RRT), dry weight, height, HD modality, HD technique, diabetes status and vascular access type. Multivariate logistic regression was used to study the probability of receiving HD for <12 h per week. RESULTS Seven registries contributed data on 26 136 patients on HD on 31 December 2005. Eighty-three percent of the patients received HD for at least 12 h per week as recommended by the EBPG (range 49.0-97.3% across countries). Multivariate analysis showed significant differences across countries concerning the risk of receiving <12 h. Other risk factors included age (older), sex (female), BMI (low) and duration of RRT (shorter). Diabetes was associated with longer total HD duration. CONCLUSION This study shows a great international variability in weekly HD duration and some discrepancies between current practices and the EBPG. It also points out the difficulty of obtaining and comparing Kt/V values under current registry practices.
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