Renal replacement therapy in the critical patient: Treatment variation over time

Abstract Based on projected numbers, approximately only 50% of those requiring renal replacement therapy (RRT) receive it. Many patients who require RRT live in low- and middle-income countries. The objective of this study was to examine the changing pattern over time of entry into the RRT programme in Thailand following RRT’s inclusion in the Universal Coverage Scheme. This study was an ecological study using the age-period-cohort analysis to look at dialysis registration and kidney transplant trends during RRT programme implementation. Data from 2008 to 2016 of patients diagnosed with end-stage renal disease (ESRD) were obtained from the National Health Security Office. The study found that the numbers of new patients with ESRD, aged 20–69, registered with the dialysis programme increased over time. For patients aged 20–40 years, the dialysis programme took up to 400 new patients for every 1000 new ESRD diagnoses. For kidney transplant, the rates increased slowly. The kidney transplant programme could at best treat only around 50 cases for every 1000 new ESRD diagnoses in patients aged 20–30 years. Findings of this study highlighted the importance of promoting strategies to reduce the increasing number of patients with kidney disease, to consider conservative therapy for older/frail patients, and to improve access to kidney transplantation and live-donation.

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Variability in the incidence of renal replacement therapy over time in Western industrialized countries: A retrospective registry analysis

PLoS ONE ◽

10.1371/journal.pone.0235004 ◽

2020 ◽

Vol 15 (6) ◽

pp. e0235004

Author(s):

Vicky De Meyer ◽

Daniel Abramowicz ◽

Johan De Meester ◽

Fréderic Collart ◽

Jean-Louis Bosmans ◽

...

Keyword(s):

Renal Replacement Therapy ◽

Replacement Therapy ◽

Industrialized Countries ◽

Registry Analysis ◽

Over Time

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MO077TEN YEAR TRENDS IN PAEDIATRIC RENAL REPLACEMENT THERAPY IN EUROPE: DATA FROM THE ESPN/ERA-EDTA REGISTRY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa140.mo077 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Marjolein Bonthuis ◽

Jerome Harambat ◽

Enrico Vidal ◽

Kitty J Jager

Keyword(s):

Renal Replacement Therapy ◽

Replacement Therapy ◽

Time Trends ◽

Cox Regression ◽

Patient Survival ◽

Resource Planning ◽

Treatment Modalities ◽

Change Over Time ◽

The Past ◽

Over Time

Abstract Background and Aims The ESPN/ERA-EDTA Registry includes data on children with end-stage kidney disease receiving renal replacement therapy (RRT) in Europe for 10 consecutive years. We examined time trends in incidence, prevalence and patient survival for paediatric RRT in Europe. Method We included all children aged < 15 years starting RRT in 22 European countries from 2007 to 2016. General population statistics were derived from Eurostat. Incidence and prevalence were expressed per million age related population (pmarp) and time trends were studied with Joinpoint regression. We analyzed patient survival using Cox regression. Results The incidence of children commencing RRT < 15 years remained stable over the past ten years, varying between 5.5 pmarp to 6.5 pmarp. The incidence by treatment modality did not change over time: 2.0 to 3.0 pmarp for haemodialysis (HD) and peritoneal dialysis (PD) and 1.0 pmarp for transplantation. Overall prevalence rose by 2% annually (95% CI: 1.5-2.3%) from 29.5 pmarp in 2007 to 35.6 pmarp in 2016. The increase in prevalence was observed in all age categories, but was strongest among children older than 5 years at RRT initiation. The prevalence of patients on all treatment modalities increased during the study period: from 4.5 to 5.4 pmarp for HD, from 4.9 pmarp to 6.0 pmarp for PD and from 19.6 to 23.9 pmarp for transplantation (Figure). Four-year adjusted patient survival on RRT was around 96% and similar for those initiating from 2007-2009 and from 2010-2012 (adjusted HR: 0.97, 95% CI: 0.69-1.36). Conclusion Over the past decade we found a stable incidence and an increasing prevalence of European children on RRT. Four-year patient survival was good, and did not change over time. These data are important to inform patients and healthcare providers and to aid health policy makers on future resource planning of pediatric RRT in Europe.

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MO076LONGITUDINAL CHANGES AND OUTCOME OF HIGH BLOOD PRESSURE IN EUROPEAN CHILDREN ON RENAL REPLACEMENT THERAPY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa140.mo076 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Enrico Vidal ◽

Marjolein Bonthuis ◽

Kitty J Jager ◽

Jerome Harambat

Keyword(s):

Blood Pressure ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Progressive Increase ◽

Proportional Hazard ◽

Antihypertensive Medications ◽

Similar Reduction ◽

Cox Proportional Hazard ◽

Cox Proportional Hazard Models ◽

Over Time

Abstract Background and Aims Few studies have focused on trends of hypertension (HTN) and status of blood pressure (BP) control over time in children on renal replacement therapy (RRT). In this study, we aimed to evaluate the 5-year trend in BP antihypertensive medications (AHs) use, as well as the association between HTN and mortality among RRT patients enrolled within the ESPN/ERA-EDTA Registry. Method 25.223 BP measurements from 5.032 patients who started RRT before 20 years of age, between 2007-2016, were included. Mixed models were used to analyse trends of BP, the JointPoint regression to assess prevalence of uncontrolled HTN (uHTN) over time, and multivariable Cox proportional hazard models to evaluate association of BP with mortality. Results Mean systolic BP (SBP) at RRT initiation was 1.66(+0.15), 1.05(+0.15) and 1.09(+0.08) SDS in HD, PD and transplanted (Tx) patients, respectively, while it was 1.41(+0.19), 1.12(+0.18), and 0.79(+0.06) SDS in the corresponding RRT categories after 5 years. Patients on HD showed a significant decrease in the prevalence of uHTN over time (57.1% at dialysis start vs 41.4% after 5 years; annual percentage change [APC] -4%; 95% CI: -5.7;-2.2; p<0.05), coupled with a significant reduction in AHs use (APC -3.5%; 95% CI: -6.7;-0.2). PD patients showed a similar reduction in uHTN prevalence (APC -4.9%; 95% CI: -7.2;-2.6; p<0.05), but a significant increase in AHs use (APC +3.6%; 95% CI: 0.6;6.6; p<0.05). After 5 years, Tx patients showed a significant reduction in both prevalence of uHTN (APC -4.8%; 95% CI: -7.8;-1.7; p<0.05) and use of AHs (APC -2.2%; 95% CI: -4.1;-0.3%; p<0.05). Having uHTN was not associated with mortality (HR 0.95; 95% CI: 0.68-1.33). Conclusion A more adequate control of BP over time seemed to be obtained in children on RRT. Findings in PD patients suggest that this requires a progressive increase in the use of AHs.

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