MO930BURDEN OF DISEASE IN INCIDENT DIALYSIS PATIENTS WAIT LISTED FOR KIDNEY TRANSPLANTATION 2008 – 2016 IN GERMANY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Martin Wagner ◽  
Wolfgang Arns ◽  
Katherine Rascher ◽  
Heyke Cramer ◽  
Mathias Schaller ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Mortality Risk ◽  
Burden Of Disease ◽  
Waiting Times ◽  
Patient Characteristics ◽  
Waiting List ◽  
Dialysis Patients ◽  
Non Profit ◽  
Laboratory Variables ◽  
Over Time

Abstract Background and Aims Only a subset of all patients on dialysis is eligible for kidney transplantation (KTx) due to the large variation of mortality risk. It has been shown that the burden of disease is increasing over the last years in patients at dialysis inception. Moreover, the number of available kidney grafts is decreasing, resulting in a prolonged time on the waiting list. In our study we describe the burden of disease and 3-year mortality in a sample of incident dialysis patients in Germany, stratified by KTx status, including trends over time. Method The QiN (Quality in Nephrology) dataset is a registry-based observational study in which >90% of all patients treated in dialysis centers of the non-profit kidney care provider KfH are enrolled. In our analyses we included all adult patients beginning dialysis treatment between 2008 and 2016. Primary outcome was 3-year all-cause death up until Dec 31, 2019. Patients were stratified by last available KTx- status: (a) KTx within 3 years, (b) on dialysis - on waiting list, (c) on dialysis - in evaluation for KTx, (d) on dialysis - KTx never planned, (e) on dialysis - KTx status missing. The burden of disease was assessed by the AROii score (Floege et al. 2015), a predictive model including patient characteristics, laboratory variables and dialysis parameters. Results Of a total of n=25987 incident patients analyzed, 3.2% underwent KTx within 3 years, 10.6% were listed for KTx, and 13.4% were in evaluation. In 49.5% KTx was never planned and in 23.3% KTx status was missing. These groups differed significantly in median AROii score, reflecting their burden of disease at dialysis inception: KTx never planned or missing (AROii score 10) as compared to KTx (AROii score 1), listed (AROii score 3) and in evaluation (AROii score 4) (p<0.001). Similarly, 3-year observed mortality (n=8059 [31%]) differed widely across KTx strata (log rank p<0.001), ranging from 11% in listed patients to 44% (HR 5,982; [5.335; 6.707]) in those with missing KTx status (figure). In the period 2008-2019 the number of KTx within 3 years decreased, but the proportion of patients on the waiting list and the proportion of patients in evaluation increased. In all patients on dialysis the burden of disease at dialysis inception increased over time across KTx strata (p<0.05). Conclusion About three quarters of patients started dialysis with a very high mortality risk and at least half of them were considered ineligible for KTx. Patients listed or in evaluation for KTx in Germany have become sicker over the last decade. With decreasing numbers of KTx in Germany the time on the waiting list is prolonged. Longer waiting times and the increasing burden of disease result in advanced risk at the time of transplantation.

SO062TRENDS OF BASELINE-RISK OF MORTALITY AND OBSERVED 3-YEAR MORTALITY IN INCIDENT DIALYSIS PATIENTS IN GERMANY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Martin Wagner ◽  
Katherine Rascher ◽  
Heyke Cramer ◽  
Mathias Schaller ◽  
Rolf Dieter Bach ◽  
...  
Keyword(s):  
Mortality Risk ◽  
Patient Characteristics ◽  
Baseline Risk ◽  
Dialysis Patients ◽  
Cox Models ◽  
Non Profit ◽  
C Statistic ◽  
Risk Of Mortality ◽  
Baseline Mortality ◽  
End Stage

Abstract Background and Aims The risk of mortality varies considerably among end stage kidney disease patients. As the population ages, patients on renal replacement therapy are presenting with an increasing number of non-renal complications such as heart failure and, subsequently, an increased mortality risk. Thus, in recent years, patient care in dialysis units has become more complex. In this study we describe trends in baseline risk of mortality and 3-year mortality risk in a sample of incident dialysis patients in Germany. Method The QiN (Quality in Nephrology) dataset is a registry-based observational study in which >90% of all patients treated in dialysis centers of the non-profit kidney care provider KfH are enrolled. In our analyses we included all adult patients beginning hemodialysis (HD) or peritoneal dialysis (PD) treatment between 2008 and 2014 who were enrolled in QiN within 6 months after inception of dialysis. Primary outcome was all-cause death within 3 years. Cox models were censored for transplantation and loss to follow-up. Baseline risk of mortality was assessed by the AROii score (Floege et al. 2015), a predictive model including patient characteristics, laboratory variables and dialysis parameters. In this score higher values indicate greater mortality risk. Results A total of n=20369 patients were analyzed, HD n=18255 (89.6%), PD n=2114 (10.4%). Baseline mortality risk increased over time: AROii score for the 2008/09 incidence cohort was median 8.1 (interquartile range 4.4; 11.9), for the 2010/11 cohort 8.8 (5.0; 12.0) and for the 2012-14 cohort 9.0 (5.0; 12.0), p<0.001. The AROii score was highly predictive for observed 3-year mortality (Hazard Ratio [HR] 1.196 [1.190; 1.203], p<0.001; C-statistic 0.736). In spite of higher baseline mortality risk in patients starting dialysis in more recent years, mortality was lower as compared to the earlier cohorts (HR 0.976 [0.964; 0.988), p<0.001). The results were mainly driven by HD patients. In PD patients baseline mortality risk increased, but no trend on mortality was observed. Conclusion Our results show that patients starting dialysis in Germany have become sicker over the last decade, as indicated by the AROii risk score. Simultaneously the observed risk of mortality decreased in recent years, indicating success of optimized medical treatment including dialysis therapy as well as non-nephrology medical care.

scholarly journals COVID-19—Importance for Patients on the Waiting List and after Kidney Transplantation—A Single Center Evaluation in 2020–2021

Pathogens ◽  
2021 ◽  
Vol 10 (4) ◽  
pp. 429
Author(s):  
Simone C. Boedecker ◽  
Pascal Klimpke ◽  
Daniel Kraus ◽  
Stefan Runkel ◽  
Peter R. Galle ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Waiting List ◽  
Smoking History ◽  
Immunocompromised Patients ◽  
Dialysis Patients ◽  
Vaccination Programs ◽  
Mild Disease ◽  
Probability Of Survival ◽  
Number Of Patients ◽  
Immunosuppressed Patients

(1) Background: Dialysis patients and recipients of a kidney allograft are at high risk for infection with SARS-CoV-2. It has been shown that the development of potent neutralizing humoral immunity against SARS CoV-2 leads to an increased probability of survival. However, the question of whether immunocompromised patients develop antibodies has not yet been sufficiently investigated; (2) Methods: SARS-CoV-2 antibodies were examined in hemodialysis patients on the waiting list for kidney transplantation as well as patients after kidney transplantation. Patients were interviewed about symptoms and comorbidities, BMI, and smoking history; (3) Results: SARS-CoV-2 antibodies were found in 16 out of 259 patients (6%). The trend of infections here reflects the general course of infection in Germany with a peak in November/December of 2020. Remarkably, patients on the waiting list experienced only mild disease. In contrast, transplanted patients had to be hospitalized but recovered rapidly from COVID-19. Most interesting is that all immunosuppressed patients developed antibodies against SARS-CoV-2 after infection; (4) Conclusions: Even with extensive hygiene concepts, an above-average number of patients were infected with SARS-CoV-2 during the second wave of infections in Germany. Because SARS-CoV-2 infection triggered the formation of antibodies even in these immunocompromised patients, we expect vaccination to be effective in this group of patients. Thus, dialysis patients and patients after kidney transplantation should be given high priority in vaccination programs.

scholarly journals Time evolution of restless legs syndrome in haemodialysis patients

2019 ◽  
Author(s):  
Irene Capelli ◽  
Fabio Pizza ◽  
Marco Ruggeri ◽  
Lorenzo Gasperoni ◽  
Elisa Carretta ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Kidney Transplantation ◽  
Restless Legs Syndrome ◽  
Statistical Significance ◽  
Dialysis Patients ◽  
Restless Legs ◽  
Continuous Form ◽  
Over Time

Abstract Background Restless legs syndrome (RLS) is characterized by an urge to move the extremities, accompanied by paraesthesiae, in the evening and at night. Uraemic RLS, a type of secondary RLS, occurs commonly in chronic kidney disease and end-stage renal disease. Progression of uraemic RLS over time is unclear. Therefore we investigated the prevalence, progression over time, risk factors and impact on survival of uraemic RLS in a cohort of dialysis patients. Methods We reviewed at the 7-year follow-up a cohort of haemodialysis (HD) patients we had previously investigated for RLS, through interviews, validated questionnaires and analysis of demographic and clinical data. Results At the 7-year follow-up, RLS was present in 16% of patients, with a persistence rate of 33%. A correlation was obtained between RLS and older age, diabetes, low albumin and low body mass index. RLS was associated with reduced overall survival (median survival of 3.3 versus 3.7 years), particularly with the continuous form of RLS (1.61 years). There was a higher incidence of myocardial infarction and peripheral vascular disease, although not reaching statistical significance. RLS patients had absolute higher scores in all quality of life domains. A large majority of study patients (96%) reported being symptom-free within a few days or weeks following kidney transplantation. Conclusions The development of RLS, especially the continuous form, in patients undergoing HD has important consequences associated with decreased survival. Our results indicated an association between uraemic RLS and ageing, diabetes and malnutrition. Considerable efforts should be focused on the treatment of RLS, since it significantly and persistently impacts the quality of life of HD patients. Kidney transplantation could represent an effective treatment option for that RLS impacts on dialysis patients' quality of life, thus confirming the secondary nature of RLS in most HD patients.

Failure to Advance Access to Kidney Transplantation over Two Decades in the United States

2021 ◽  
Vol 32 (4) ◽  
pp. 913-926
Author(s):  
Jesse D. Schold ◽  
Sumit Mohan ◽  
Anne Huml ◽  
Laura D. Buccini ◽  
John R. Sedor ◽  
...  
Keyword(s):  
United States ◽  
Kidney Transplantation ◽  
The United States ◽  
Waiting List ◽  
Adult Patients ◽  
Policy Reforms ◽  
Cox Models ◽  
Longitudinal Pattern ◽  
Dialysis Facilities ◽  
Over Time

BackgroundExtensive research and policies have been developed to improve access to kidney transplantation among patients with ESKD. Despite this, wide variation in transplant referral rates exists between dialysis facilities.MethodsTo evaluate the longitudinal pattern of access to kidney transplantation over the past two decades, we conducted a retrospective cohort study of adult patients with ESKD initiating ESKD or placed on a transplant waiting list from 1997 to 2016 in the United States Renal Data System. We used cumulative incidence models accounting for competing risks and multivariable Cox models to evaluate time to waiting list placement or transplantation (WLT) from ESKD onset.ResultsAmong the study population of 1,309,998 adult patients, cumulative 4-year WLT was 29.7%, which was unchanged over five eras. Preemptive WLT (prior to dialysis) increased by era (5.2% in 1997–2000 to 9.8% in 2013–2016), as did 4-year WLT incidence among patients aged 60–70 (13.4% in 1997–2000 to 19.8% in 2013–2016). Four-year WLT incidence diminished among patients aged 18–39 (55.8%–48.8%). Incidence of WLT was substantially lower among patients in lower-income communities, with no improvement over time. Likelihood of WLT after dialysis significantly declined over time (adjusted hazard ratio, 0.80; 95% confidence interval, 0.79 to 0.82) in 2013–2016 relative to 1997–2000.ConclusionsDespite wide recognition, policy reforms, and extensive research, rates of WLT following ESKD onset did not seem to improve in more than two decades and were consistently reduced among vulnerable populations. Improving access to transplantation may require more substantial interventions.

scholarly journals Patient outcomes from time of listing for lung transplantation in the UK: are there disease-specific differences?

Thorax ◽  
2018 ◽  
Vol 74 (1) ◽  
pp. 60-68 ◽  
Author(s):  
Antonios Kourliouros ◽  
Rachel Hogg ◽  
Jenny Mehew ◽  
Mohamed Al-Aloul ◽  
Martin Carby ◽  
...  
Keyword(s):  
Lung Transplantation ◽  
Lung Disease ◽  
Blood Group ◽  
Patient Outcomes ◽  
Waiting Times ◽  
Patient Characteristics ◽  
Waiting List ◽  
Lung Pathology ◽  
Disease Category ◽  
The Uk

BackgroundThe demand for lung transplantation vastly exceeds the availability of donor organs. This translates into long waiting times and high waiting list mortality. We set out to examine factors influencing patient outcomes from the time of listing for lung transplantation in the UK, examining for differences by patient characteristics, lung disease category and transplant centre.MethodsData were obtained from the UK Transplant Registry held by NHS Blood and Transplant for adult lung-only registrations between 1January 2004 and 31 March 2014. Pretransplant and post-transplant outcomes were evaluated against lung disease category, blood group and height.ResultsOf the 2213 patient registrations, COPD comprised 28.4%, pulmonary fibrosis (PF) 26.2%, cystic fibrosis (CF) 25.4% and other lung pathologies 20.1%. The chance of transplantation after listing differed by the combined effect of disease category and centre (p<0.001). At 3 years postregistration, 78% of patients with COPD were transplanted followed by 61% of patients with CF, 59% of other lung pathology patients and 48% of patients with PF, who also had the highest waiting list mortality (37%). The chance of transplantation also differed by height with taller patients having a greater chance of transplant (HR: 1.03, 95% CI: 1.02 to 1.04, p<0.001). Patients with blood group O had the highest waiting mortality at 3 years postregistration compared with all other blood groups (27% vs 20%, p<0.001).ConclusionsThe way donor lungs were allocated in the UK resulted in discrepancies between the risk profile and probability of lung transplantation. A new donor lung allocation scheme was introduced in 2017 to try to address these shortcomings.

Waiting time information services: what are the implications of waiting list behaviour for their design?

2002 ◽  
Vol 25 (4) ◽  
pp. 40 ◽  
Author(s):  
David Cromwell ◽  
David Griffiths
Keyword(s):  
Waiting Time ◽  
Elective Surgery ◽  
Waiting Times ◽  
Waiting Lists ◽  
Information Services ◽  
Waiting List ◽  
Surgical Units ◽  
Time Information ◽  
Over Time ◽  
Sydney Australia

In some countries, patients requiring elective surgery can access comparative waiting time information for various surgical units. What someone can deduce from this information will depend upon how the statistics are derived, and how waiting lists behave. However, empirical analyses of waiting list behaviour are scarce. This study analysed three years of waiting list data collected at one hospital in Sydney, Australia. The results highlight various issues that raise questions about using particular waiting time statistics to make inferences about patient waiting times. In particular, the results highlight the considerable variation in behaviour that can exist between surgeons in the same specialty, and that can occur over time.

P1550ACCESS TO KIDNEY TRANSPLANTATION IN A NON-PROFIT FACILITY IN GERMANY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Stephan Kemmner ◽  
Wolfgang Arns ◽  
Gero Von Gersdorff ◽  
Rolf Dieter Bach ◽  
Michael Fischereder
Keyword(s):  
Kidney Transplantation ◽  
Waiting List ◽  
Dialysis Treatment ◽  
Non Profit ◽  
For Profit ◽  
The Status ◽  
Dialysis Facility ◽  
Transplant Evaluation ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background and Aims Recent studies demonstrate that US patients undergoing chronic dialysis treatment for end stage renal disease (ESRD) at for-profit facilities had a lower access to kidney transplantation than patients at non-profit facilities. However, even at non-profit facilities only around 20% of patients were placed on the kidney transplantation waiting list. At first glance, this number appears rather low, as kidney transplantation is the only way to curatively treat ESRD. We want to compare these figures with a recently performed survey in Germany. Method We analyzed the status of transplant evaluation in the largest non-profit facility in Germany, the Kuratorium für Dialyse und Nierentransplantation e.V. (kfh, www.kfh.de). In total, the transplant status was assessed in 16,705 patients. Results Out of these only 19.4% of patients (n=3241) are on the kidney transplant waiting list, comparable to recently performed US studies. The reason why patients are not waitlisted are multifaceted as seen in attached figure. Due to severe comorbidities about 50% are considered too sick to benefit from transplantation, in turn representing the complex and high multi-morbidity of patients with ESRD. On the other hand, approximately 10% of dialysis patients actively decline listing for renal transplantation at least at some point. Conclusion We conclude that further research is needed to identify and break the mechanisms behind the low likelihood for access to kidney transplantation waiting list. Distribution of patients with surveyed transplant status in the largest non-profit dialysis facility (kfh, www.kfh.de) in Germany

scholarly journals Improving COVID-19 critical care mortality over time in England: A national cohort study, March to June 2020

2020 ◽  
Author(s):  
John Dennis ◽  
Andrew McGovern ◽  
Sebastian Vollmer ◽  
Bilal A Mateen
Keyword(s):  
Critical Care ◽  
Mortality Risk ◽  
Proportional Hazards ◽  
Linear Trend ◽  
Patient Characteristics ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Models ◽  
National Cohort ◽  
Mortality Improvement ◽  
Over Time

Objectives: To determine the trend in mortality risk over time in people with severe COVID-19 requiring critical care (high intensive unit [HDU] or intensive care unit [ICU]) management. Methods: We accessed national English data on all adult COVID-19 specific critical care admissions from the COVID-19 Hospitalisation in England Surveillance System (CHESS), up to the 29th June 2020 (n=14,958). The study period was 1st March until 30th May, meaning every patient had 30 days of potential follow-up available. The primary outcome was in-hospital 30-day all-cause mortality. Hazard ratios for mortality were estimated for those admitted each week using a Cox proportional hazards models, adjusting for age (non-linear restricted cubic spline), sex, ethnicity, comorbidities, and geographical region. Results: 30-day mortality peaked for people admitted to critical care in early April (peak 29.1% for HDU, 41.5% for ICU). There was subsequently a sustained decrease in mortality risk until the end of the study period. As a linear trend from the first week of April, adjusted mortality risk decreased by 11.2% (adjusted HR 0.89 [95% CI 0.87 - 0.91]) per week in HDU, and 9.0% (adjusted HR 0.91 [95% CI 0.88 - 0.94]) in ICU. Conclusions: There has been a substantial mortality improvement in people admitted to critical care with COVID-19 in England, with markedly lower mortality in people admitted in mid-April and May compared to earlier in the pandemic. This trend remains after adjustment for patient demographics and comorbidities suggesting this improvement is not due to changing patient characteristics. Possible causes include the introduction of effective treatments as part of clinical trials and a falling critical care burden.

scholarly journals Effect of Perceived Social Support on Mortality Rate Among Older Chinese Americans

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 198-199
Author(s):  
Charu Verma ◽  
Mengting Li ◽  
XinQi Dong
Keyword(s):  
Social Support ◽  
Mortality Risk ◽  
Perceived Social Support ◽  
Chinese Americans ◽  
Well Being ◽  
Time Of Death ◽  
All Cause Mortality ◽  
Older Chinese ◽  
Older Chinese Americans ◽  
Over Time

Abstract Most existing studies have examined the relationship between social support and health in cross-sectional data. However, the changing dynamics of social support over time and its relationship with all-cause mortality have not been well explored. Using data from the Pine Study (N = 3,157), this study examined whether social support was associated with time of death at an 8 years follow-up among older Chinese Americans. Social support from a spouse, family members and friend were collected at the baseline using an HRS social support scale. Perceived social support and time of death were ascertained from the baseline through wave 4. Cox proportional hazard models were used to assess associations of perceived support with the risk of all-cause mortality using time-varying covariate analyses. Covariates included age, sex, education, income, and medical comorbidities. All study participants were followed up for 8 years, during which 492 deaths occurred. In multivariable analyses, the results showed that positive family support [HR 0.91; 95% CI (0.86, 0.98)] and overall social support [HR 0.95; 95% CI (0.92,0.98)] were significantly associated with a lower risk of 8-year mortality. Results demonstrate robust association in which perceived positive family and overall social support over time had a protective effect on all-cause mortality risk in older Chinese Americans. Interventions could focus on older adults with low social support and protect their health and well-being. Future studies could further explore why social support from family is different from social support from other sources regarding mortality risk in older Chinese Americans.

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