FC 118DIALYSIS WITHDRAWAL IN THE NETHERLANDS BETWEEN 2000-2020: TIME TRENDS AND CENTRE VARIATION

Abstract Background and Aims Treatment withdrawal is an important cause of death among dialysis-dependent patients. Widely variable withdrawal rates were reported in studies using varying designs and definitions in culturally different regions of the world, limiting comparability of individual studies. Cessation of life-prolonging treatment is a well-accepted option in the Netherlands, however it is unclear if these premises result in higher dialysis withdrawal rates and if this effect is generalisable. This study aims to describe dialysis withdrawal practice in the Netherlands, focussing on time trends and practice variation between centres. Method Patient data was retrieved from RENINE, the Dutch national registration which includes nearly all patients requiring dialysis for at least 28 days. All patients who initiated maintenance dialysis from January 1, 2000, to December 31, 2020, and died within this period were included for analysis. Since the primary aim of this study concerned cause of death on dialysis, data of patients in whom dialysis was stopped due to kidney transplantation or recovery of kidney function, were excluded. Main outcome was death by dialysis withdrawal, as registered by the treating physician using ERA-EDTA codes. Other causes of death were used as comparison. Time trends for dialysis withdrawal were first analysed as unadjusted data (proportion per year). Univariable logistic regression analyses were then used to identify factors associated with dialysis withdrawal, including year of death in five-year strata. A multivariable model was subsequently used to determine risks, adjusting for factors associated with dialysis withdrawal. Centre variation was compared visually by using funnel plots. Results A total of 34.692 patients commenced maintenance dialysis of which 20.389 died. After applying exclusion criteria, a cohort of 18.412 patients was used for analysis. Dialysis withdrawal was an increasingly common cause of death, increasing from 13.5% in 2000 to 31.2% in 2019 (22.1% overall). In multivariable analysis, increasing age, female sex, increasing dialysis vintage, haemodialysis as treatment modality, and year of death were independent factors associated with death by dialysis withdrawal. Centre variation was large, even after correction for confounding factors (36.6% outside 95% control limits). Conclusion Treatment withdrawal has become the main cause of death in the Netherlands among dialysis-dependent patients during 2000-2020. Large practice variations were observed between centres, even after correction for confounding factors. These findings emphasize the need for timely advance care planning and urge treating health care professionals to better inform their patients when choosing to start dialysis or not.

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Hemodialysis versus peritoneal dialysis: an observational study in two international centers

The International Journal of Artificial Organs ◽

10.5301/ijao.5000656 ◽

2017 ◽

Vol 41 (1) ◽

pp. 58-65 ◽

Cited By ~ 1

Author(s):

Renhua Lu ◽

Carla Estremadoyro ◽

Xiaohuan Chen ◽

Mingli Zhu ◽

Leonardo C. Ribeiro ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Lipid Metabolism ◽

Vascular Disease ◽

Cause Of Death ◽

Patient Survival ◽

Dialysis Patients ◽

Cerebral Vascular Disease ◽

Kaplan Meier ◽

Dialysis Vintage ◽

Maintenance Dialysis

Introduction: Given that it is difficult to randomize end-stage renal disease (ESRD) patients to either hemodialysis (HD) or peritoneal dialysis (PD), differences between these renal replacement therapy (RRT) modalities are of major interest and remain controversial. Methods: All data on maintenance dialysis patients during 2009 to 2013 in the Renji Hospital in Shanghai, China and in the San Bortolo Hospital in Vicenza, Italy were selected. Patients who changed their therapy from HD to PD or PD to HD during this study were excluded. Results: 919 maintenance dialysis patients were included in the present study, including 509 patients on HD and 410 on PD. During the 5-year follow-up, mean arterial pressure (MAP) was higher in HD patients. The level of serum HCO3- was significantly better in PD patients than in HD patients. Phosphate was significantly higher in HD patients than in PD patients. With respect to lipid metabolism, triglyceride, total cholesterol and LDL were significantly higher in PD patients. Serum protein and albumin were higher in HD patients than in PD patients. Overall, 236 patients died (25.7%); 150 (16.3%) on HD and 86 (9.4%) on PD. The main cause of death in HD and PD patients was cerebral vascular disease and infection, respectively. After adjusting for dialysis vintage, the Kaplan-Meier patient survival was similar between HD and PD patients. Conclusions: Based on 5 years of data, we demonstrate that lipid metabolism and nutritional status were better in HD patients. However, blood pressure control, acid-base balance, phosphate (P) control were better in PD patients. The main cause of death in HD and PD was cerebral vascular disease and infection, respectively. Considering the dialysis vintage, the Kaplan-Meier patient survival was similar between HD and PD patients.

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Antimicrobial resistance and antibiotic consumption in intensive care units, Switzerland, 2009 to 2018

Eurosurveillance ◽

10.2807/1560-7917.es.2021.26.46.2001537 ◽

2021 ◽

Vol 26 (46) ◽

Author(s):

Stefanie Barnsteiner ◽

Florent Baty ◽

Werner C Albrich ◽

Baharak Babouee Flury ◽

Michael Gasser ◽

...

Keyword(s):

Logistic Regression ◽

Intensive Care ◽

Antimicrobial Resistance ◽

Intensive Care Units ◽

Time Trends ◽

Multivariable Analysis ◽

Antibiotic Consumption ◽

Factors Associated ◽

Defined Daily Doses ◽

Bed Days

Background Intensive care units (ICU) constitute a high-risk setting for antimicrobial resistance (AMR). Aim We aimed to describe secular AMR trends including meticillin-resistant Staphylococcus aureus (MRSA), glycopeptide-resistant enterococci (GRE), extended-spectrum cephalosporin-resistant Escherichia coli (ESCR-EC) and Klebsiella pneumoniae (ESCR-KP), carbapenem-resistant Enterobacterales (CRE) and Pseudomonas aeruginosa (CRPA) from Swiss ICU. We assessed time trends of antibiotic consumption and identified factors associated with CRE and CRPA. Methods We analysed patient isolate and antibiotic consumption data of Swiss ICU sent to the Swiss Centre for Antibiotic Resistance (2009–2018). Time trends were assessed using linear logistic regression; a mixed-effects logistic regression was used to identify factors associated with CRE and CRPA. Results Among 52 ICU, MRSA decreased from 14% to 6% (p = 0.005; n = 6,465); GRE increased from 1% to 3% (p = 0.011; n = 4,776). ESCR-EC and ESCR-KP increased from 7% to 15% (p < 0.001, n = 10,648) and 5% to 11% (p = 0.002; n = 4,052), respectively. CRE, mostly Enterobacter spp., increased from 1% to 5% (p = 0.008; n = 17,987); CRPA remained stable at 27% (p = 0.759; n = 4,185). Antibiotic consumption in 58 ICU increased from 2009 to 2013 (82.5 to 97.4 defined daily doses (DDD)/100 bed-days) and declined until 2018 (78.3 DDD/100 bed-days). Total institutional antibiotic consumption was associated with detection of CRE in multivariable analysis (odds ratio per DDD: 1.01; 95% confidence interval: 1.0–1.02; p = 0.004). Discussion In Swiss ICU, antibiotic-resistant Enterobacterales have been steadily increasing over the last decade. The emergence of CRE, associated with institutional antibiotic consumption, is of particular concern and calls for reinforced surveillance and antibiotic stewardship in this setting.

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FRI0152 PULMONARY HYPERTENSION IN NEWLY DIAGNOSED SPANISH PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS: DATA FROM THE RELES COHORT

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.4906 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 660.2-660

Author(s):

J. Álvarez Troncoso ◽

Á. Robles Marhuenda ◽

F. Mitjavila Villero ◽

F. J. García Hernández ◽

A. Marín Ballvé ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Pulmonary Hypertension ◽

Lupus Erythematosus ◽

Multivariable Analysis ◽

Systolic Pressure ◽

High Morbidity ◽

Inception Cohort ◽

Systemic Lupus ◽

Factors Associated ◽

Pulmonary Arterial

Background:Systemic lupus erythematosus (SLE) is a systemic autoimmune disease characterized by multiorgan involvement. Pulmonary hypertension (PH) is an uncommon manifestation with high morbidity and mortality whose characteristics, prevalence and evolution in SLE are not completely defined.Objectives:Using data of patients from the inception cohort Registro Español de Lupus Eritematoso Sistémico (RELES), we aimed to to identify the factors associated with pulmonary hypertension (PH) in systemic lupus erythematosus (SLE).Methods:Prospective observational study on a multicenter Spanish inception cohort. Patients with SLE, diagnosed by the American College of Rheumatology (ACR) criteria, since January 2009, who had at least one transthoracic echocardiogram (TTE) performed were selected. Demographic data, diagnostic criteria, follow-ups, treatments and SLEDAI were analyzed.Results:Of 289 patients diagnosed with SLE with TTE performed, 15 (5.2%) patients were identified to have PH. Mean age was 56,9±7,7 years, of which 93,3% (14) were women and 80% (12) Caucasian. The ACR score at diagnosis was 4.66. Mean SLEDAI was 15. Only 5 patients had dyspnea at the time of diagnosis. Mean pulmonary arterial systolic pressure was 49.2±5.6 mmHg. Among the PH, 4 patients had pericarditis (26.6%), 3 (20%) valvulopathies (1 antiphospholipid syndrome), 1 patient pulmonary embolism and 1 shrinking lung. Multivariable analysis indicated that pericarditis (odds ratio (OR)=2.53), and valvulopathies (OR 8.96) were independently associated with the development of PH in SLE. Having PH was associated with older age at diagnosis (p<0.001), more dyspnea (p<0.001), higher ESR (p=0.007), more serositis (p<0.001), higher SLEDAI (p=0.011), higher SLICC (p <0.001), higher number of admissions (p=0.006) and higher mortality (p=0.003).Conclusion:PH in SLE is a serious comorbidity with high mortality. In the RELES cohort it was associated with increased disease activity, pericarditis and valvulopathies. Performing TTE in patients with SLE may favor early diagnosis and treatment.References:[1]Kim JS, Kim D, Joo YB, et al. Factors associated with development and mortality of pulmonary hypertension in systemic lupus erythematosus patients.Lupus. 2018;27(11):1769–1777.[2]Bazan IS, Mensah KA, Rudkovskaia AA, et al. Pulmonary arterial hypertension in the setting of scleroderma is different than in the setting of lupus: A review.Respir Med. 2018;134:42–46.Disclosure of Interests:Jorge Álvarez Troncoso: None declared, Ángel Robles Marhuenda: None declared, Francesca Mitjavila Villero: None declared, Francisco José García Hernández: None declared, Adela Marín Ballvé: None declared, Antoni Castro Consultant of: Actelion pharmaceuticals, GSK, MSD., Gonzalo Salvador Cervelló: None declared, Eva Fonseca: None declared, Isabel Perales Fraile: None declared, Guillermo Ruiz-Irastorza: None declared

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Frailty status among older critically ill patients with severe acute kidney injury

Critical Care ◽

10.1186/s13054-021-03510-y ◽

2021 ◽

Vol 25 (1) ◽

Author(s):

William Beaubien-Souligny ◽

Alan Yang ◽

Gerald Lebovic ◽

Ron Wald ◽

Sean M. Bagshaw

Keyword(s):

Acute Kidney Injury ◽

Critically Ill ◽

Critically Ill Patients ◽

Multivariable Analysis ◽

Kidney Injury ◽

Multivariable Logistic Regression Analysis ◽

Clinical Frailty Scale ◽

Factors Associated ◽

Frailty Status ◽

Physiological Variables

Abstract Background Frailty status among critically ill patients with acute kidney injury (AKI) is not well described despite its importance for prognostication and informed decision-making on life-sustaining therapies. In this study, we aim to describe the epidemiology of frailty in a cohort of older critically ill patients with severe AKI, the outcomes of patients with pre-existing frailty before AKI and the factors associated with a worsening frailty status among survivors. Methods This was a secondary analysis of a prospective multicentre observational study that enrolled older (age > 65 years) critically ill patients with AKI. The clinical frailty scale (CFS) score was captured at baseline, at 6 months and at 12 months among survivors. Frailty was defined as a CFS score of ≥ 5. Demographic, clinical and physiological variables associated with frailty as baseline were described. Multivariable Cox proportional hazard models were constructed to describe the association between frailty and 90-day mortality. Demographic and clinical factors associated with worsening frailty status at 6 months and 12 months were described using multivariable logistic regression analysis and multistate models. Results Among the 462 patients in our cohort, median (IQR) baseline CFS score was 4 (3–5), with 141 (31%) patients considered frail. Pre-existing frailty was associated with greater hazard of 90-day mortality (59% (n = 83) for frail vs. 31% (n = 100) for non-frail; adjusted hazards ratio [HR] 1.49; 95% CI 1.11–2.01, p = 0.008). At 6 months, 68 patients (28% of survivors) were frail. Of these, 57% (n = 39) were not classified as frail at baseline. Between 6 and 12 months of follow-up, 9 (4% of survivors) patients transitioned from a frail to a not frail status while 10 (4% of survivors) patients became frail and 11 (5% of survivors) patients died. In multivariable analysis, age was independently associated with worsening CFS score from baseline to 6 months (adjusted odds ratio [OR] 1.08; 95% CI 1.03–1.13, p = 0.003). Conclusions Pre-existing frailty is an independent risk factor for mortality among older critically ill patients with severe AKI. A substantial proportion of survivors experience declining function and worsened frailty status within one year.

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AB0898-HPR WICH FACTORS ARE RELATED TO PAINFUL EXPERIENCE IN PATIENTS AFFECTED BY CHRONIC INFLAMMATORY RHEUMATIC DISEASE DURING THE COVID-19 PANDEMIC?

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.4073 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 1472.2-1472

Author(s):

T. El Joumani ◽

H. Rkain ◽

T. Fatima Zahrae ◽

H. Kenza ◽

R. Abouqal ◽

...

Keyword(s):

Psychological Impact ◽

Multivariable Analysis ◽

Cross Sectional Study ◽

Sectional Study ◽

Quality Of Sleep ◽

Cross Sectional ◽

Therapeutic Adherence ◽

Factors Associated ◽

Painful Experience

Objectives:To evaluate the effect of containment, during the Covid-19 pandemic, on the pain of patients with CIRD, and to analyze the factors associated with the experience of pain.Methods:A cross-sectional study was conducted among patients with rheumatic diseases using a questionnaire providing information on patients and disease characteristics. Impact of COVID-19 on This is a cross-sectional study that consecutively includedPatients were asked to assess the global pain which they had experienced before and during the containment period, using a single Visual Analogue Scale (VAS) ranging from 0 (no pain) to 10 (greatest pain).Statistical Analysis System IBM SPSS Statistics V20.0.0 was used to analyze the study data.We performed univariate then multivariate analysis to search any related factors to pain perception during to quarantines. Qualitative values were analyzed by the chi2 test. Quantitative values were analyzed by the Student test when the measures were normally distributed or by nonparametric test (Mann–Whitney U) when the measures were not normally distributed (Kolmogorov–Smirnov test was used to test normality).Results:Among the 350 patients who answered to the questionnaire online, rheumatoid arthritis represented 62.3%, spondyloarthropathy 34.3% and undifferentiated CIRD 3.4%.Pain experience caused by the CIRD during the containment was reported by 79.1% of patients.The level of pain, using the VAS of Pain increased significantly during the COVID-19 pandemic (4,6 ± 2,8 and 5,4 ± 3 before and during the containment; p<0.001).In multivariate analysis, the factors implicated in pain were the negative impact of Coronavirus on access to rheumatologic care, discontinuation of therapeutic adherence, the disturbed quality of sleep and the negative psychological impact (table 1).Table 1: Summarize multivariable analysis of factors associated with painful experience related to CIRD during containement.Table 1.Multivariable analysis of factors associated with painful experience related to CIRD during containementPImpact on monitoring0.05Impact on therapeutic adherence<0.001Quality of sleep disturbed0.001Negative psychological impact0.02Conclusion:This survey showed the that the COVID-19 pandemic have incresed painful experience in CIRD patients. Factors influencing painful experience should be taken into account to help patients to cope with their chronic rheumatism and this global health crisis.Disclosure of Interests:None declared

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The reliability of cause-of-death coding in The Netherlands

European Journal of Epidemiology ◽

10.1007/s10654-010-9445-5 ◽

2010 ◽

Vol 25 (8) ◽

pp. 531-538 ◽

Cited By ~ 82

Author(s):

Peter Harteloh ◽

Kim de Bruin ◽

Jan Kardaun

Keyword(s):

The Netherlands ◽

Cause Of Death

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Time trends in treatment strategies and survival of older versus younger patients with synchronous metastasized melanoma – a population-based study in the Netherlands Cancer Registry

Journal of Geriatric Oncology ◽

10.1016/s1879-4068(21)00336-2 ◽

2021 ◽

Vol 12 (8) ◽

pp. S5

Author(s):

D. van der Ziel ◽

M. Derks ◽

E. Kapiteijn ◽

E. Bastiaannet ◽

M. Louwman ◽

...

Keyword(s):

The Netherlands ◽

Cancer Registry ◽

Time Trends ◽

Treatment Strategies ◽

Population Based ◽

Population Based Study ◽

Younger Patients ◽

Netherlands Cancer Registry

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Atherogenic dyslipidemia, but not hyperglycemia, is an independent factor associated with liver fibrosis in subjects with type 2 diabetes and NAFLD: A population –based study

Acta Endocrinologica ◽

10.1530/eje-20-1240 ◽

2021 ◽

Author(s):

María Teresa Julián ◽

Guillem Pera ◽

Berta Soldevila ◽

Llorenç Caballería ◽

Josep Julve ◽

...

Keyword(s):

Type 2 Diabetes ◽

Liver Fibrosis ◽

Multivariable Analysis ◽

Liver Stiffness ◽

Population Based ◽

Atherogenic Dyslipidemia ◽

Population Based Study ◽

Factors Associated ◽

Advanced Liver Fibrosis

Objective: To investigate the prevalence and risks factors associated with the presence of significant liver fibrosis in subjects with nonalcoholic fatty liver disease (NAFLD) with and without type 2 diabetes mellitus (T2D). Design and methods: This study was part of a population-based study conducted in the Barcelona metropolitan area among subjects aged 18-75 years old. Secondary causes of steatosis were excluded. Moderate-to-advanced liver fibrosis was defined as a liver stiffness measurement (LSM) ≥ 8.0 kPa assessed by transient elastography. Results: Among 930 subjects with NAFLD, the prevalence of moderate-to-advanced liver fibrosis was higher in subjects with T2D compared those without (30.8% vs. 8.7%). By multivariable analysis, one of the main factors independently associated with increased LSM in subjects with NAFLD was atherogenic dyslipidemia, but only in those with T2D. The percentage of subjects with LSM ≥ 8.0 kPa was higher in subjects with T2D and atherogenic dyslipidemia than in those with T2D without atherogenic dyslipidemia, both for the cut-off point of LSM ≥8.0 kPa (45% vs 24%, p=0.002) and 13 kPa (13% vs 4%, p=0.020). No differences were observed in the prevalence of LSM ≥8.0 kPa regarding glycemic control among NAFLD-diabetic subjects. Conclusions: Factors associated with moderate-to-advanced liver fibrosis in NAFLD are different in subjects with and without T2D. Atherogenic dyslipidemia was associated with the presence of moderate-to-advanced liver fibrosis in T2D with NAFLD but not in non-diabetic subjects. These findings highlight the need for an active search for liver fibrosis in subjects with T2D, NAFLD and atherogenic dyslipidemia.

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LONG-TERM TRENDS IN MARITAL STATUS MORTALITY DIFFERENCES IN THE NETHERLANDS 1850–1970

Journal of Biosocial Science ◽

10.1017/s0021932001002796 ◽

2001 ◽

Vol 33 (2) ◽

pp. 279-303 ◽

Cited By ~ 26

Author(s):

FRANS VAN POPPEL ◽

INEZ JOUNG

Keyword(s):

World War Ii ◽

The Netherlands ◽

Marital Status ◽

Cause Of Death ◽

Relative Increase ◽

World War ◽

Men And Women ◽

Married Men ◽

Long Term Trends

This article describes the long-term trends in marital status mortality differences in the Netherlands using a unique dataset relating to the period 1850–1970. Poisson regression analysis was applied to calculate relative mortality risks by marital status. For two periods, cause-of-death by marital status could be used. Clear differences in mortality by marital status were observed, with strongly increasing advantages for married men and women and a relative increase in the mortality of widowed compared with non-married people. Excess mortality among single and formerly married men and women was visible in many cause-of-death categories, and this became more widespread during the last decades of the nineteenth century. Hypotheses are formulated that might explain why married men and women underwent a stronger decrease in mortality up until the end of World War II.

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