Brazilian dialysis survey 2019

Abstract Introduction: National data on chronic dialysis treatment are essential for the development of health policies that aim to improve the treatment of patients. Objective: To present data from the Brazilian Dialysis Survey 2019, promoted by the Brazilian Society of Nephrology. Methods: Data collection from dialysis units in the country through a completed online questionnaire for 2019. Results: 314 (39%) centers responded the questionnaire. In July 2019, the estimated total number of patients on dialysis was 139,691. Estimates of the prevalence and incidence rates of patients undergoing dialysis treatment per million of the population (pmp) were 665 and 218, respectively, with mean annual increases of 25 pmp and 14 pmp for prevalence and incidence, respectively. The annual gross mortality rate was 18.2%. Of the prevalent patients, 93.2% were on hemodialysis and 6.8% on peritoneal dialysis; and 33,015 (23.6%) on the waiting list for transplantation. 55% of THE centers offered treatment with peritoneal dialysis. Venous catheters were used as access in 24.8% of THE patients on hemodialysis. 17% of the patients had K ≥ 6.0mEq/L; 2.5% required red blood cell transfusion in July 2019 and 10.8% of the patients had serum levels of 25-OH vitamin D < 20 ng/mL. Conclusion: The absolute number of patients, the incidence and prevalence rates in dialysis in the country continue to increase, as well as the percentage of patients using venous catheter as dialysis access. There was an increase in the number of patients on the list for transplantation and a tendency to reduce gross mortality.

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Brazilian Dialysis Census: analysis of data from the 2009-2018 decade

Brazilian Journal of Nephrology ◽

10.1590/2175-8239-jbn-2019-0234 ◽

2020 ◽

Vol 42 (2) ◽

pp. 191-200 ◽

Cited By ~ 3

Author(s):

Precil Diego Miranda de Menezes Neves ◽

Ricardo de Castro Cintra Sesso ◽

Fernando Saldanha Thomé ◽

Jocemir Ronaldo Lugon ◽

Marcelo Mazza Nasicmento

Keyword(s):

Hepatitis C ◽

Absolute Number ◽

Incidence Rates ◽

Chronic Dialysis ◽

Patient Treatment ◽

Positive Serology ◽

Online Questionnaire ◽

Dialysis Treatment ◽

Number Of Patients ◽

Treatment Objective

ABSTRACT Introduction: National data on chronic dialysis treatment are essential for the development of health policies that aim to improve patient treatment. Objective: To present data from the Brazilian Society of Nephrology on patients with chronic dialysis for kidney disease in July 2018, making a comparative analysis of the past 10 years. Methods: Data collection from dialysis units, with filling in an online questionnaire for 2018. Data from 2009, 2013 and 2018 were compared. Results: 288 (36.6%) centers answered the questionnaire. In July 2018, the estimated total number of patients on dialysis was 133,464. Estimates of the prevalence and incidence rates of patients undergoing dialysis treatment per million of the population (pmp) were 640 and 204, respectively, with average annual increases of 23.5 pmp and 6 pmp for prevalence and incidence, respectively. The annual gross mortality rate was 19.5%. Of the prevalent patients, 92.3% were on hemodialysis and 7.7% on peritoneal dialysis, with 29,545 (22.1%) on the waiting list for transplantation. Median bicarbonate concentration in the hemodialysis bath was 32 mEq/L. Venous catheters were used as access in 23.6% of the hemodialysis patients. The prevalence rate of positive serology for hepatitis C showed a progressive reduction (3.2%). Conclusion: The absolute number of patients and rates of incidence and prevalence in dialysis in the country increased substantially in the period, although there are considerable differences in rates by state. There has been a persistent increase in the use of venous catheters as an access for dialysis; and reduction in the number of patients with positive serology for hepatitis C.

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MO706PATIENTS AND CENTER-RELATED FACTORS IN PERIOTONEAL CHOICE IN INCIDENT PATIENTS: A REGIONAL EXPERIENCE

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab101.0028 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Vincenzo Antonio Panuccio ◽

Giovanna Parlongo ◽

Rocco Tripepi ◽

Giovanni Luigi Tripepi ◽

Paola Cianfrone ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Venous Catheter ◽

Dialysis Access ◽

Related Factors ◽

Early Referral ◽

Dialysis Treatment ◽

Outpatient Program ◽

Dialytic Modality ◽

Late Referral

Abstract Background and Aims Effective outpatient organization is essential in the management of patients with chronic kidney disease. Although peritoneal dialysis (PD) has many advantages it is still not popular. Method The aim of this study was to evaluate patient and center-related factors that affect the final choice of peritoneal dialysis (PD) versus hemodialysis (HD) in the Calabrian region (Italy). We analyzed 2 annual regional surveys performed by nephrologists (2017 and 2018) in incident dialysis patients. Collected factors included: early and late referral to the dialysis program, pre-dialysis participation in outpatient visits, first dialysis access [peritoneal catheter (PC), central venous catheter (CVC), arteriovenous fistula (AVF)], final dialysis treatment (HD or PD) and the care giver. Results The study sample included 296 incident patients (63% males) aged 66±15 years. Time to referral influenced the type of first dialysis access. Among patients with early referral, 35% initiated dialysis by a PC, 34% by AVF and 31% by CVC, while among those with late referral, only 5% started dialysis by a PC, 15% by AVF, and the majority (80%) by CVC (P<0.001). Time to referral was also associated with pre-dialysis visits (34%, 33% and 34% versus 5%, 22% and 73%, respectively, P<0.001). When evaluating clinical suitability for treatment modality, 54% of early referrals and 45% of late referrals were eligible for PD. The choice of dialytic modality was again related to time to referral: 38% with early referral chose PD compared to 15% of those with late referral (P<0.001). Furthermore, in patients who participated in the pre-dialysis program, 38% started PD versus 11% of patients that did not participate (P<0.001). The role of the caregiver remains uncertain. Conclusion These data confirm that a more attentive and dedicated organization of the pre-dialysis outpatient program would contribute to a greater expansion of the peritoneal dialysis program.

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Brazilian chronic dialysis survey 2017

Brazilian Journal of Nephrology ◽

10.1590/2175-8239-jbn-2018-0178 ◽

2019 ◽

Vol 41 (2) ◽

pp. 208-214 ◽

Cited By ~ 19

Author(s):

Fernando Saldanha Thomé ◽

Ricardo Cintra Sesso ◽

Antonio Alberto Lopes ◽

Jocemir Ronaldo Lugon ◽

Carmen Tzanno Martins

Keyword(s):

Mortality Rate ◽

Venous Catheter ◽

Absolute Number ◽

Incidence Rates ◽

Chronic Dialysis ◽

Dialysis Patients ◽

Positive Serology ◽

The North ◽

Number Of Patients ◽

National Estimates

Abstract Introduction: Having national data on chronic dialysis is essential in treatment planning. Objective: To present data of the survey from the Brazilian Society of Nephrology on patients with chronic kidney disease on dialysis in July 2017. Methods: Data was collected from dialysis units in Brazil. The data collection was done using a questionnaire completed online by the dialysis units. Results: Two hundred and ninety-one centers (38.4%) answered the questionnaire. In July 2017, the estimated total number of dialysis patients was 126,583. National estimates of prevalence and incidence rates of dialysis patients per million population (pmp) were 610 (range: 473 in the North region and 710 in the Midwest) and 194, respectively. The incidence rate of new dialysis patients with diagnosis of diabetic nephropathy was 77 pmp. The annual gross mortality rate was 19.9%. Of the prevalent patients, 93.1% were on hemodialysis and 6.9% on peritoneal dialysis, with 31,226 (24%) on the waiting list for renal transplantation. Venous catheter was used as access in 22.6% of patients on hemodialysis. The prevalence rate of positive serology for hepatitis C continued with a tendency to decrease (3.3%). Conclusion: The absolute number of patients and rates of incidence and prevalence on dialysis continued to increase; the mortality rate tended to rise. There were obvious regional and state discrepancies in these rates.

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Recent epidemiological trends in extrapulmonary TB in Galicia, Spain

The International Journal of Tuberculosis and Lung Disease ◽

10.5588/ijtld.20.0910 ◽

2021 ◽

Vol 25 (5) ◽

pp. 373-381

Author(s):

L. Ferreiro ◽

A. Ruano-Raviña ◽

R. Otero-Mallo ◽

C. Pou-Álvarez ◽

V. Riveiro-Blanco ◽

...

Keyword(s):

Retrospective Cohort ◽

Prevention And Control ◽

Extrapulmonary Tuberculosis ◽

Absolute Number ◽

Incidence Rates ◽

Age Group ◽

Number Of Patients ◽

Epidemiological Trends ◽

And Control ◽

Epidemiological Characteristics

OBJECTIVE: To describe the epidemiological trends and characteristics of extrapulmonary tuberculosis (EPTB) in Galicia, Spain, from 2000 to 2019.METHODS: This was a retrospective cohort study based on data from the Galician TB information system.RESULTS: Of the total number of TB cases (n = 15,871), 5,428 (34.2%) had EPTB. The absolute number of cases and incidence of EPTB decreased dramatically (from 480 cases and 17.8 cases/100,000 in 2000, to 172 and 6.4 cases/100,000 in 2019, respectively), with a mean annual decrease of respectively 64% and 4.7% for absolute cases and incidence rates. The risk for EPTB was higher in men than in women (RR 3.86, 95% CI 3.66–4.07). The most frequent age group was 15–44 years (2,234 patients, 41.2%); overall reductions per age group were 82% (0–14 years), 75% (15–44 years), 44% (45–64 years) and 63% (≥65 years), with statistically significant differences. The most frequently locations were the pleura (1,916 cases; 35.3%) and the lymph nodes (1,504; 27.7%).CONCLUSION: The incidence of EPTB in Galicia has decreased significantly in the last 20 years. The epidemiological characteristics have not changed, except for the number of patients with risk factors. This improvement of EPTB epidemiological trends coincides with the implementation of the programme for the prevention and control of TB, which suggests that it has been very effective in the control of the EPTB.

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Cost Analysis of Hemodialysis and Peritoneal Dialysis Access in Incident Dialysis Patients

Peritoneal Dialysis International ◽

10.3747/pdi.2011.00309 ◽

2013 ◽

Vol 33 (6) ◽

pp. 662-670 ◽

Cited By ~ 14

Author(s):

Luis A. Coentrão ◽

Carla S. Araújo ◽

Carlos A. Ribeiro ◽

Claúdia C. Dias ◽

Manuel J. Pestana

Keyword(s):

Peritoneal Dialysis ◽

First Year ◽

Dialysis Access ◽

Demographic Information ◽

Dialysis Treatment ◽

Intention To Treat ◽

The Mean ◽

Adjusted Rate ◽

Rate Ratios ◽

Access Complications

BackgroundAlthough several studies have demonstrated the economic advantages of peritoneal dialysis (PD) over hemodialysis (HD), few reports in the literature have compared the costs of HD and PD access. The aim of the present study was to compare the resources required to establish and maintain the dialysis access in patients who initiated HD with a tunneled cuffed catheter (TCC) or an arteriovenous fistula (AVF) and in patients who initiated PD.MethodsWe retrospectively analyzed the 152 chronic kidney disease patients who consecutively initiated dialysis treatment at our institution in 2008 (HD-AVF, n = 65; HD-CVC, n = 45; PD, n = 42). Detailed clinical and demographic information and data on access type were collected for all patients. A comprehensive measure of total dialysis access costs, including surgery, radiology, hospitalization for access complications, physician costs, and transportation costs was obtained at year 1 using an intention-to-treat approach. All resources used were valued using 2010 prices, and costs are reported in 2010 euros.ResultsCompared with the HD-AVF and HD-TCC modalities, PD was associated with a significantly lower risk of access-related interventions (adjusted rate ratios: 1.572 and 1.433 respectively; 95% confidence intervals: 1.253 to 1.891 and 1.069 to 1.797). The mean dialysis access–related costs per patient–year at risk were €1171.6 [median: €608.8; interquartile range (IQR): €563.1 – €936.7] for PD, €1555.2 (median: €783.9; IQR: €371.4 – €1571.7) for HD-AVF, and €4208.2 (median: €1252.4; IQR: €947.9 – €2983.5) for HD-TCC ( p < 0.001). In multivariate analysis, total dialysis access costs were significantly higher for the HD-TCC modality than for either PD or HD-AVF (β = –0.53; 95% CI: –1.03 to –0.02; and β = –0.50; 95% CI: –0.96 to –0.04).ConclusionsCompared with patients initiating HD, those initiating PD required fewer resources to establish and maintain a dialysis access during the first year of treatment.

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Dialysis access: issues related to conversion from peritoneal dialysis to hemodialysis and vice versa

The Journal of Vascular Access ◽

10.5301/jva.5000695 ◽

2017 ◽

Vol 18 (1_suppl) ◽

pp. S41-S46 ◽

Cited By ~ 2

Author(s):

Maurizio Gallieni ◽

Antonino Giordano ◽

Anna Ricchiuto ◽

Davide Gobatti ◽

Maurizio Cariati

Keyword(s):

Peritoneal Dialysis ◽

End Stage Renal Disease ◽

Venous Catheter ◽

Infectious Complications ◽

Dialysis Access ◽

Central Venous ◽

Treatment Start ◽

Alternative Approach ◽

Stage Renal Disease ◽

End Stage

Hemodialysis (HD) and peritoneal dialysis (PD) represent two complementary modalities of renal replacement therapy (RRT) for end-stage renal disease patients. Conversion between the two modalities is frequent and more likely to happen from PD to HD. Every year, 10% of PD patients convert to HD, suggesting the need for recommendations on how to proceed with the creation of a vascular access in these patients. Criteria for selecting patients who would likely fail PD, and therefore take advantage of a backup access, are undefined. Creating backup fistulas at the time of PD treatment start to allow emergency access for HD has proved to be inefficient, but it may be considered in patients with progressive difficulty in achieving adequate depuration and/or peritoneal ultrafiltration. A big challenge is represented by patients switching from PD to HD for unexpected infectious complications. Those patients need to start HD with a central venous catheter (CVC), but an alternative approach might be using an early cannulation graft, provided that infection has been cleared by the circulation. An early cannulation graft might also be used to considerably shorten the time spent using a CVC. In patients who need a conversion from HD to PD, urgent-start PD is now an accepted and well-established approach.

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Peritoneal Dialysis as an Urgent-Start Option for Incident Patients on Chronic Renal Replacement Therapy: World Experience and Review of Literature

Blood Purification ◽

10.1159/000506505 ◽

2020 ◽

Vol 49 (6) ◽

pp. 652-657 ◽

Cited By ~ 1

Author(s):

Dayana Bittencourt Dias ◽

Marcela Lara Mendes ◽

Camila Albuquerque Alves ◽

Jacqueline Teixeira Caramori ◽

Daniela Ponce

Keyword(s):

Peritoneal Dialysis ◽

Observational Studies ◽

Bloodstream Infections ◽

Venous Catheter ◽

Cost Effective ◽

Initial Time ◽

Dialysis Access ◽

Review Of Literature ◽

Collective Experience ◽

Cost Effective Alternative

Chronic kidney disease is a significant problem of public health worldwide, and up to 60% of patients start dialysis in an unplanned manner without a definitive dialysis access. Recently, peritoneal dialysis (PD) has emerged as an alternative to unplanned chronic dialytic method, and the world collective experience shows that PD can be an efficient, safe, and cost-effective alternative with comparable outcomes to the planned PD and urgent-start hemodialysis (HD). More importantly, as compared to urgent-start HD using a central venous catheter, urgent-start PD has significantly fewer incidences of catheter-related bloodstream infections, dialysis-related mechanical complications, and need for dialysis catheter reinsertions during the initial time of the therapy. An integrative review was conducted on PD urgent start compared to HD urgent start and to planned PD, identifying its potential advantages and limitations. Literature search was performed within multiple databases, and observational studies on clinical experience with urgent PD were reviewed and appraised.

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Success of Urgent-Start Peritoneal Dialysis in a Large Canadian Renal Program

Peritoneal Dialysis International ◽

10.3747/pdi.2014.00148 ◽

2016 ◽

Vol 36 (2) ◽

pp. 171-176 ◽

Cited By ~ 48

Author(s):

Ali M.A. Alkatheeri ◽

Peter G. Blake ◽

Daryl Gray ◽

Arsh K. Jain

Keyword(s):

Peritoneal Dialysis ◽

Venous Catheter ◽

Infectious Complications ◽

Outpatient Setting ◽

Dialysis Access ◽

Safe Alternative ◽

Canadian Experience ◽

Academic Center ◽

Alternative Approach ◽

A Minor

BackgroundMany patients start renal replacement therapy urgently on in-center hemodialysis via a central venous catheter, which is considered suboptimal. An alternative approach to manage these patients is to start them on peritoneal dialysis (PD). In this report, we describe the first reported Canadian experience with an urgent-start PD program. Additionally we reviewed the literature in this area.MethodsIn this prospective observational study, we report on our experience in a single academic center. This program started in July 2010. We included patients who initiated PD urgently, that is within 2 weeks of catheter insertion. We followed all incident PD patients until October 2013 for mechanical and infectious complications. Peritoneal dialysis catheters were inserted either percutaneously or laparoscopically and dialysis was initiated in either an inpatient or outpatient setting.ResultsThirty patients were started on urgent PD during our study period. Follow-up ranged from 28 to 1,050 days. Twenty insertions (66.7 %) were done percutaneously and 10 (33.3%) were laparoscopic. Dialysis was initiated within 2 weeks (range: 0 – 13 days, median = 6 days). Twenty-four patients (80%) started PD in an outpatient setting and 6 patients (20%) required immediate inpatient PD start. Three patients (10%) developed a minor peri-catheter leak during the first week of training that was managed conservatively. There were no episodes of peritonitis or exit-site/tunnel infection during the first 4 weeks post-insertion. Four patients (13.3 %) from the percutaneous insertion group and 2 patients (6.7%) from laparoscopic insertions developed catheter dysfunction due to migration, which was managed by repositioning, without need for catheter replacement or modality switch.ConclusionsOur results are consistent with other studies in this area and demonstrate that urgent-start PD is an acceptable and safe alternative to hemodialysis in patients who need to start dialysis urgently without established dialysis access.

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Options for end stage vascular access: Translumbar catheter, arterial-arterial access or right atrial graft?

The Journal of Vascular Access ◽

10.1177/1129729819841153 ◽

2019 ◽

Vol 21 (1) ◽

pp. 7-18 ◽

Cited By ~ 1

Author(s):

Nicholas Inston ◽

Aurangzaib Khawaja ◽

Hiren Mistry ◽

Robert Jones ◽

Domenico Valenti

Keyword(s):

Vascular Access ◽

Treatment Options ◽

Venous Catheter ◽

Right Atrial ◽

Secondary Patency ◽

Dialysis Access ◽

Arterial Access ◽

Secondary Patency Rate ◽

Number Of Patients ◽

End Stage

Background: Running out of vascular access for dialysis is thankfully rare, but despite this, most units will have a number of patients with few options and in a precarious state. The increasing longevity of dialysis patients portends more patients will reach minimal access options. End stage vascular access is poorly defined but classification may enable assessment and comparison of treatment options. Three options for patients with end stage access are a central venous catheter through a translumbar or transhepatic route, arterial-arterial prosthetic loop or a right atrial graft. Aims: The aims of this study are to provide a structured review of evidence for these procedures to allow application and guide practice for patients with end stage vascular access. Methods: A standardised search of published literature was performed of relevant studies. In addition, the references cited in those papers were assessed for any further available articles. All study types were included and reviewed by two authors independently. Primary outcomes were patient survival and secondary patency rate at 3 and 12 months. Secondary outcomes were long-term patency rates, mean time to cannulation and complications such as access dysfunction, thrombosis and infection. Summary: Based on the available evidence, it would appear that arterial-arterial prosthetic loop is a definitive option for maintaining dialysis access in patients with no more arteriovenous access options. Translumbar and transhepatic dialysis catheters may offer short- and medium-term options and right atrial grafts may also be suitable as an option where arterial-arterial prosthetic loop is unsuitable.

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Center-effect of incident hemodialysis vascular access use: Analysis of a bi-national registry

Kidney360 ◽

10.34067/kid.0005742020 ◽

2021 ◽

pp. 10.34067/KID.0005742020

Author(s):

Samantha Ng ◽

Elaine M. Pascoe ◽

David W. Johnson ◽

Carmel M. Hawley ◽

Kevan R. Polkinghorne ◽

...

Keyword(s):

Peritoneal Dialysis ◽

New Zealand ◽

Kidney Disease ◽

Smoking Status ◽

Venous Catheter ◽

National Registry ◽

Factors Associated ◽

Patient Level ◽

Number Of Patients ◽

Arteriovenous Access

Background: Commencing hemodialysis (HD) with an arteriovenous access is associated with superior patient outcomes compared to a catheter but the majority of patients in Australia and New Zealand (ANZ) initiate HD with a central venous catheter. This study examined patient and center factors associated with arteriovenous fistula/graft access use at HD commencement. Methods: All adult patients starting chronic HD in Australia and New Zealand between 2004 and 2015 were included. Access type at HD initiation was analyzed using logistic regression. Patient-level factors included sex, age, race, body mass index (BMI), smoking status, primary kidney disease, late nephrologist referral, comorbidities and prior kidney replacement therapy (KRT). Center-level factors included size, transplant capability, home HD proportion, incident peritoneal dialysis (average number of patients commencing KRT with peritoneal dialysis per year), mean weekly HD hours, average blood flow and achievement of phosphate, hemoglobin and weekly Kt/V targets. The study included 27,123 patients from 61 centers. Results: Arteriovenous access use at HD commencement varied 4-fold from 15% to 62% (median 39%) across centers. Incident arteriovenous access use was more likely in patients aged 51-72 years, males and patients with BMI >25kg/m2 and polycystic kidney disease but less likely in patients with BMI<18.5kg/m2, late nephrologist referral, diabetes mellitus, cardiovascular disease, chronic lung disease and prior KRT. Starting HD with an arteriovenous access was less likely in centers with the highest proportion of home HD and no center factor was associated with higher arteriovenous access use. Adjustment for center-level characteristics resulted in a 25% reduction in observed inter-center variability of arteriovenous access use at hemodialysis initiation compared to the model adjusted for only patient-level characteristics. Conclusions: This study identified several patient- and center-factors associated with incident hemodialysis access use, yet these factors did not fully explain the substantial variability in arteriovenous access use across centers.

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