Current trends in European renal epidemiology

The incidence of end-stage renal disease (ESRD) continues to vary substantially between the countries in Europe that contribute data to the ERA-EDTA Registry. Differences can be attributed to socioeconomic factors and prophylaxis programs for patients with chronic kidney disease (CKD) and may also express real differences in CKD incidence. Recently, age-adjusted ESRD incidence has begun to fall in many countries, probably related to improved prophylaxis. However, absolute rates may increase, partly due to socioeconomic advances in countries with a low gross domestic product and partly due to continuing increases in the proportion of elderly patients. Prevalence rates are expected to continue to increase, mainly due to increases in relative transplant prevalence, improved graft survival times and continuing improvements in both dialysis and transplant patient survival. Overall treatment results continue to improve

Root-cause analysis of RSAF Maintenance-related Flight Safety Mishaps

Poor maintenance is a major factor in many aviation mishaps. This is due to the fact that some maintenance activities are carried out improperly or overlooked as a result of human error. It is important to acknowledge that maintenance mistakes are a visible sign of deeper organizational issues. Therefore, adequate solutions to maintenance issues must consider organizational influences. Despite efforts to reduce the accident rate within the Royal Saudi Air Force (RSAF), the RSAF suffers from an increasing trend in mishaps attributed to maintenance. Therefore, safety data was analyzed to examine trends. Additionally, the Human Factors Analysis and Classification System (HFACS) was used to investigate accident reports in an attempt to discover the root causes of the accidents. HFACS was applied to 16 maintenance-related accidents to capture the nature of and connections among latent conditions and active failures, as well as uncover the underlying causes to the accidents. Twelve-hour shifts, fatigue, shift handover documentation & record-keeping, and management response to maintenance issues were among the underlying causes discovered in this research

Measuring senescence rates of patients with end-stage renal disease while accounting for population heterogeneity : an analysis of data from the ERA-EDTA Registry

Purpose: Although a population's senescence rate is classically measured as the increase in mortality rate with age on a logarithmic scale, it may be more accurately measured as the increase on a linear scale. Patients on dialysis, who suffer from accelerated senescence, exhibit a smaller increase in their mortality rate on a logarithmic scale, but a larger increase on a linear scale than patients with a functioning kidney transplant. However, this comparison may be biased by population heterogeneity. Methods: Follow-up data on 323,308 patients on dialysis and 91,679 patients with a functioning kidney transplant were derived from the ERA-EDTA Registry. We measured the increases in their mortality rates using Gompertz frailty models that allow individual variation in this increase. Results: According to these models, the senescence rate measured as the increase in mortality rate on a logarithmic scale was smaller in patients on dialysis, while the senescence rate measured as the increase on a linear scale was larger in patients on dialysis than patients with a functioning kidney transplant. Conclusions: Also when accounting for population heterogeneity, a population's senescence rate is more accurately measured as the increase in mortality rate on a linear scale than a logarithmic scale. (C) 2016 Elsevier Inc. All rights reserved.Peer reviewe

Choice of dialysis modality among patients initiating dialysis : results of the Peridialysis study

© The Author(s) 2020. Published by Oxford University Press on behalf of ERA-EDTA.Background: In patients with end-stage kidney disease (ESKD), home dialysis offers socio-economic and health benefits compared with in-centre dialysis but is generally underutilized. We hypothesized that the pre-dialysis course and institutional factors affect the choice of dialysis modality after dialysis initiation (DI). Methods: The Peridialysis study is a multinational, multicentre prospective observational study assessing the causes and timing of DI and consequences of suboptimal DI. Clinical and biochemical data, details of the pre-dialytic course, reasons for DI and causes of the choice of dialysis modality were registered. Results: Among 1587 included patients, 516 (32.5%) were judged unsuitable for home dialysis due to contraindications [384 ( 24.2%)] or no assessment [106 (6.7%); mainly due to late referral and/or suboptimal DI] or death [26 (1.6%)]. Older age, comorbidity, late referral, suboptimal DI, acute illness and rapid loss of renal function associated with unsuitability. Of the remaining 1071 patients, 700 (65.4%) chose peritoneal dialysis (61.7%) or home haemodialysis (HD; 3.6%), while 371 (34.6%) chose in-centre HD. Somatic differences between patients choosing home dialysis and in-centre dialysis were minor; factors linked to the choice of in-centre dialysis were late referral, suboptimal DI, acute illness and absence of a 'home dialysis first' institutional policy. Conclusions: Given a personal choice with shared decision making, 65.4% of ESKD patients choose home dialysis. Our data indicate that the incidence of home dialysis potentially could be further increased to reduce the incidence of late referral and unplanned DI and, in acutely ill patients, by implementing an educational programme after improvement of their clinical condition.publishersversionPeer reviewe

Survival Benefit in Renal Transplantation Despite High Comorbidity

BACKGROUND: The age and degree of comorbidity among transplant candidates is increasing. Knowledge of survival benefit in relation to recipient age and comorbidity is important, considering the scarcity of organs available for transplantation. The aim of the present study was to analyze the chances and survival benefit of transplantation among patients in different age groups and with different degrees of comorbidity score at the time of entering the waiting list. METHODS: Data from the Danish Nephrology Registry and Scandiatransplant were merged. Charlson Comorbidity Index scores were derived from the National Danish Admissions Registry. Study period is from January 1, 1995, to December 31, 2011. A multistate model was used to analyze the chance of having a renal transplantation and the effect of transplantation in different patients groups. RESULTS: Patients older than 65 years and patients with high comorbidity score had a decreased chance of being transplanted. However, if patients older than 65 years were transplanted with deceased donor, the mortality risk was reduced by 55% (hazard rate, 0.45 (0.26-0.75). In patients with a comorbidity score of 5 or greater, receiving a deceased donor transplant reduced the mortality risk by 72% (hazard rate, 0.28 (0.20-0.39). The overall survival benefit was 62% versus 70% in deceased versus living donor transplanted patients. CONCLUSIONS: Poor health and old age reduced the chance of being transplanted. However, patients older than 65 years and patients with high comorbidity still had a survival benefit from renal transplantation

Referral rate of chronic kidney disease patients to a nephrologist in the Region of Southern Denmark:results from KidDiCo

BACKGROUND: Data on the referral rate of chronic kidney disease (CKD) patients to specialists are sparse. Investigating referral rates and characterizing patients with kidney disease not followed by a nephrologist are relevant for future measures in order to optimize public health and guideline implementation.METHODS: Data were extracted from the Kidney Disease Cohort of Southern Denmark (KidDiCo). Referral rates for all incident CKD patients below 60 mL/min/1.73 m² and referral rates according to the KDIGO guidelines based on glomerular filtration rates below 30 mL/min/1.73 m² were calculated. Information on contact with one of the nephrologist outpatient clinics in the Region of Southern Denmark was collected from the Danish National Patient Registry. The individual follow-up time for nephrology contact was 12 months. Additional data were accessed via the respective national databases. CKD patients on dialysis and kidney transplanted patients were excluded.RESULTS: A total of 3% of patients with an eGFR &lt;60 mL/min/1.73 m²-16% of patients with an eGFR &lt;30 mL/min/1.73 m² and 35% of patients with an eGFR &lt;15 mL/min/1.73 m² were in contact with a nephrologist in the outpatient settings. Younger age, male sex, diabetes, hypertension, higher education and proximity to a nephrology outpatient clinic increased the chance of nephrology follow-up.CONCLUSION: Only a small fraction of CKD patients are followed by a nephrologist. More studies should be performed in order to find out which patients will profit the most from renal referral and how to optimize the collaboration between nephrologists and general practitioners.</p

Adult Height in Patients with Advanced CKD Requiring Renal Replacement Therapy during Childhood.

BACKGROUND AND OBJECTIVES: Growth and final height are of major concern in children with ESRD. This study sought to describe the distribution of adult height of patients who started renal replacement therapy (RRT) during childhood and to identify determinants of final height in a large cohort of RRT children. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A total of 1612 patients from 20 European countries who started RRT before 19 years of age and reached final height between 1990 and 2011 were included. Linear regression analyses were performed to calculate adjusted mean final height SD score (SDS) and to investigate its potential determinants. RESULTS: The median final height SDS was -1.65 (median of 168 cm in boys and 155 cm in girls). Fifty-five percent of patients attained an adult height within the normal range. Adjusted for age at start of RRT and primary renal diseases, final height increased significantly over time from -2.06 SDS in children who reached adulthood in 1990-1995 to -1.33 SDS among those reaching adulthood in 2006-2011. Older age at start of RRT, more recent period of start of RRT, cumulative percentage time on a functioning graft, and greater height SDS at initiation of RRT were independently associated with a higher final height SDS. Patients with congenital anomalies of the kidney and urinary tract and metabolic disorders had a lower final height than those with other primary renal diseases. CONCLUSIONS: Although final height remains suboptimal in children with ESRD, it has consistently improved over time

Changes in clinical indicators related to the transition from dialysis to kidney transplantation-data from the ERA-EDTA Registry

Background. Kidney transplantation should improve abnormalities that are common during dialysis treatment, like anaemia and mineral and bone disorder. However, its impact is incompletely understood. We therefore aimed to assess changes in clinical indicators after the transition from chronic dialysis to kidney transplantation. Methods. We used European Renal Association-European Dialysis and Transplant Association Registry data and included adult dialysis patients for whom data on clinical indicators before and after transplantation (2005-15) were available. Linear mixed models were used to quantify the effect of transplantation and of time after transplantation for each indicator. Results. In total, 16 312 patients were included. The mean age at transplantation was 50.1 (standard deviation 14.2) years, 62.9% were male and 70.2% were on haemodialysis before transplantation. Total, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol and triglycerides increased right after transplantation but decreased thereafter. All other indicators normalized or approached the target range soon after transplantation and these improvements were sustained for the first 4 years of follow-up. In patients with higher estimated glomerular filtration rate (eGFR) levels (30-60 and >60 mL/min/1.73 m(2)), the improvement of haemoglobin, ferritin, ionized calcium, phosphate, parathyroid hormone, HDL cholesterol, triglycerides, albumin and C-reactive protein levels was more pronounced than in patients with a lower eGFR ( Conclusions. Except for total cholesterol, LDL cholesterol and triglycerides, all clinical indicators improved after transplantation. These improvements were related to eGFR. Nevertheless, values remained out of range in a considerable proportion of patients and anaemia and hyperparathyroidism were still common problems. Further research is needed to understand the complex relationship between eGFR and the different clinical indicators.Peer reviewe