Mortalidad y recurrencia de la enfermedad tromboembólica venosa en pacientes adultos: cohorte prospectiva

INTRODUCCIÓN: La enfermedad tromboembólica venosa (ETV) es una patología que aumenta con la edad. Objetivo: comparar la sobrevida de los ancianos y los jóvenes con un primer episodio de ETV aguda y sintomática. MATERIALES Y MÉTODOS: Cohorte prospectiva de casos incidentes de ETV incluidos en el Registro Institucional de Enfermedad Tromboembólica venosa (NCT01372514) del Hospital Italiano de Buenos Aires entre 2012-2014, dividido en grupos jóvenes (17-64 años) y ancianos (≥ 65 años). Todos los pacientes fueron seguidos anualmente para evaluar el tiempo a la recurrencia (progresión o nuevo evento sintomático de ETV) como eventos competitivos en contexto de muerte y sangrado mayor. Se presentaron los riesgos crudos (c) y ajustados (a). RESULTADOS: se incluyeron 446 pacientes, el 63% (292) fueron mayores de 65 años. La sobrevida fue menor en los ancianos comparados con los jóvenes (p 0.007), a los 3 meses 87% vs 95% y al año 73% vs 87%, respectivamente. Los ancianos presentaron un HRc1,71 y HR a 1.68. La recurrencia global fue 5% (IC 95% 3-8) al mes, 6% (IC 95% 4-9) a los 3 meses, 8% (IC 95% 6-11) al año y 13% (IC 95% 9-18) a los dos años. No se encontró asociación entre la edad y la recurrencia sub hazard 0.8(IC 0,34-1,86). El sangrado ocurrió en un 9% (39) de los pacientes. CONCLUSIONES: La mortalidad global en pacientes con ETV confirmada es mayor en la población anciana. No hubo diferencias en relación a la recurrencia de ETV, ni el sangrado y tampoco con la edad.INTRODUCTION: Venous thromboembolic disease (VTE) is a pathology that increases with age. OBJECTIVE: to compare the survival of the elderly and the young with a first episode of acute and symptomatic VTE. MATERIALS AND METHODS: Prospective cohort of incident VTE cases included in the Institutional Registry of Venous Thromboembolic Disease (NCT01372514) of the Italian Hospital of Buenos Aires between 2012-2014, divided into young groups (17-64 years old) and elderly (65 years old). All the patients were followed annually to assess the time to recurrence (progression or new symptomatic event of VTE) as competitive events in the context of death and major bleeding. Raw (c) and adjusted (a) risks were presented. RESULTS: 446 patients were included, 63% (292) were older than 65 years. Survival was lower in the elderly compared to the young (p 0.007), at 3 months 87% vs. 95% and at one year 73% vs. 87%, respectively. The elderly had a HRc1.71 and HR at 1.68. The overall recurrence was 5% (95% CI 3-8) at one month, 6% (95% CI 4-9) at 3 months, 8% (95% CI). 6-11) at one year and 13% (95% CI 9-18) at two years. No association was found between age and recurrence sub hazard 0.8 (CI 0.34- 1.86). Bleeding occurred in 9% (39) of the patients. CONCLUSIONS: The overall mortality in patients with confirmed VTE is higher in the elderly population. There were no differences in relation to the recurrence of VTE, or bleeding, and neither with age.INTRODUÇÃO: A doença tromboembólica venosa (TEV) é uma patologia que aumenta com a idade. OBJETIVO: comparar a sobrevida de idosos e jovens com um primeiro episódio de TEV agudo e sintomático. MATERIAIS E MÉTODOS:Coorte prospectiva de casos de TEV incidentes incluídos no Registro Institucional de Doença Tromboembólica Venosa (NCT01372514) do Hospital Italiano de Buenos Aires entre 2012-2014, divididos em grupos jovens (17 a 64 anos) e idosos (65 anos) velho). Todos os pacientes foram acompanhados anualmente para avaliar o tempo de recorrência (progressão ou novo evento sintomático de TEV) como eventos competitivos no contexto de morte e sangramento grave. Os riscos brutos (c) e ajustados (a) foram apresentados. RESULTADOS:446 pacientes foram incluídos, 63% (292) tinham idade superior a 65 anos. A sobrevida foi menor nos idosos em comparação aos jovens (p 0,007), aos 3 meses 87% vs. 95% e aos um ano 73% vs. 87%, respectivamente. Os idosos apresentaram HRc1.71 e FC em 1,68. A recorrência geral foi de 5% (IC95% 3-8) em um mês, 6% (IC95% 4-9) em 3 meses, 8% (IC95%). 6-11) em um ano e 13% (IC95% 9-18) em dois anos. Não foi encontrada associação entre idade e recorrência sub-risco 0,8 (IC 0,34-1,86). Ocorreu sangramento em 9% (39) dos pacientes. CONCLUSÕES: A mortalidade geral em pacientes com TEV confirmado é maior na população idosa. Não houve diferenças em relação à recorrência de TEV ou sangramento e nem com a idade.Fil: Posadas Martinez, Maria Lourdes. Hospital Italiano. Departamento de Medicina. Servicio de Clínica Médica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Pagotto, Vanina Laura. Hospital Italiano. Departamento de Medicina. Servicio de Clínica Médica; ArgentinaFil: Grande Ratti, Maria Florencvia. Hospital Italiano. Departamento de Medicina. Servicio de Clínica Médica; ArgentinaFil: Alfie, Veronica. Hospital Italiano. Departamento de Medicina. Servicio de Clínica Médica; ArgentinaFil: Andresik, Diego. Hospital Italiano. Departamento de Medicina. Servicio de Clínica Médica; ArgentinaFil: Torres Gomez, Felipe. Hospital Italiano. Departamento de Medicina. Servicio de Clínica Médica; ArgentinaFil: Giunta, Diego Hernan. Hospital Italiano. Departamento de Medicina. Servicio de Clínica Médica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Luxardo, Rosario. Hospital Italiano. Departamento de Medicina. Servicio de Clínica Médica; ArgentinaFil: Scolnik, Marina. Hospital Italiano. Departamento de Medicina. Servicio de Clínica Médica; ArgentinaFil: Vazquez, Fernando Javier. Hospital Italiano. Departamento de Medicina. Servicio de Clínica Médica; Argentin

The epidemiology of renal replacement therapy in two different parts of the worldThe Latin American Dialysis and Transplant Registry versus the European Renal Association-European Dialysis and Transplant Association Registry

Funding Information: This paper was written by Rosario Luxardo et al. as part of the 2015-2016 ERA-EDTA/SLANH Registries fellowship. The ERAEDTA Registry is funded by the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) and is an official body of the ERA-EDTA. We would like to thank the patients and staff of all the dialysis and transplant units that have contributed data via their national and subnational renal registries. In addition, we would like to thank all persons and organizations that have contributed to the work of the RLADTR and ERA-EDTA registries. Funding Information: paper was written by Rosario Luxardo et al. as part of the 2015–2016 ERA-EDTA/ SLANH Registries fellowship. The ERA-EDTA Registry is funded by the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) and is an official body of the ERA-EDTA. We would like to thank the patients and staff of all the dialysis and transplant units that have contributed data via their national and subnational renal registries. In addition, we would like to thank all persons and organizations that have contributed to the work of the RLADTR and ERA-EDTA registries. Publisher Copyright: © 2018 Pan American Health Organization. All rights reserved.Objective: To compare the epidemiology of renal replacement therapy (RRT) for end-stage renal disease (ESRD) in Latin America and Europe, as well as to study differences in macro-economic indicators, demographic and clinical patient characteristics, mortality rates, and causes of death between these two populations. Methods: We used data from 20 Latin American and 49 European national and subnational renal registries that had provided data to the Latin American Dialysis and Renal Transplant Registry (RLADTR) and the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) Registry, respectively. The incidence and prevalence of RRT in 2013 were calculated per million population (pmp), overall and by subcategories of age, sex, primary renal disease, and treatment modality. The correlation between gross domestic product and the prevalence of RRT was analyzed using linear regression. Trends in the prevalence of RRT between 2004 and 2013 were assessed using Joinpoint regression analysis. Results: In 2013, the overall incidence at day 91 after the onset of RRT was 181 pmp for Latin American countries and 130 pmp for European countries. The overall prevalence was 660 pmp for Latin America and 782 pmp for Europe. In the Latin American countries, the annual increase in the prevalence averaged 4.0% (95% confdence interval (CI): 2.5%-5.6%) from 2004 to 2013, while the European countries showed an average annual increase of 2.2% (95% CI: 2.0%-2.4%) for the same time period. The crude mortality rate was higher in Latin America than in Europe (112 versus 100 deaths per 1 000 patient-years), and cardiovascular disease was the main cause of death in both of those regions. Conclusions. There are considerable differences between Latin America and Europe in the epidemiology of RRT for ESRD. Further research is needed to explore the reasons for these differences.publishersversionPeer reviewe

The epidemiology of renal replacement therapy in two different parts of the worldThe Latin American Dialysis and Transplant Registry versus the European Renal Association-European Dialysis and Transplant Association Registry

Publisher Copyright: © 2018 Pan American Health Organization. All rights reserved.Objective: To compare the epidemiology of renal replacement therapy (RRT) for end-stage renal disease (ESRD) in Latin America and Europe, as well as to study differences in macro-economic indicators, demographic and clinical patient characteristics, mortality rates, and causes of death between these two populations. Methods: We used data from 20 Latin American and 49 European national and subnational renal registries that had provided data to the Latin American Dialysis and Renal Transplant Registry (RLADTR) and the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) Registry, respectively. The incidence and prevalence of RRT in 2013 were calculated per million population (pmp), overall and by subcategories of age, sex, primary renal disease, and treatment modality. The correlation between gross domestic product and the prevalence of RRT was analyzed using linear regression. Trends in the prevalence of RRT between 2004 and 2013 were assessed using Joinpoint regression analysis. Results: In 2013, the overall incidence at day 91 after the onset of RRT was 181 pmp for Latin American countries and 130 pmp for European countries. The overall prevalence was 660 pmp for Latin America and 782 pmp for Europe. In the Latin American countries, the annual increase in the prevalence averaged 4.0% (95% confdence interval (CI): 2.5%-5.6%) from 2004 to 2013, while the European countries showed an average annual increase of 2.2% (95% CI: 2.0%-2.4%) for the same time period. The crude mortality rate was higher in Latin America than in Europe (112 versus 100 deaths per 1 000 patient-years), and cardiovascular disease was the main cause of death in both of those regions. Conclusions. There are considerable differences between Latin America and Europe in the epidemiology of RRT for ESRD. Further research is needed to explore the reasons for these differences.Peer reviewe

Changes in co-morbidity pattern in patients starting renal replacement therapy in Europe:data from the ERA-EDTA Registry

Patients starting renal replacement therapy (RRT) for end-stage renal disease often present with one or more co-morbidities. This study explored the prevalence of co-morbidities in patients who started RRT in Europe during the period from 2005 to 2014. Using data from patients aged 20 years or older from all 11 national or regional registries providing co-morbidity data to the European Renal Association - European Dialysis and Transplant Association Registry, we examined the prevalence of the following co-morbidities: diabetes mellitus (DM) (primary renal disease and/or co-morbidity), ischaemic heart disease (IHD), congestive heart failure (CHF), peripheral vascular disease (PVD), cerebrovascular disease (CVD) and malignancy. Overall, 70% of 7578 patients who initiated RRT in 2014 presented with at least one co-morbidity: 39.0% presented with DM, 25.0% with IHD, 22.3% with CHF, 17.7% with PVD, 16.4% with malignancy and 15.5% with CVD. These percentages differed substantially between countries. Co-morbidities were more common in men than in women, in older patients than in younger patients, and in patients on haemodialysis at Day 91 when compared with patients on peritoneal dialysis. Between 2005 and 2014 the prevalence of DM and malignancy increased over time, whereas the prevalence of IHD and PVD declined. More than two-thirds of patients initiating RRT in Europe have at least one co-morbidity. With the rising age at the start of RRT over the last decade, there have been changes in the co-morbidity pattern: the prevalence of cardiovascular co-morbidities decreased, while the prevalence of DM and malignancy increase