Survival on Renal Replacement Therapy: Data from the EDTA Registry

Extensive survival data are presented from the EDTA Registry's files for patients who started renal replacement therapy in 1970-1974 compared to 1980-1984. The contribution of the different treatment modalities (haemodialysis, continuous peritoneal dialysis, and transplantation) to the survival of patients according to geographical region is also shown. Survival on renal replacement therapy, irrespective of treatment modality and of primary renal disease, was best in the 10-14-year-old patients, with 58% at 10 years and 52% at 15 years, and decreased with rising age to 28% at 10 years and 16% at 15 years in patients aged 45-54 when they commenced therapy in 1970-1974. When comparing the 0-4-year-old with the 10-14-year-old cohort of the paediatric patients, 5-year survival rates for patients starting renal replacement therapy in the early eighties declined from 85% to 70% with decreasing age. Treatment policy, as reflected by the proportion of patients on different modes of therapy, varied markedly between European regions but affected survival to a small extent only. The large population with diabetic nephropathy incurred annual mortality rates 2-3 times greater than those observed in patients with ‘standard' primary renal diseases. Haemodialysis and continuous peritoneal dialysis, although not comparable because of important differences in selection policy, yielded similar survival rates. Patient and graft survival rates have improved markedly when comparing patients starting renal replacement therapy in the early seventies with the eighties; particularly for cadaveric transplantation. Patient survival after second grafting was similar to that after first grafting, with 83% at 5 years after second cadaveric grafting in the 15-44-year-old cohort, vs 85% after first cadaver transplantation in 1980-1984. Second cadaveric graft survival was superior to average first-graft survival for those recipients whose first graft had been functioning for more than 1 year. However, second-graft survival in rapid rejectors of a first graft as well as third cadaveric graft survival were curtailed by the large number of early losses, with only 52% of third grafts functioning at 1 year. For living related donor transplantation, parents were mostly used in children whilst identical siblings predominated in adults older than 45. In the early eighties, patient survival was 92% at 5 years for recipients younger than 15, 87% for the 15-45 year old cohort and 72% for those aged 45 or older. From the overall survival rates on renal replacement therapy obtained at 5 years in the early eighties, it appears safe to predict that at least 65% of young adults and 25% of patients aged 55-64 will be surviving at 10 years after starting therap

Demography of Dialysis and Transplantation in Europe, 1984: Report from the European Dialysis and Transplant Association Registry

The demography of treatment of children by renal replacement therapy in Europe is presented based on returns of individual patient questionnaires to the EDTA Registry up until the close of 1984. Patient questionnaires for 1984 were completed by all centres which defined themselves as special paediatric units. A total of 4983 patients have been reported to the Registry up until 31 December 1984 as having commenced renal replacement therapy under the age of 15. Of these, 1570 were known to be alive on a defined form of treatment at the end of 1984 and still under the age of 15. The numbers of these patients kept alive by different forms of treatment in individual countries are presented. The stock of patients aged under 15 at the end of 1984 exceeded 30 per million child population in Belgium, France, Iceland and Luxembourg. The highest age specific acceptance rates for children onto renal replacement therapy during 1984 were noted in those aged between 10 and 14 at first treatment. Age specific acceptance rates for children varied greatly between individual countries, and 18 countries reported no new patients under the age of 5 during 1984. Transplant activity in paediatric patients during 1984 has been analysed and results on regrafting presented. Proportional distribution of primary renal diseases amongst children commencing therapy in 1984 is shown according to age at start of treatment. Haemolytic uraemic syndrome was reported as the cause of end-stage renal failure in 12.0% of children commencing treatment under the age of 5, and 12.3% of children between 5 and 9. Finally, information on cause of death in paediatric patients dying during 1984 is presented, and shows cardiovascular disease was the leading cause of mortalit

EDTA Registry Centre Survey, 1985: Report from the European Dialysis and Transplant Association Registry*

This paper summarises the information given on the 1985 EDTA Registry centre questionnaire which was returned by 82% of 1959 known dialysis and transplant units in 33 European countries. Trends in the use of different forms of renal replacement therapy are discussed, and attention drawn to the discrepancy between the EDTA centre and individual patient questionnaires as a source of demographic information on dialysis and transplantation. The results of special questions on dialyser re-use, dialysis equipment, AIDS, and hepatitis are presented, and information obtained from the special paediatric section of the centre questionnaire is also give

Survival of elderly patients with stage 5 CKD: comparison of conservative management and renal replacement therapy

Background. Elderly patients with end-stage renal disease and severe extra-renal comorbidity have a poor prognosis on renal replacement therapy (RRT) and may opt to be managed conservatively (CM). Information on the survival of patients on this mode of therapy is limited

Circulating and cellular markers of endothelial dysfunction with aging in rats

International audienceThe influence of age on endothelial functional markers was investigated in rats. Angiotensin I converting enzyme (ACE) activity and nitric oxide synthase (NOS) mRNA expressions were examined in the lung and aorta of 10-, 20-, and 30-mo-old normotensive rats. These data were extended by the measurement of circulating endothelial cells. ACE activity was significantly decreased in plasma ( P < 0.01) and lungs ( P < 0.01) at 30 mo, whereas it was significantly increased in the aorta ( P < 0.001) at this age. Conversely, ACE mRNA levels decreased with age in the lung ( P < 0.05). The level of constitutive endothelial NOS (eNOS) mRNA was significantly reduced in the aorta of 30-mo-old rats ( P < 0.05), but no changes were observed in the lungs. The level of inducible NOS (iNOS) mRNA in the aorta was significantly decreased in 20- and 30-mo-old rats ( P < 0.01), whereas it was significantly increased in the lung at 30 mo ( P < 0.01). Interestingly, eNOS was expressed ∼30 times more ( P < 0.001) in the aorta than iNOS, whereas in the lung it was only slightly higher than iNOS (35%; P < 0.001). Neuronal NOS mRNA expression was not modified with aging. In the aorta, guanosine 3′,5′-cyclic monophosphate concentration followed NOS expressions and showed a significant decrease at 30 mo ( P < 0.001). An increase in the number of circulating endothelial cells was observed in the oldest rats, possibly reflecting an increase in endothelial cell turnover with aging. The present results demonstrate that aging modifies the expression of endothelial markers implicated in the regulation of vasomotor tone. This age-dependent impairment of endothelial functions could contribute to the increased risk of pathological processes within the arterial wall associated with aging

Transforming growth factor-beta 1 production is correlated with genetically determined ACE expression in congenic rats: a possible link between ACE genotype and diabetic nephropathy.

Genetic background appears to modulate the development of diabetic vascular complications. In particular, polymorphisms in the ACE gene have been associated with diabetic nephropathy and, in some studies, macrovascular complications. However, the links between ACE gene polymorphism and factors implicated in diabetes complications remain unknown. The aim of this study was to determine whether the ACE genotype could modify factors, such as transforming growth factor (TGF)-beta 1, involved in the complications of diabetes. For this purpose, congenic rats (L.BNAce10), differing from the LOU strain in only a small segment of chromosome 10 containing the ACE locus, were generated. These congenic rats have plasma ACE levels twice as high as the donor strain. Diabetes was induced in rats of both strains, and its effects on ACE and TGF-beta 1 expressions were evaluated in lungs and kidneys. In lung, the main source of ACE production, ACE mRNA levels and activity were higher in L.BNAce10 rats than in LOU rats. Diabetes increased ACE lung expression in rats of both strains in a similar manner. TGF-beta 1 expression was also higher in lungs of L.BNAce10 compared with LOU rats and was also increased by diabetes. Furthermore, a strong correlation was found between TGF-beta 1 and ACE expressions. In renal arterioles, ACE and TGF-beta mRNA expressions were higher in L.BNAce10 rats than LOU rats (both diabetic and nondiabetic). In these vessels, there was also a correlation between ACE and TGF-beta 1 expressions. Urine TGF-beta 1 concentration depended on the genotype and was further increased by diabetes. These results show that TGF-beta 1 expression is correlated with ACE expression and suggest that this growth factor could be a link between ACE gene polymorphism and diabetic vascular complications