Nutritional research and intensive nutritional counselling of the chronic kidney disease patients after kidney transplantation

Background: Dietology treatment is the one of the foundation stones in the complex treatment of the chronic kidney disease (CKD) patients together with all other treatments. The dietary intervention plays an important role to determine the effects to a decrease of metabolic abnormalities.Aim: The aim of the long-term study was to monitor nutritional parameters in the post-transplant period.Subjects and methods: We studied 28 clinically stable consecutive nondiabetic kidney transplant patients: 12 males at the age of 42.8 ± 16.1 years, and 16 females at the age of 47.0 ± 14.9 years. Intensive nutritional counselling and dietary consultation by a dietitian were carried out for all the studied patients during one and a half years after the kidney transplantation. Initial data were compared with the results obtained at the end of the study. During the 3-days dietary records analysis and counselling of CKD patients, giving answers to their questions about their food and portion sizes, the dietitian used the standards portion book with many photographs.Results: The consumption of vegetables and fruit was modest compared to Estonian food and nutrition recommendations. The food frequency questionnaire revealed that the patients consumed different foodstuffs at different frequencies, but there was a tendency to excessive consumption of foodstuffs rich in proteins and carbohydrates. To consumption of fat-rich foodstuffs a tendency of decrease was found.Conclusion: An intensive nutritional counselling and healthy diet, avoiding excessive amounts of alcohol as well as regular exercise can help to reduce the chance of developing of chronic transplant nephropathy

Peritoneal Dialysis Penetration and Peritonitis Rate at a Single Centre during Last Decade

Peritoneal dialysis (PD) has been intensively offered at our centre to patients (pts) with end-stage renal disease (ESRD) from 2000, and the number of PD pts was noticed to raise. We aimed to analyse the PD population from the aspect of penetration and peritonitis rate during eleven years. Cumulative number of new RRT pts was 378 during the study period. We found high PD penetration rate: 53% (range 32–72%). The rate of peritonitis was as high as 9.8 during first study years, but it has declined progressively last year being 29.1 by September 2010 and 21.7 by December 2010. Most cases of peritonitis were due to gram-positive pathogens. We have demonstrated steady high single-centre PD penetration rate and improvement of management of patients during last decade probably because of the result of better pts education and a continued dedication of the staff

Impact of Anthropometric Measurements in Clinical Practice

Anthropometry helps to assess nutritional status which is an important determinant of clinical outcome in many patients, including the number of those suffering from chronic kidney disease (CKD). Weight gain after successful kidney transplantation is a well-known phenomenon, therefore we hypothesized that intensive counseling, based of menu analysis by a dietitian of CKD patients with a kidney transplant, can prevent the significant body weight (BW) gain after the transplant operation. The aim of the investigation was to study long-term anthropometrical, biochemical and dual-energy densitometry changes in the kidney transplant patients, to study correlations between the studied parameters and to compare those with the follow-up data. The prospective long-term study was carried out in 28 clinically stable renal transplant patients. Control groups consisted both transplant patients (47 patients), receiving ordinary nutritional counseling, and of healthy population subjects (342). Anthropometry and biochemistry were studied in patients twice: the first follow-up (FU1) data were collected 1.3±0.2 years, and the second follow-up (FU2) data were collected 2.7±0.3 years after the transplant. Significant BW gain was found only in renal transplant male patients (FU1 vs. FU2, p<0.001) but not in females. The mean weight gain in control group patients was significant both in the male and female groups. In males, the mean C-reactive protein was significantly correlated with different body circumferences. But, in females, no clear associations were found. In females, significant correlation was found between mean body weight, body mass index and triglycerides. We conclude that the use of anthropometry in clinical practice, together with intensive and individual counseling by a dietitian, should be regular in the kidney transplant patients’ population to prevent overweight. Monitoring of the dynamics of anthropometrical and biochemical parameters are clinically relevant in the post-transplant period together with densitometry

Suboptimal dialysis initiation is associated with comorbidities and uraemia progression rate but not with estimated glomerular filtration rate

Publisher Copyright: © 2020 The Author(s) 2020. Published by Oxford University Press on behalf of ERA-EDTA.Background: Despite early referral of uraemic patients to nephrological care, suboptimal dialysis initiation (SDI) remains a common problem associated with increased morbimortality. We hypothesized that SDI is related to pre-dialysis care. Methods: In the 'Peridialysis' study, time and reasons for dialysis initiation (DI), clinical and biochemical data and centre characteristics were registered during the pre- and peri-dialytic period for 1583 end-stage kidney disease patients starting dialysis over a 3-year period at 15 nephrology departments in the Nordic and Baltic countries to identify factors associated with SDI. Results: SDI occurred in 42%. Risk factors for SDI were late referral, cachexia, comorbidity (particularly cardiovascular), hypoalbuminaemia and rapid uraemia progression. Patients with polycystic renal disease had a lower incidence of SDI. High urea and C-reactive protein levels, acidosis and other electrolyte disorders were markers of SDI, independently of estimated glomerular filtration rate (eGFR). SDI patients had higher eGFR than non-SDI patients during the pre-dialysis period, but lower eGFR at DI. eGFR as such did not predict SDI. Patients with comorbidities had higher eGFR at DI. Centre practice and policy did not associate with the incidence of SDI. Conclusions: SDI occurred in 42% of all DIs. SDI was associated with hypoalbuminaemia, comorbidity and rate of eGFR loss, but not with the degree of renal failure as assessed by eGFR.Peer reviewe

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

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.</p

Suboptimal dialysis initiation is associated with comorbidities and uraemia progression rate but not with estimated glomerular filtration rate

Background Despite early referral of uraemic patients to nephrological care, suboptimal dialysis initiation (SDI) remains a common problem associated with increased morbimortality. We hypothesized that SDI is related to pre-dialysis care.Methods In the 'Peridialysis' study, time and reasons for dialysis initiation (DI), clinical and biochemical data and centre characteristics were registered during the pre- and peri-dialytic period for 1583 end-stage kidney disease patients starting dialysis over a 3-year period at 15 nephrology departments in the Nordic and Baltic countries to identify factors associated with SDI.Results SDI occurred in 42%. Risk factors for SDI were late referral, cachexia, comorbidity (particularly cardiovascular), hypoalbuminaemia and rapid uraemia progression. Patients with polycystic renal disease had a lower incidence of SDI. High urea and C-reactive protein levels, acidosis and other electrolyte disorders were markers of SDI, independently of estimated glomerular filtration rate (eGFR). SDI patients had higher eGFR than non-SDI patients during the pre-dialysis period, but lower eGFR at DI. eGFR as such did not predict SDI. Patients with comorbidities had higher eGFR at DI. Centre practice and policy did not associate with the incidence of SDI.Conclusions SDI occurred in 42% of all DIs. SDI was associated with hypoalbuminaemia, comorbidity and rate of eGFR loss, but not with the degree of renal failure as assessed by eGFR.</p

Supplemented ERA-EDTA Registry data evaluated the frequency of dialysis, kidney transplantation, and comprehensive conservative management for patients with kidney failure in Europe

The aims of this study were to determine the frequency of dialysis and kidney transplantation and to estimate the regularity of comprehensive conservative management (CCM) for patients with kidney failure in Europe. This study uses data from the ERA-EDTA Registry. Additionally, our study included supplemental data from Armenia, Germany, Hungary, Ireland, Kosovo, Luxembourg, Malta, Moldova, Montenegro, Slovenia and additional data from Israel, Italy, Slovakia using other information sources. Through an online survey, responding nephrologists estimated the frequency of CCM (i.e. planned holistic care instead of kidney replacement therapy) in 33 countries. In 2016, the overall incidence of replacement therapy for kidney failure was 132 per million population (pmp), varying from 29 (Ukraine) to 251 pmp (Greece). On 31 December 2016, the overall prevalence of kidney replacement therapy was 985 pmp, ranging from 188 (Ukraine) to 1906 pmp (Portugal). The prevalence of peritoneal dialysis (114 pmp) and home hemodialysis (28 pmp) was highest in Cyprus and Denmark respectively. The kidney transplantation rate was nearly zero in some countries and highest in Spain (64 pmp). In 28 countries with five or more responding nephrologists, the median percentage of candidates for kidney replacement therapy who were offered CCM in 2018 varied between none (Slovakia and Slovenia) and 20% (Finland) whereas the median prevalence of CCM varied between none (Slovenia) and 15% (Hungary). Thus, the substantial differences across Europe in the frequency of kidney replacement therapy and CCM indicate the need for improvement in access to various treatment options for patients with kidney failure.Peer reviewe

The ERA Registry Annual Report 2019 : summary and age comparisons

Background Data on renal replacement therapy (RRT) for end-stage renal disease were collected by the European Renal Association (ERA) Registry via national and regional renal registries in Europe and countries bordering the Mediterranean Sea. This article provides a summary of the 2019 ERA Registry Annual Report, including data from 34 countries and additional age comparisons. Methods Individual patient data for 2019 were provided by 35 registries and aggregated data by 17 registries. Using these data, the incidence and prevalence of RRT, the kidney transplantation activity and the survival probabilities were calculated. Results In 2019, a general population of 680.8 million people was covered by the ERA Registry. Overall, the incidence of RRT was 132 per million population (p.m.p.). Of these patients, 62% were men, 54% were >= 65 years of age and 21% had diabetes mellitus as primary renal disease (PRD), and 84% had haemodialysis (HD), 11% had peritoneal dialysis (PD) and 5% had pre-emptive kidney transplantation as an initial treatment modality. The overall prevalence of RRT on 31 December 2019 was 893 p.m.p., with 58% of patients on HD, 5% on PD and 37% living with a kidney transplant. The overall kidney transplant rate was 35 p.m.p. and 29% of the kidney grafts were from a living donor. The unadjusted 5-year survival probability was 42.3% for patients commencing dialysis, 86.6% for recipients of deceased donor grafts and 94.4% for recipients of living donor grafts in the period 2010-14. When comparing age categories, there were substantial differences in the distribution of PRD, treatment modality and kidney donor type, and in the survival probabilities.Peer reviewe

The ERA Registry Annual Report 2021:a summary

BackgroundThe European Renal Association (ERA) Registry collects data on kidney replacement therapy (KRT) in patients with end-stage kidney disease (ESKD). This paper is a summary of the ERA Registry Annual Report 2021, including a comparison across treatment modalities.MethodsData was collected from 54 national and regional registries from 36 countries, of which 35 registries from 18 countries contributed individual patient data and 19 registries from 19 countries contributed aggregated data. Using this data, incidence and prevalence of KRT, kidney transplantation rates, survival probabilities and expected remaining lifetimes were calculated.ResultsIn 2021, 533.2 million people in the general population were covered by the ERA Registry. The incidence of KRT was 145 per million population (pmp). In incident patients, 55% were 65 years or older, 64% were male, and the most common primary renal disease (PRD) was diabetes (22%). The prevalence of KRT was 1040 pmp. In prevalent patients, 47% were 65 years or older, 62% were male, and the most common PRDs were diabetes and glomerulonephritis/sclerosis (both 16%). On 31 December 2021, 56% of patients received haemodialysis, 5% received peritoneal dialysis, and 39% were living with a functioning graft. The kidney transplantation rate in 2021 was 37 pmp, a majority coming from deceased donors (66%). For patients initiating KRT between 2012–2016, 5-year survival probability was 52%. Compared to the general population, life expectancy was 65% and 68% shorter for males and females receiving dialysis, and 40% and 43% shorter for males and females living with a functioning graft