Determinants of hospitalization in a cohort of chronic dialysis patients in central Italy

Background: Few studies linking hospital discharge records with the population register of chronic dialysis (CD) patients are available. This study aimed to evaluate the frequency and the determinants of hospitalization, taking into account the demographic, clinical and biochemical data. Methods: We conducted a retrospective cohort study in 3411 patients starting dialysis from 1996-2000, reported to the Lazio Dialysis Registry (RDL) (Italy). These patients were linked with the hospital information system from 1996-2002. Hospital admission probability was calculated using the Kaplan-Meier method. To evaluate the determinants of hospitalization risk we used Cox's proportional hazards for the first admission and a marginal model considering competitive effect of mortality, the Wei-Lin-Weissfeld model, for any admission. Results: We found 7530 hospital admissions, referring to 1711 patients (50.7%), with a rate of 63/100 person-years. The most prevalent diagnoses were "diseases of the genitourinary system", (37.4%), and "diseases of the circulatory system", among secondary diagnoses (46.6%). Hospitalization probability was 34.4% at 1 yr after starting dialysis. The risk of first and any hospital admission was higher (p<0.05) for patients having more than one comorbid disease, hematocrit (Hct) level <30%, serum albumin level <3.5 g/dL, and a low degree of self-sufficiency. Conclusions: Hospitalization frequency, mainly during the first months of dialysis, suggests the need to improve the early management of chronic renal failure and indicates the importance of preventing complications and maximizing functional status among the dialysis population

Human immunodeficiency virus continuum of care in 11 european union countries at the end of 2016 overall and by key population: Have we made progress?

Background. High uptake of antiretroviral treatment (ART) is essential to reduce human immunodeficiency virus (HIV) transmission and related mortality; however, gaps in care exist. We aimed to construct the continuum of HIV care (CoC) in 2016 in 11 European Union (EU) countries, overall and by key population and sex. To estimate progress toward the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 target, we compared 2016 to 2013 estimates for the same countries, representing 73% of the population in the region. Methods. A CoC with the following 4 stages was constructed: number of people living with HIV (PLHIV); proportion of PLHIV diagnosed; proportion of those diagnosed who ever initiated ART; and proportion of those ever treated who achieved viral suppression at their last visit. Results. We estimated that 87% of PLHIV were diagnosed; 92% of those diagnosed had ever initiated ART; and 91% of those ever on ART, or 73% of all PLHIV, were virally suppressed. Corresponding figures for men having sex with men were: 86%, 93%, 93%, 74%; for people who inject drugs: 94%, 88%, 85%, 70%; and for heterosexuals: 86%, 92%, 91%, 72%. The proportion suppressed of all PLHIV ranged from 59% to 86% across countries. Conclusions. The EU is close to the 90-90-90 target and achieved the UNAIDS target of 73% of all PLHIV virally suppressed, significant progress since 2013 when 60% of all PLHIV were virally suppressed. Strengthening of testing programs and treatment support, along with prevention interventions, are needed to achieve HIV epidemic control