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

Ceretta, Maria L; Noordzij, Marlies; Luxardo, Rosario; Meester, Johan De; Díez, José María Abad; Finne, Patrik; Heaf, James; Couchoud, Cécile; Kramar, Reinhard; Collart, Frédéric; Cases, Aleix; Pálsson, Runólfur; Reisæter, Anna Varberg; Rydell, Helena; Massy, Ziad A.; Jager, Kitty J.; Kramer, Anneke

doi:10.1093/ndt/gfx355

Cited by 30 publications

(27 citation statements)

References 20 publications

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“…The present study identified hypertension (87.2%, n = 129) as the most common comorbidity, followed by anemia (48.6%, n = 72), diabetes (47.3%, n = 70), dyslipidemia (19.6%, n = 29), and peptic ulcer (19.6%, n = 29). The discovery that hypertension and diabetes were among the most common comorbidities was in agreement with several related studies [4,13,30]. Notably, this study discovered that anemia was the second most common comorbidity, which is in agreement with the findings of another study [31].…”

Section: Discussionsupporting

confidence: 92%

“…Furthermore, WBC counts and HBC, HCT, albumin, total protein, and creatinine levels were found to be variables of critical significance. Because studies have suggested that most patients with ESKD can develop one or multiple comorbidities [12,13], the 3 most common comorbidities, namely hypertension (87.2%), anemia (48.6%), and diabetes (47.3%), were analyzed in this study. The other comorbidities that were studied were dyslipidemia and peptic ulcer.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with ESKD are required to undergo consecutive time-based blood and biochemical tests to determine the progression of a disease [11]. In several studies on comorbidities associated with ESKD, researchers have reported that patients with ESKD who receive renal replacement therapy usually develop one or multiple comorbidities or complications [12,13]. Studies have predominantly involved obtaining risk factors from baseline.…”

Section: Introductionmentioning

confidence: 99%

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A five-year longitudinal study of the relation between end-stage kidney disease as the outcomes

Tai

Hwang

et al. 2020

BMC Nephrol

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Background: Patients with end-stage kidney disease (ESKD) are required to undergo consecutive time-based blood and biochemical tests to determine the progression of the disease according to changes in their blood and biochemical data. This study employed a random intercept model to investigate whether time-based blood and biochemical data present any notable clinical meaning that can be used to track disease progression.Methods: This study conducted a retrospective analysis on the dialytic data of 148 patients with ESKD, who received hemodialysis between January 2005 and December 2015. The patients were all at least 20 years old, and the data used included patient demographic information and results for at least 60 blood and biochemical tests. A random intercept model was used to analyze the relationships among blood and biochemical test results, explanatory variables of patient comorbidities, and time.Results: The age range of patients was between 33 and 98 years, with an average of 66.1 years and those over 65 years old comprising 51.3% (n = 76) of the total. Furthermore, hypertension was found to be the most common comorbidity among patients (87.2%, n = 129), followed by anemia (48.6%, n = 72), diabetes (47.3%, n = 70), dyslipidemia (19.6%, n = 29), and peptic ulcer (19.6%, n = 29). Coronary atherosclerotic heart disease is a comorbidity that can serve as a strong and independent marker for prognosis in patients with ESKD. Serum creatinine level can serve as an alternative indicator because patients with ESKD and comorbid diabetes may exhibit increased creatinine levels. Conclusions:The results of a parameter estimation for longitudinal data analysis suggested that comorbidity and time were critical variables influencing blood and biochemical test results. Furthermore, WBC and HBC, HCT, albumin, protein, and creatinine levels were recognized as variables of critical significance. The results obtained in this study indicate that multimorbidity increases the treatment burden on patients, leading to polypharmacy. For this reason, comprehensive care and treatment of ESKD cannot rely solely on data from one single time point; instead, longitudinal analysis and other data that can affect patient prognosis must also be considered.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A five-year longitudinal study of the relation between end-stage kidney disease as the outcomes

Tai

Hwang

et al. 2020

BMC Nephrol

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“…[27][28][29][30] However, because of the multifactorial nature of excess cardiovascular mortality in this patient group, the observed decrease may be explained by multiple changes instead of 1 single intervention. Ceretta et al 31 showed that in Europe between 2005 and 2014, the percentage of patients with ischemic heart disease as a comorbidity at the start of KRT decreased, indicating that patients start dialysis in better cardiovascular health, which may have contributed to the improved survival observed in this study. Furthermore, better management of dialysis patients with myocardial infarction or stroke in the last decades may partly explain the decrease in excess atheromatous CVD mortality.…”

Section: Trends In Dialysis Patientsmentioning

confidence: 53%

Data from the ERA-EDTA Registry were examined for trends in excess mortality in European adults on kidney replacement therapy

Boenink

Stel

Waldum-Grevbo

et al. 2020

Kidney International

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atients with end-stage kidney disease are at a high risk of death. Even after starting kidney replacement therapy (KRT), half of the patients will die within 5 years. 1 On the other hand, analyses of registry data have shown that patient survival on KRT has moderately improved over the last few decades. 2-4 Part of this increase may reflect the overall increase in survival of the general population.

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“…This increase did not come to a halt in the $75 years KRT cohort, despite the declining male-to-female ratio in the general population. The greater comorbidity burden among males may play an important role (28). Further investigations in the elderly population with advanced CKD (stage 4 or 5) will be useful in identifying potentially protective biologic factors and perhaps also behavioral factors in women underlying this phenomenon.…”

Section: Discussionmentioning

confidence: 99%

Sex Differences in Kidney Replacement Therapy Initiation and Maintenance

Antlanger

Noordzij

Luijtgaarden

et al. 2019

CJASN

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Background and objectives More men than women undergo kidney replacement therapy (KRT) despite a larger number of women being affected by CKD. The aim of this multinational European study was to explore whether there might be historic and geographic trends in sex-specific incidence and prevalence of various KRT modalities. Design, setting, participants, & measurements We assessed sex-specific differences in KRT incidence and prevalence using data from nine countries reporting to the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) Registry for at least 40 years, during the period 1965-2015. Sex distribution data were compared with the European general population (Eurostat). Statistical methodology included basic descriptive statistics, incidence and prevalence calculations per million population (pmp), as well as their male-tofemale ratios. Analyses were stratified by age group and diabetic status. Results We analyzed data from 230,378 patients receiving KRT (38% women). For all KRT modalities, the incidence and prevalence rates were consistently higher in men than women. For example, the KRT incidence increased from 8 pmp in 1965-1974 to 98 pmp in 2005-2015 in women, whereas it rose from 12 to 173 pmp in men during the same period. Male-to-female ratios, calculated for incident and prevalent KRT patients, increased with age (range 1.2-2.4), showing consistency over decades and for individual countries, despite marked changes in primary kidney disease (diabetes more prevalent than glomerulonephritis in recent decades). The proportion of kidney transplants decreased less with age in incident and prevalent men compared with women on KRT. Stratified analysis of patients who were diabetic versus nondiabetic revealed that the male-to-female ratio was markedly higher for kidney transplantation in patients with diabetes. Conclusions Since the beginning of KRT programs reporting to the ERA-EDTA Registry since the 1960s, fewer women than men have received KRT. The relative difference between men and women initiating and undergoing KRT has remained consistent over the last five decades and in all studied countries.

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

Cited by 30 publications

References 20 publications

A five-year longitudinal study of the relation between end-stage kidney disease as the outcomes

A five-year longitudinal study of the relation between end-stage kidney disease as the outcomes

Data from the ERA-EDTA Registry were examined for trends in excess mortality in European adults on kidney replacement therapy

Sex Differences in Kidney Replacement Therapy Initiation and Maintenance

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