Renal replacement therapy in Sweden

Schön, Staffan; Ekberg, Henrik; Wíkström, Björn; Odén, Anders; Ahlmén, J

doi:10.1080/00365590410033380

Cited by 75 publications

(74 citation statements)

References 7 publications

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“…However, the patient survival rate after transplantation was significantly poorer in diabetic than in non-diabetic patients, whereas the graft survival rate was similar in the two groups. These findings are in line with a Swedish report [18], where the 5-year survival rates in diabetic vs non-diabetic patients were 79.8 vs 86.8% in transplanted patients and 14.5 vs 25.5% in patients treated with dialysis. In the present study the corresponding 5-year survival rates were: 80 vs 85% for transplanted patients and 18 vs 30% for dialysis patients.…”

Section: Discussionsupporting

confidence: 92%

Improved survival rate in patients with diabetes and end-stage renal disease in Denmark

et al. 2007

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Aims/hypothesis We investigated the survival rate of Danish diabetic patients with end-stage renal disease (ESRD) between 1990 and 2005 and evaluated possible predictors of survival rate. Materials and methods Data were obtained from the Danish National Register on Dialysis and Transplantation and from the Scandiatransplant database. Survival rates in different patient groups and association with age, sex, calendar time, waiting-list status and renal transplantation were evaluated using a multivariate Cox regression model. Results During the study period 8,421 patients (13% type 1 diabetic, 9% type 2 diabetic and 78% non-diabetic) started renal replacement therapy. The overall survival rate improved by 15% per five calendar years (hazard ratio [HR]=0.85, 95% CI: 0.81-0.88). The percentage of patients within each group who received renal transplantation was: type 1 diabetic: 26%, type 2 diabetic: 5%, non-diabetic: 24%. The survival rate of transplanted patients with diabetes mellitus (types 1 and 2) compared with nondiabetic patients at 1 year was: 95 vs 93%, at 5 years: 80 vs 85% and at 10 years: 52 vs 71%. Among diabetic patients survival rate was better in transplanted than in waiting-list patients (HR =0.21, 95% CI 0.13-0.34), whereas the survival rate in waiting-list patients seemed to be superior to the survival rate among non-transplantation candidates (HR=0.75, 95% CI 0.53-0.1.02, p=0.07). Conclusions/interpretation The survival rate of diabetic patients with ESRD has improved during the last 15 years. Although some selection bias may exist, significantly improved survival rate was observed among transplanted patients compared with dialysis patients on the waiting-list for transplantation. Renal transplantation should therefore be offered to diabetic patients with ESRD whenever possible.

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Section: Discussionsupporting

confidence: 92%

Improved survival rate in patients with diabetes and end-stage renal disease in Denmark

et al. 2007

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“…The Swedish Renal Registry includes >95% of patients on dialysis and almost 100% of patients who underwent renal transplantation. 19,20 This study used the date of the first renal replacement therapy to define the start of ESRD. Survival status was determined with the Swedish personal identification number and the continuously updated Total Population Register at Statistics Sweden.…”

Section: Outcome Datamentioning

confidence: 99%

“…Outcome data were obtained from the Swedish Renal Registry and the national Total Population Registry, which include almost complete coverage of the whole country, thereby ensuring that no patients were lost to followup. 19 In addition, the study cohort was relatively large, and the analyses included several potential confounding factors. The preoperative eGFR was available for all subjects.…”

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confidence: 99%

Acute Kidney Injury After Coronary Artery Bypass Grafting and Long-Term Risk of End-Stage Renal Disease

et al. 2014

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Background-Acute kidney injury (AKI) is a common complication after coronary artery bypass grafting (CABG) and is associated with adverse outcomes. However, the relationship between AKI after CABG and the long-term risk of endstage renal disease (ESRD) is unknown. Methods and Results-This study included 29 330 patients who underwent primary isolated CABG in Sweden between2000 and 2008. AKI was classified according to the Acute Kidney Injury Network (AKIN) classification: stage 1, >0.3 mg/dL (>26 μmol/L) or 50% to 100% increase; stage 2, 100% to 200% increase; and stage 3, >200% increase from the preoperative to postoperative serum creatinine level. Cox proportional hazards regression analysis was used to calculate hazard ratios with 95% confidence intervals for ESRD in AKIN stage 1 and stage 2 to 3. Postoperative AKI occurred in 13% of patients. During a mean follow-up of 4.3±2.4 years, 123 patients (0.4%) developed ESRD, including 50 (1.6%) in AKIN stage 1, 29 (5.2%) in AKIN stage 2 to 3, and 44 (0.2%) without AKI after CABG. After multivariable adjustment, the hazard ratio for ESRD was 2.92 (95% confidence interval, 1.87-4.55) for AKIN stage 1 and 3.81 (95% confidence interval, 2.14-6.79) for AKIN stage 2 to 3. Conclusions-This nationwide study of patients who underwent CABG found that a small increase in the postoperative serum creatinine level was associated with an almost 3-fold increase in the long-term risk of ESRD after adjustment for a number of confounders, including preoperative renal function. According to Recommended Therapies (SWEDEHEART) registry. 15This registry includes all patients who have undergone coronary angiography, percutaneous coronary intervention, or cardiac surgery in Sweden since 1992, with complete coverage of the whole country. Agreement between information in the registry and the medical records was reported to be between 93% and 97%. 15 The present study included all patients who underwent CABG in Sweden between 2000 and 2008. The exclusion criteria are shown in Figure 1. Patients were excluded if they had undergone prior cardiac surgery, had undergone vascular or valvular surgery concurrently with CABG, had missing preoperative or postoperative s-Cr levels, had undergone surgery within 24 hours of the decision to operate, had a preoperative estimated glomerular filtration rate (eGFR) of <15 mL·min, or were dialysis dependent before surgery. Diabetes mellitus, hypertension, chronic obstructive pulmonary disease, and hyperlipidemia were recorded if patients were receiving ongoing pharmacological treatment for these conditions.Patients were usually reviewed by a cardiologist a few weeks after surgery and then followed up by their family doctor.The study complied with the guidelines of the Declaration of Helsinki and was approved by the regional ethics review board in Stockholm. The postoperative s-Cr level recorded in the SWEDEHEART registry is the highest level measured during the postoperative hospital stay. In a subgroup of 483 patients who underwent CABG at 1 center (Karolinsk...

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“…Patients on chronic hemodialysis (HD) suffer from an increased risk for morbidity and mortality, and the main cause of death is cardiovascular disease (1). Many uremic solutes are retained in the body of these patients (2).…”

Section: Introductionmentioning

confidence: 99%

NT-proBNP and Troponin T Levels Differ after Haemodialysis with a Low versus High Flux Membrane

et al. 2015

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Background Brain natriuretic peptide (BNP), N-terminal-proBNP (NT-proBNP), and high sensitive cardiac troponin T (TnT) are markers that are elevated in chronic kidney disease and correlate with increased risk of mortality. Data are conflicting on the effect of biomarker levels by hemodialysis (HD). Our aim was to clarify to what extent HD with low-flux (LF) versus high-flux (HF) membranes affects the plasma levels of BNP, NT-proBNP, and TnT. Methods and Materials 31 HD patients were included in a crossover design, randomized to start dialysis with a LF-HD or HF-HD dialyzer. Each patient was his/her own control. The dialyses included in the study were the first treatments of two consecutive weeks with each mode of dialysis. Patients normally on hemodiafiltration (HDF) also performed a HDF the third week. Values after HD were corrected for extent of ultrafiltration. Results During LF-HD the biomarkers NT-proBNP and TnT increased (15 versus 6%, P≤.001) while there was a slight decrease in BNP (P<.05). During HF-HD the NT-proBNP, BNP and TnT levels decreased (P≤.01 for all). During HDF all three markers decreased (P<.01 for all). The rise in TnT during LF-HD correlated with dialysis vintage (months on HD, r = .407, P = .026), Kt/V-urea (r = .383, P = .037), HD time in hours/treatment (r = .447, P = .013) and inversely with residual urinary output (r = -.495, P = .005). The baseline levels of BNP and NT-proBNP correlated with blood pressure. Conclusions Cardiac biomarkers increase slightly during LF-HD. A HF-HD eliminates the biomarkers and can mask increases caused by, e.g., myocardial infarction.

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Renal replacement therapy in Sweden

Cited by 75 publications

References 7 publications

Improved survival rate in patients with diabetes and end-stage renal disease in Denmark

Improved survival rate in patients with diabetes and end-stage renal disease in Denmark

Acute Kidney Injury After Coronary Artery Bypass Grafting and Long-Term Risk of End-Stage Renal Disease

NT-proBNP and Troponin T Levels Differ after Haemodialysis with a Low versus High Flux Membrane

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