Characteristics and Mortality of Incident Haemodialysis Patients: Analysis of a Portuguese Cohort
Palavras-chave:
Kidney Failure, Chronic, Renal Dialysis/mortality, Renal Insufficiency, Chronic, Vascular Access DevicesResumo
Introduction: Portugal has one of the highest incidences and prevalence of end‐stage kidney disease in Europe, with haemodialysis (HD) being the most common modality of renal replacement therapy. The aim of our study was to analyse a cohort of patients who started HD in a large tertiary care hospital.
Methods: Retrospective analysis of all adult individuals who started HD between January of 2014 and December of 2019 in Centro Hospitalar Universitário Lisboa Norte. The primary outcome was mortality. Statistical significance was defined as a p‐value <0.05.
Results: We included 1122 patients (mean age 64.9 ±16.8 years, 21.2% at least 80 years old; 60.9% male; 79.7% cau‐ casian). At HD start, mean eGFR was 8.98 ±5.66 mL/min/1.73 m2 and the vascular access was a central venous catheter in 56.0%.
The percentage of elderly patients increased throughout the years (p=0.029) and HD was started with progressively lower eGFR (p<0.001). The percentage of patients with central venous catheter increased (p<0.001).
In total 392 patients died (7.5% within the first 90 days). Mortality rate within the first year declined over time (p<0.001).
Conclusion: Despite the increase in elderly patients, mortality within the first years declined, highlighting the quality of care provided, in addition to better acknowledgment and referal to conservative care.
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USRDS. United States Renal Data System. Introduction to Volume 1: CKD in the United States. Published 2016. [Accessed March 7, 2023] Available at: https://www.usrds.org/2015/download/vol1_00_Introduction_15.pdf
European Renal Association. ERA Registry: ERA Registry Annual Report 2020. ERA; 2022.
de Almeida EAF, Raimundo M, Coelho A, Sá H. Incidence, prevalence and crude survival of patients starting dialysis in Portugal (2010‐16): analysis of the National Health System individual registry. Clin Kidney J. 2021;14:869‐75. doi:10.1093/ckj/sfaa023
Thurlow JS, Joshi M, Yan G, Norris KC, Agodoa LY, Yuan CM, et al. Global epidemiology of end‐stage kidney disease and disparities in kidney replacement therapy. Am J Nephrol. 2021;52:98‐107. doi:10.1159/000514550
Robinson BM, Akizawa T, Jager KJ, Kerr PG, Saran R, Pisoni RL. Factors affecting outcomes in patients reaching end‐stage kidney disease worldwide: differences in access to renal replacement therapy, modality use, and haemodialysis practices. Lancet. 2016;388:294‐ ‐306. doi:10.1016/S0140‐6736(16)30448‐2
Galvão A. Portuguese Registry of Dialysis and Transplantation 2021. Gabinete de registo da Sociedade Portuguesa de Nefrologia. [Accessed March 7, 2023] Available at: https://www.spnefro.pt/ sociedade/gabinete‐de‐registo‐de‐doenca‐renal‐terminal
Araújo Correia J. Plano de Atividades. Med Interna. 2019;26:88‐8. doi:10.24950/rspmi/pp/2/2019
Inker LA, Eneanya ND, Coresh J, Tighiouart H, Wang D, Sang Y, et al. New Creatinine and Cystatin C‐Based Equations to Estimate GFR without Race. New Engl J Med. 2021;385:1737‐49. doi:10.1056/ NEJMoa2102953
Ethier J, Mendelssohn DC, Elder SJ, Hasegawa T, Akizawa T, Akiba T, et al. Vascular access use and outcomes: an international perspective from the Dialysis Outcomes and Practice Patterns Study. Nephrol Dial Transplant. 2008;23:3219‐26. doi: 10.1093/ndt/gfn261. Erratum in: Nephrol Dial Transplant. 2008;23:4088.
Instituto Nacional de Estatística. Estatísticas Demográficas: 2020. Lisboa: INE; 2021.
Mallappallil M, Friedman EA, Delano BG, McFarlane SI, Salifu MO. Chronic kidney disease in the elderly: evaluation and management. Clin Pract. 2014;11:525‐35. doi: 10.2217/cpr.14.46.
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Direitos de Autor (c) 2024 Carolina Branco, Joana Gameiro, Cláudia Costa, Bernardo Silva, Nadiesda Peres, Mariana Sant'Ana, José Agapito Fonseca, Cristina Outerelo, Cristina Resina, José António Lopes (Author)
Este trabalho encontra-se publicado com a Licença Internacional Creative Commons Atribuição-NãoComercial 4.0.
