Gabinete do Registo da Doença Renal Crónica da Sociedade ... · Sociedade Portuguesa de Nefrologia . Gabinete de Registo da SPN, 2016 – Fernando Macário Portuguese Society of

Gabinete do Registo da Doença Renal Crónica

da

Sociedade Portuguesa de Nefrologia

Gabinete de Registo da SPN, 2016 – Fernando Macário Portuguese Society of Nephrology, 2017 – Fernando Macário

Abbreviations

• CKD – Chronic Kidney Disease

• HD - Haemodialysis

• PD - Peritoneal Dialysis

• KTr - Kidney Transplant

• PMP - Per Million Population

• RRT - Renal Replacement Therapy

• Pts – patients

• Nº - number

• VA – Vascular Access

• AVFistula – Arteriovenous fistula

• Cat. – Catheter

• CVC – Central Vein Catheter

• EDTA – European Dialysis and Transplantation Association

Brief appointment of the Portuguese Registry of Dialysis and Transplantation

• 1984: national registry for Chronic Renal Insufficiency was created by Prof. Dr. Jacinto Simões, President of the Portuguese Society of

Nephrology

• From 1984 till end of eighties the registry follows casuistic EDTA model

• From the end of eighties till 1996 permanent registry with data on incidence, prevalence, mortality and other clinical data

• 1997 to 2007, aggregated data on incidences, prevalence and mortality with 100% of clinics and hospitals reporting

• Since 2007, analysis of new clinical data on several aspects of CKD 5 treatment: incidence, prevalence, analysis by sexes and country

regions, median age and age groups, etiology of CKD, gross mortality rates, vascular access, virology status, etc. Hundred percent

response rate

• 2010, online registry

• Head of Registry:

– 1984 – 1990: Dr. João Ribeiro Santos

– 1991 – 1992: Dr. Pedro Ponce

– 1993: Dr. João Ribeiro Santos

– 1994 – 1996: Dr. Francisco Remédio

– 1997 – 2007: Dr. João Pinto dos Santos

– 2007 - ... Fernando Macário

Portuguese Society of Nephrology, 2017 – Fernando Macário


Questionnaires for Hemodialysis (HD),

Peritoneal Dialysis (PD) and Kidney Transplantation

123 Hemodialysis Centers

25 Peritoneal Dialysis Units

8 adult and 1 pediatric kidney transplantation centers

100% response rate

Portuguese Registry of Dialysis and Transplantation 2017


New patients starting dialysis or submitted to renal transplantation during 2017 (n=2372)

0

500

1000

1500

2000

2500

HD PD TX

2113

228

31

716

157

895

50

499

14 3 7

Nº

of

patients

All 18 to 65 years (37,3%) 65 to 80 years (40,4%)

> 80 years (21,9%) < 15 years (0,4%)


0

2.000

4.000

6.000

8.000

10.000

12.000

HD PD TX

11.985

756

7.518

4.499

552

4866

175

2620

29

Nº

pa

tien

ts

Total < 65 years (39,6%) 65 to 80 years (39,6%) > 80 years (20,8%)

Total number of pts – 20259

Prevalence - 1965,1 pmp

Nº of KTx pt / NºD pt = 0,59 (0,58 in 2016)

?

Portuguese Society of Nephrology, 2017 – Fernando Macário Mean age HD + PD = 67,1 years

Patients treated by dialysis or with functioning kidney transplant

31st December 2017

Incident patients accepted for RRT per million population during 2017

230,08 227,07

204,96

22,12

3,01

pm

p

All HD + PD HD PD KTx


166

176

195

190

198 200

204

215

204

230 227

231 232 235,2

224,4

218,14

230,56 234,86

225,08

233,73

227,07

97 98 99 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

pm

p


Incident patients accepted for dialysis HD and PD per million population 2007 - 2017

0,00

100,00

200,00

300,00

400,00

500,00

600,00

700,00

800,00

900,00

Global < 65 years 65 to 80years

> 80 years

227,07

108,57

612,16

810,53

204,96

88,41

579,77

788,41

22,17 20,16 32,39 22,12

HD + PD HD PD


Incident patients accepted for dialysis HD and PD per million population by age group during 2017

Prevalent patients on RRT by modality per million population 31st December 2017

1965,07

1235,84 1162,51

73,33

729,23

pm

p

All HD + PD HD PD KTx


0,0

500,0

1000,0

1500,0

2000,0

2500,0

3000,0

3500,0

4000,0

4500,0


> 80 years

1235,8

621,2

3265,5

4185,4

1162,5

553,2

3152,1

4139,5

73,3 68,0 113,4 45,8

pm

p

HD + DP HD DP


Prevalence of CKD patients treated by dialysis per million population by age group in 2017

Incident and prevalent pediatric patients on dialysis HD and PD per million population 2017

0,00

5,00

10,00

15,00

Incidence Prevalence

5,00

10,50

1,50

3,50 3,50

7,00

pm

p

HD + PD HD PD



1000

3000

5000

7000

9000

11000

13000

97 98 99 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

Nº

of

pts

4%

4,1%

4,3%

6,4%

2,7%

4,4%

5,8%

3,9%

8%

4,7%

2.7%

3,9%

5,6%

1,5%

3,9%

3,2%

5970

2,7%

1,5%

12556

1,6%

12741

1,47%

Patients on dialysis and annual growth per million population end of each year 1997 - 2017

595 626

675 701 716

744 760

804 834

870 902

924 961

1016 1052

1068

1116

1159 1182

1212 1236

500

600

700

800

900

1000

1100

1200

1300

97 98 99 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

pm

p


Prevalent patients on dialysis per million population end of each year 1997 - 2017

1374 1410

1507

1578

1662 1670

1749

1794 1824

1911

1965

1200

1300

1400

1500

1600

1700

1800

1900

2000

7 8 9 10 11 12 13 14 15 16 17

pm

p


Prevalent patients on RRT per million population end of each year 1997 - 2017


Incident patients starting PD vs HD 1997 - 2017

97 98 99 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

HD 1531 1655 1833 1800 1939 1956 2016 2129 2038 2273 2286 2285 2300 2312 2143 2084 2210 2233 2106 2166 2113

PD 91 103 108 93 101 118 102 135 116 149 147 170 229 190 227 220 208 216 229 215 228

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

PD HD


97 98 99 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

HD 5710 5989 6455 6701 7071 7370 7559 8077 8392 8708 9037 9303 9646 10152 10409 10540 10977 11350 11514 11738 11985

PD 206 261 293 311 346 376 398 390 437 481 517 511 571 660 704 742 732 735 751 720 758

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

PD HD


Prevalent patients on PD vs HD 1997 - 2017


Percentage of dialysis patients treated by PD Incident and prevalent pts 1997 - 2017

5,6 5,9

5,6

4,9 5,0

5,7

4,8

6,0

5,4

6,2 6,0

6,9

9,1

7,6

9,6 9,5

8,6 8,8

9,8

9,0

9,7

3,5

4,2 4,3 4,4 4,7 4,9

5,0

4,6 4,9

5,2 5,4 5,2

5,6

6,1 6,3

6,6 6,3 6,1 6,1

5,8 5,9

0,0

2,0

4,0

6,0

8,0

10,0

12,0

97 98 99 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

% P

D v

s al

l dia

lysi

s

Incident PD Prevalent PD

7122 408 4672

4822 308 2774

0%

20%

40%

60%

80%

100%

HD PD Kidney tx

Man Women

* 153 missing data

Gabinete de Registo da SPN, 2016 – Fernando Macário

Gender distribution in each modality 31st December 2017


2499,5

1456,4

pm

p

Man Women


Prevalence by gender, all RRT per million population 31st December 2017


Not available = 6

Diabetes 32,2%

Hypertension 15,0%

Chronic Gln 10,8%

Policystic Disease 5,4% Hipoplasia/Displasia

0,6%

Other Known 19,4%

Unknown 16,5%


Primary renal disease of patients accepted for dialysis HD and PD during 2017

N = 12548 Not available = 193

Diabetes 28,0%

Hypertension 13,3%

Chronic Gln 12,8%

Policystic Disease 6,2%

Hipoplasia/Displasia 0,7%

Other Known 19,9%

Unknown 19,1%


Primary renal disease of prevalent patients HD and PD, 31st December 2017


1531

1655

1833 1800

1939 1956 2016

2129 2038

2273 2286 2285 2300 2312

2143 2084

2210 2233

2106 2206

2113

0

500

1000

1500

2000

2500

97 98 99 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17


New patients accepted for hemodialysis 1997 - 2017

Incident patients accepted for hemodialysis per million population 2007 - 2017


213,20

215,21 216,42

217,34

202,90

197,31

210,73

214,15

202,99

212,97

204,96

185,00

190,00

195,00

200,00

205,00

210,00

215,00

220,00

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

pm

p

97 98 99 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

PD or Ktx to HD 211 178 172 213 268 208 251 274 224

Incident 1531 1655 1833 1800 1939 1956 2016 2129 2038 2273 2286 2285 2300 2312 2143 2084 2210 2233 2106 2206 2113

1400

1600

1800

2000

2200

2400

2600


All patients accepted for hemodialysis Incident and returning from other modalities 1997 - 2017

214,15

202,99

212,97

204,96

234,10

225,06

239,43

226,68

2014 2015 2016 2017

pm

p

HD as first treatment Incidence of HD


Patients accepted for hemodialysis “Incident” and “Incident plus returning from other modalities”, pmp, 2014-2017

202

197

210,7

214,15

202,99

212,97

204,96

186,52 185,3

199,8

202,26

190,75

199,17

193,51

180

190

200

210

220

2011 2012 2013 2014 2015 2016 2017

pm

p H

D

Inc d0 Inc d91

5,6%

7,7%

6,5% 5,2%

Incident patients accepted for hemodialysis Day 0 and day 91, 2011-2017

5,9%

6,0% 5,6%


0

200

400

600

800

1000

HD

3

716

895

499

Pat

ien

ts c

ou

nt

< 18 years old (0,1%) 18 to 65 years old (33,9%) 65 to 80 years old (42,4%) >80 years old (23,6%)


Patients accepted for hemodialysis by age group, during 2017

N = 2113

0

1000

2000

3000

4000

5000

HD

7

4492 4866

2620

Pat

ien

ts c

ou

nt

< 18 years old (0,06%) 18 to 65 years old (37,48%) 65 to 80 years old (40,6%) >80 years old (21,86%)


Patients treated by hemodialysis by age group , 31st December 2017

N = 11985

Incident and prevalent patients treated by hemodialysis

per million population by age group, 2017

0,00

1000,00

2000,00

3000,00

4000,00

5000,00


> 80 years

204,96 88,41

579,77 788,41

1162,51

553,18

3152,13

4139,60 p

mp

Incidence Prevalence


5710 5989

6455 6701

7071 7370

7559

8077 8392

8708 9037

9303 9646

10152 10409 10540

10977

11350 11514

11836 11985

4000

5000

6000

7000

8000

9000

10000

11000

12000

13000

97 98 99 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

Pat

ien

ts c

ou

nt


Patients treated by hemodialysis 31st of December each year, 1997 – 2017


Distribution of hemodialysis patients by type of dialysis facility

31st of December 2017

1126; 9,4%

10859; 90,6%

In Hospital In center


13,8

14,5

16,7

19,4

17,7

19,2

16,5

15,7 15,8

10,6 10,3 10,2

10,7 10,7

10,4

8,5 9,01

9,4

5

10

15

20

2009 2010 2011 2012 2013 2014 2015 2016 2017

Pat

ien

ts %

Incident pts (%) Prevalent pts (%)


Hemodialysis patients treated in Hospital (%) 31st of December each year (2009 – 2017)


Hemodialysis growth 2017 vs 2016 (%) 31st of December each year

-4,22

-2,05

-4,61

1,26

6,43

0,75

-6,00

-4,00

-2,00

0,00

2,00

4,00

6,00

8,00

ALL IN HOSPITAL IN CENTER

Var

iati

on

20

17

/ 2

01

6 (

%)

Hemodialysis Growth Portugal

Incident pts % Prevalent pts %

-4,10

8,88

-5,90

1,08

6,49

0,66

-8,00

-6,00

-4,00

-2,00

0,00

2,00

4,00

6,00

8,00

10,00

ALL IN HOSPITAL IN CENTER

Var

iati

on

20

17

/ 2

01

6 (%

)

Hemodialysis Growth Continental Portugal

Incident pts % Prevalent pts %

Patients treated by hemodialysis distribution by techniques in each age group, 31st of December 2017

0

1000

2000

3000

4000

5000

6000

7000

Low flux HD High flux HD Hemodiafiltration

323

5166

6496

172

1893

2434

68

2100 2697

83

1173 1365

Nº

pat

ien

ts

Total < 65 years 65 to 80 years >80 years


N = 11985 ; low flux 2,4% (2,6% in 2016); 62,5% older than > 65 years ; 21,9% older > 80 years (21,3% in 2016)

1259 946 761 874 629 405 346 314 313 304 323

3542 5269

5307 4843

4726 5000 5080

4076 4013 4117 5166

2436 3088 3574 4435

5054 5132 5551

6960 7188 7317 6496

0%

20%

40%

60%

80%

100%

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Nº

pat

ien

ts

Low flux High flux Hemodialfiltration


* Due to water shortage in Portugal many patients

were switched from HDF to high flux HD by the end of 2017 and later returned to HDF

*

Patients treated by hemodialysis distribution by techniques, 31st Dec.1997 - 2017

50 0 11 92

170

323

267

56

1465 923 716

2016

46

5166

445

4721

1961 1369 1299

1670

197

6496

414

6082

0%

20%

40%

60%

80%

100%

North Centre South Lisbon Azores Madeira Global In Hospital In Center

Pat

ien

ts c

ou

nt

Low Flux High Flux Hemodiafiltration

Portuguese Society of Nephrology, 2017 – Fernando Macário N = 11985 by end of December 2017

Patients treated by hemodialysis distribution by techniques by region and facility type, 31st Dec. 2017

Mean Age of patients treated by hemodialysis 31st of December 2007 – 2017


63,8

64,3

65,02

65,99

66,49 66,8 66,9

67,17 67,47

67,68 67,89

61

62

63

64

65

66

67

68

69

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Mea

n a

ge

55

60

65

70

20

07

20

08

20

09

20

10

20

11

20

12

20

13

20

14

20

15

20

16

20

17

Mea

n a

ge

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Islands 59,3 60,8 61,9 61,9 62,4 60,3 62,4 62,6 62,4 63,6 65,0

Lisbon 62,3 62,7 62,4 64,5 65,2 65,2 65,1 65,8 66,2 66,7 66,5

North 63,3 63,7 64,8 65,8 66,3 66,7 66,8 66,8 67,2 67,4 67,7

South 65 66,2 67 67,3 66,7 68 67,9 68 69,1 68,5 69,0

Centre 65,5 66 68 68,2 68 68,7 69,1 69,5 69,5 69,7 69,9


Mean Age of patients treated by hemodialysis by country region, 31st of December 2007 – 2017


Mean Age of patients treated by hemodialysis Hemodialysis “in Center”, 31st of December 2017

62,31

68,15

79,00

60,00

62,00

64,00

66,00

68,00

70,00

72,00

74,00

76,00

78,00

80,00

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55 57 59 61 63 65 67 69 71 73 75 77 79 81 83 85 87 89 91 93

Me

an a

ge (

year

s)

National mean age = 68,15y Average of units = 68,4y Standard deviation = 2,75y Median = 68,4y

N = 2113

Diabetes 33,4%

Hypertension 15,8%

Chronic Gln 9,8%


0,4%

Other Known 19,6%

Unknown 16,1%


Primary renal disease of Incident patients accepted for hemodialysis

during 2017

N = 11949 36 not available

Diabetes 28,7%

Hypertension 13,7%

Chronic Gln 12,1%


0,6%

Other Known 19,9%

Unknown 19,2%


Primary renal disease of prevalent hemodialysis patients

31st December 2017

Diabetes as primary renal disease in HD patients Incident and prevalent (%) 2007 - 2017

29

31 32

33,6 32,6

32 32,2 33

34,6

33 33,4

23,8

25 25

26,9 27,7 28 28,2 28,2

28,7 29,1 28,7

20

25

30

35

40

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

% D

iab

ete

s

Incident Pt Prevalent Pt


Viral status in HD prevalent patients 31st December 2017

94,17%

1,18%

3,15%

1,50%

Neg Hbs Ag + HCV Ab + HIV Ab +

N = 11985


Hepatitis C viral status in HD prevalent pts 31st December 2016 - 2017


0

20

40

60

80

100

120

140

160

180

200

220

HCVAb+ / RNA + HCV Ab+ / RNA neg Seroconv to RNA neg Incident HCV +

2016 197 205 120 15

2017 149 128 119 15

2016 2017

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

NO 617 816 702 737 694 737 716 655 509 537 473

YES 1447 1464 1483 1522 1410 1342 1477 1541 1597 1629 1640

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Previous follow-up by nephrology (> 3 months) HD patients, 31st of December 2007 – 2017

Norte Centro Lisboa Sul Açores Madeira Global Hosp Perif

NO 114 81 172 91 2 13 484 135 349

YES 521 304 473 281 28 33 1629 199 1430

521 304 473 281

28

33 1629

199

1430

114 81 172 91

2

13 484

135

349

0%

20%

40%

60%

80%

100%


Previous follow-up by nephrology (> 3 months) HD patients, by country region and facility type - 31st of December 2017

Vascular access of HD incident patients during 2017

AVFistula 40,5%

Graft 2,7% Tunneled catheter

51,4%

Non-tunneled cat. 5,5%

N = 2130 17 duplicated


2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Non-tunneled cat. 296 282 219 188 163 143 163 81 103 117

Tunneled cat. 864 940 1034 1033 1007 1101 1088 1068 1093 1094

Graft 109 111 117 71 61 61 60 74 59 57

AVFistula 990 895 931 844 844 870 912 872 940 862

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Vascular access of HD incident patients 2008 – 2017


Catheter rate (%) in the first HD session of incident patients

2008 – 2017

51,4

54,8 54,5

57,2

56,4

57,2

56,3

54,8 54,5

56,9

48

49

50

51

52

53

54

55

56

57

58

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

North Centre Lisbon South Azores Madeira GlobalIn

HospitalIn

Center

Non-tunneled Cat. 34 19 43 16 5 0 117 74 43

Tunneled Catheter 262 240 370 178 9 35 1094 171 923

Graft 5 3 19 29 1 0 57 6 51

AVFistula 335 131 222 148 15 11 862 83 779

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

AVFistula Graft Tunneled Catheter Non-tunneled Cat.


N = 2130 17 duplicated

Vascular access of HD incident patients by country region and facility type - 31st of December 2017

Vascular access of HD prevalent patients 31st December 2017

AVFistula 73,3%

Graft 10,2%

Tunneled catheter 16,5%

Non-tunneled cat. 0,1%



North Centre Lisbon South Azores Madeira GlobalIn

HospitalIn

Center

Non-tunneled Cat. 1 2 1 2 4 0 10 6 4

Tunneled Catheter 467 427 662 289 20 106 1971 345 1626

Graft 95 185 514 398 12 12 1216 91 1125

AVFistula 2920 1677 2589 1337 134 125 8782 686 8096

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Vascular access of HD prevalent patients by country region and facility type, 31st of December 2017


83,8 73,2

68,7 66,0

78,8

51,4

73,3

60,8

74,6

2,7

8,1 13,6 19,6

7,1

4,9

10,2

8,1

10,4

13,4 18,7 17,6 14,4 14,1

43,6

16,5

31,1

15,0

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

North Centre Lisbon South Azores Madeira Global In Hospital In Center

AVFistula Graft Catheter


Vascular access of HD prevalent patients Percentage by country region and facility type, 31st of December 2017


2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Non-Tunneled Cat 91 76 39 42 25 16 23 15 24 2 10

Tunneled Catheter 1386 1572 1769 1953 1905 1889 1834 1770 1804 1895 1971

Graft 1185 1191 1256 1365 1402 1349 1358 1317 1273 1239 1216

AVFistula 6937 6464 6538 6788 7077 7257 7750 8202 8434 8598 8782

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Vascular access of HD prevalent patients 31st December, 2007 - 2017


Vascular access of prevalent patients (%) 31st December, 2007 - 2017

72,3 69,5

68,1 66,9 68 69 70,7

72,6 73,1 73,3 73,3

12,3 12,8 13,1 13,5 13,5 12,8 12,4 11,7 11 10,6 10,2

15,4 17,7 18,8 19,7 18,5 18,1 16,9 15,8 15,8 16,2 16,5

0

10

20

30

40

50

60

70

80

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

% o

f p

atie

nts

AVFistula Graft Catheter


AV Fistula rate of prevalent patients (%) 31st December, 2007 - 2017

72,3

69,5

68,1

66,9

68

69

70,7

72,6 73,1 73,3 73,3

60

62

64

66

68

70

72

74

76

78

80

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

% o

f p

atie

nts


Graft rate of prevalent patients (%) 31st December, 2007 - 2017

12,3

12,8 13,1

13,5 13,5

12,8

12,4

11,7

11

10,6

10,2

8

9

10

11

12

13

14

15

16

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

% o

f p

atie

nts


Catheter rate of prevalent patients (%) 31st December, 2007 - 2017

15,4

17,7

18,8

19,7

18,5 18,1

16,9

15,8 15,8 16,2

16,5

10

12

14

16

18

20

22

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

% o

f p

atie

nts


Catheter rate of prevalent patients (%) 31st December 2017

70,0

16,5

2,8

0,0

10,0

20,0

30,0

40,0

50,0

60,0

70,0

80,0

36 centers above 20% cat rate 24 centers below 10% cat rate National rate = 16,5% Average of units = 18,9% Standard deviation = 13,1% Median = 16,5%


Catheter rate of prevalent patients (%) In Hospital HD patients, 31st December 2017

70,0

31,1

2,9

0,0

10,0

20,0

30,0

40,0

50,0

60,0

70,0

80,0



Catheter rate of prevalent patients (%) In Center HD patients - 2017

35,6

15,0

2,8

0,0

10,0

20,0

30,0

40,0

50,0

60,0

70,0

80,0


Mortality - hemodialysis


< 65 years 65 - 80 years >80 years

Prevalent 4499 4866 2620

Died 263 620 667

263 620

667

4499 4866 2620

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

* 83,03% of 1550 patients that died in 2017 were more than 65 years old and 43,03% more than 80 years

* 7,8% of deaths occurred during the first 90 days after starting dialysis

* Mortality in the first 90 days was 5,05%


Deaths in hemodialysis by age group in 2017

Death causes in HD patients during 2017

Cardiovascular 24,5%

Sudden death 9,5%

Infection (related with VA) 2,3%

Infection (not related with VA)

23,0%

Malignancy 11,1%

Cachexia 8,2%

Others known 13,8%

Unknown 7,6%


N=1550

Deaths in hemodialysis 2007 - 2017

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Cardiovascular Sudden death Infection (related to VA)Infection (not related to VA) Malignancy CachexiaOthers Known Not available

Ga Portuguese Society of Nephrology, 2017 – Fernando Macário

* Sudden death and cachexia were not reported until 2010

*

Deaths in hemodialysis 2007 - 2017

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Not available 42 16 43 90 96 103 119 136 118

Others Known 472 430 454 487 205 132 219 194 212 224 214

Cachexia 109 114 117 115 129 115 127

Malignancy 144 145 134 154 159 158 150 140 167 162 172

Infection (not related to VA) 229 235 237 220 312 278 292 332 354 335 357

Infection (related to VA) 64 70 62 69 44 45 36 44 36 32 35

Sudden death 109 138 121 123 125 134 147

Cardiovascular 386 418 394 370 393 347 380 335 369 374 380

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Ga Portuguese Society of Nephrology, 2017 – Fernando Macário

* Sudden death and cachexia were not reported until 2010

*


28,9

31,8

29,8

28,5 27,7

28,6

26,9

24,2 24,4 24,7 24,5

17,1 17,9 17,9

16,9

22,0 22,9

20,7

24,0 23,4

22,2 23,0

10,0

15,0

20,0

25,0

30,0

35,0

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

CV Inf (not rel VA)

Cardiovascular and Infection deaths in hemodialysis (%)

2007 - 2017


28,9

31,8

29,8 28,5

27,7 28,6

26,9

24,2

24,4 24,7

24,5

21,9 23,2

22,6 22,2

25,1

26,7

23,2

27,1

25,8 24,3

25,3

10,0

15,0

20,0

25,0

30,0

35,0

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

CV Inf (all)

Cardiovascular and Infection deaths in hemodialysis (%)

2007 - 2017


28,9

31,8

29,8 28,5

35,3

40,0

35,5

33,0 32,7 33,6 34,0

17,1 17,9 17,9

16,9

22,0 22,9

20,7

24,0 23,4 22,2

23,0

21,9 23,2 22,6 22,2

25,1 26,7

23,2

27,1 25,8

24,3 25,3

10,0

15,0

20,0

25,0

30,0

35,0

40,0

45,0

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

CV Inf (not rel VA) Inf (all)

*

* Sudden death was not reported until 2010

Cardiovascular (+sudden death) and Infection deaths in hemodialysis (%)

2007 - 2017

Death causes during the first 90 days of HD 2017

Cardiovascular 5,9%

Sudden death 4,2%

Infection (related with VA) 17,8%

Infection (not related with VA)

15,3% Malignancy 12,7%

Cachexia 6,8%

Others known 6,8%

Unknown 30,5%


N=118

Patients movement in 2017

0

100

200

300

400

500

408

55 48

96 106 118

Nu

mb

er o

f p

ts

Out = 607 ; In = 224


IN OUT

First treatment 2113 Deaths 1550

Transplant failure 118 Transplanted 408

PD into HD 106 HD into PD 65

Stop treat. or recovery

144

National Crude Mortality Rate in HD = 13,03%


HD patients movement in 2017

National crude mortality rate = 13,03% (90 day mortality = 5,05%)

Hemodialysis in hospital 19,13% (90 day mortality = 9,41%)

Hemodialysis in center 12,42% (90 day mortality = 4,17%)


Mortality rates – hemodialysis 2017

22,48

24,51

21,31 20,95

29,44

21,39

20,03

21,41 22,14

20,79

19,13

14,46 13,28 13,24

12,35 11,82

12,76 12,39 11,49

12,49 12,36 12,42

15,26 14,45 14,01

13,24 13,79 13,65 13,18

12,49 13,28 13,09 13,03

8

10

12

14

16

18

20

22

24

26

28

30

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Gro

ss m

ort

alit

y ra

te (

%)

HD in Hospital HD in Center All pts


Crude mortality rate in hemodialysis 2007 - 2017

Crude mortality rate in hemodialysis 2007 - 2017

15,26

14,45

14,01

13,24

13,79 13,65

13,18

12,49

13,28 13,09 13,03

10

11

12

13

14

15

16

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Gro

ss m

ort

alit

y ra

te (

%)

All patients


22,48

24,51

21,31 20,95

29,44

21,39

20,03

21,41 22,14

20,79

19,13

8

10

12

14

16

18

20

22

24

26

28

30

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Gro

ss m

ort

alit

y ra

te (

%)

HD in Hospital


Crude mortality rate in hemodialysis in hospital treated patients, 2007 - 2017

14,46

13,28 13,24

12,35

11,82

12,76

12,39

11,49

12,49 12,36 12,42

10

11

12

13

14

15

16

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Gro

ss m

ort

alit

y ra

te (

%)

HD in Center


Crude mortality rate in hemodialysis in center treated patients, 2007 - 2017

Crude mortality rate Impact of deaths until day 90, 2017

13,04 12,42

19,13

12,04 11,67

15,72

7

9

11

13

15

17

19

All In Center In Hospital

Gro

ss m

ort

alit

y ra

te (

%)

Mortality since d1 Mortality since d91

4,17% died until d90




Mean Age Mortality

since d1

Mortality

since d91

Deaths until d90 (% of incident)

Global 67,9 13,03% 12,04% 5,05%

North 67,7 13,22% 12,21%

4,91%

Center 69,9 15,60%

14,55% 5,41%

South 69,0 10,96% 10,11% 4,24%

Lisbon 66,5 12,54% 11,50% 5,64%

Azores 63,6 11,90%

11,31% 2,70%

Madeira 65,9 11,37% 10,44% 4,00%


Crude mortality rates – hemodialysis since d1 and d91 by country region, 2017

21,0%

79,0%

YES NO


Waiting list for renal transplantation Hemodialysis patients, 2017

13,9%

7,2%

79,0%

Normal and Urgent Temporary out No


Waiting list for renal transplantation HD patients, Active and temporary contraindication - 2017


91

103 108

93 101

118

102

135

116

149 147

170

229

190

227 220

208 216

229

215

228

60

80

100

120

140

160

180

200

220

240

97 98 99 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17


New patients starting peritoneal dialysis 1997 - 2017


13,9

16,01

21,55

17,86

21,5 20,8

19,8

20,7

22,1

20,76

22,12

5

10

15

20

25

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

pm

p


Incident patients accepted for peritoneal dialysis per million population 2007 - 2017

206

261

293 311

346 376

398 390

437

481

517 511

571

660

704

742 732 735 751

720

756

150

250

350

450

550

650

750

97 98 99 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17


Patients treated by peritoneal dialysis Count at 31st of December each year, 1997 – 2017

N = 228 No answer:3

Diabetes 21,3%

Hypertension 7,6%

Chronic GN 20,4%

Policystic Disease 10,7% Hipoplasi/Displasia

2,7%

Other Known 17,3%

Unknown 20,0%


Primary renal disease of patients accepted for peritoneal dialysis

during 2017

Diabetes 16,4% Hypertension

7,0%

Chronic GN 24,9%



Other Known 20,5%

Unknown 18,7%

N = 755 n.avail. 1pt


Primary renal disease of prevalent peritoneal dialysis patients

31st December 2017

0

50

100

150

200

250

300

350

400

450

CAPD APD

440

316

128

76

22 7

0 14

Pat

ien

ts c

ou

nt

Total > 65 years > 80 years < 18 years

N = 756 ; APD:41,8%; Age>65 years:26,9%; Age>80years:3,8%


Patients treated by peritoneal dialysis Manual vs automated, 31st of December 2017

756

440

316

0

100

200

300

400

500

600

700

800

Total CAPD APD

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

N2017 = 756 ; CAPD:440 ; APD/Others:316


Patients treated by peritoneal dialysis Manual vs automated, 31st December 2007 - 2017

Automated Peritoneal Dialysis usage (%) 31st December 2007 - 2017


18,9

36,8

44,4

53,1

58,1 60,6

63,1 63,1

56,8

71,1

64 61,1

53,2 52,1 49,7

41,3 41,5

47,5

43,9 43,8 41,7

0

10

20

30

40

50

60

70

80

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2106 2017

% o

f p

atie

nts


0

50

100

150

200

250

300

North Center South Lisbon Islands

226

118

106

200

70 Nu

mb

er o

f Pa

tien

ts

2010 2011 2012 2013 2014 2015 2016 2017

Patients treated by peritoneal dialysis by region, 31st of December 1997 to 2017

N = 756 (2017)


89,9%

10,1%

Yes No

N = 228


Previous follow-up by nephrology (> 3 months) PD patients, 31st of December 2007 – 2017


49,5

50,3

50,9

51,5

50,1

52,2

53,7 53,9

54,5 54,5 54,8

46

47

48

49

50

51

52

53

54

55

56

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Mea

n a

ge (

year

s)


Mean Age of patients treated by peritoneal dialysis 31st of December 2007 – 2017

95,90%

1,32%

1,59%

1,19%

Neg HbsAg + AntiVHC + AntiHIV +

N = 756


Viral status in PD prevalent patients 31st December 2017

IN OUT

New patients 228 Death 44

KTr failure 14 Transplant 71

HD to PD 37 PD to HD 126

Suspension 1

Renal Recovery 3

National Crude Mortality Rate in PD = 5,16 % (90 d mortality = 2,5%)


PD patients movement in 2017

7,65

8,93

7,09

5,62

6,79 6,73

5,54 5,42 5,33

7

5,16

4

5

6

7

8

9

10

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Gro

ss m

ort

alit

y ra

te (

%)


Crude mortality rate in peritoneal dialysis 2007 - 2017

Reasons for PD withdraw 2017

N = 119

Infection 35,3%

UF failure/Inadequacy 30,3%

Mechanical problems 10,1%

Non compliance 9,2%

Others 15,1%


Peritonitis episodes 2017

N = 246

0,29 episodes / patients-2017


0,5 0,48

0,45 0,46 0,43

0,45

0,41

0,37 0,35

0,29

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Per

ito

nit

is r

ate


Death causes in PD patients 31st December 2014 - 2017

N = 44

7 patients died until day 90; 3,0% of incident patients and 15,9% of all deaths

CardioVasc 43,2%

Sudden death 11,4%

Infection (PD related) 6,8%

Infection ( Not PD related) 22,7%

Neoplasia 2,3%

Cachexia 11,4%

Others Known 2,3%



PD patients in waiting list for renal transplantation Active and excluded for transplantation,

31st December 2014 - 2017

386 416 388 401

349 335 322 355

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2014 2015 2016 2017

Yes No


PD patients in waiting list for renal transplantation Active, temporary contraindication and excluded for transplantation

31st December 2014 - 2017

326 358 332 355

60 58 105 92

349 335 283 309

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2014 2015 2016 2017

Active List Temporary CI No



8 26 30

69 63

99 106

182 199

260 256

304

367

286

346 370

400 382

309

367 358 359

398

355

436

380 393

480

525

593 573

530

429 448 448

485

513 527

0

100

200

300

400

500

600

80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

Ren

al T

ran

spla

nt

cou

nts

per

yea

r

Years

Renal Transplants performed 1980-2017

Total = 12659


Renal transplantation activity characterization 2017

31 pre-emptive (3 receptors <18A)

0

100

200

300

400

500

Dec

ease

d d

on

or

Dec

ease

d d

on

or

/R

ecep

tor

<18

y

Dec

ease

d d

on

or

/R

ecep

tor>

65

y

Livi

ng

do

no

r

Livi

ng

do

no

r /

Rec

epto

r <1

8Y

Livi

ng

do

no

r /

Rec

epto

r >6

5y

450

10

61 77

3 6

Nº

of

Pa

tie

nts


0

20

40

60

80

100

120

140

HGSA HSMaria HG Orta CHLO StC HS João HC Cabral HSM-Ped CHUC CVP

92

55

16

37

68

56

3

121

2

30

5

0

18 13

0 0 0 0

13

0 0 0 1 0 1

Pat

ien

t n

um

ber

s

Deceased donor Living donor Kidney and Pancreas Kidney and Liver Kidney and Heart Pacreas after Kidney

Portuguese Transplant Centers Activity 2017

N = 450 tx deceased donor and 77 (14,6%) live donor; 34 multi-organ transplants (total = 527)


Renal transplantation: living vs deceased donor pts with functioning Ktx, 31st December 2017

9,3%

90,7%

Living donor Deceased donor


N = 7518


Prevalent Renal Transplanted Patients Previous renal replacement therapy, 2015-2017


N = 527 (2017)

375

65

17

377

101

25

414

82

31

0

50

100

150

200

250

300

350

400

450

Hemodialysis Peritoneal Dialysis Pre-emptive

2015

2016

2017



38

31

37 35

34

38

34

41

36 38

45,3

49,45

55,8 53,9

50,2

40,6 42,7 43

46,75

49,53 51,12

0

10

20

30

40

50

60

19

97

19

98

19

99

20

00

20

01

20

02

20

03

20

04

20

05

20

06

20

07

20

08

20

09

20

10

20

11

20

12

20

13

20

14

20

15

20

16

20

17

pm

p


Renal Transplants Performed per million population, 2007 - 2017


Diabetes 14,9% Hypertension

10,0%

Chronic GN 29,4%



Other Known 22,7%


Primary renal disease of renal transplanted patients

during 2017

267

2843 2989

3256 3472

3673 3861

4140 4408

4538

5013 5151

5794 5976

6440 6359 6636 6618 6681

7242 7518

0

1000

2000

3000

4000

5000

6000

7000

8000

97 98 99 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

CUMUL

%

10,5%

2,9%

6,5% 7,2%

5,1%

5,8%

6,6%

8,9%

5,1% 6,6%

2,8%

12,4%

3,1%


7,8%

-1,2% 4,3% 0,9%

8,4%

3,8%


Patients with functioning graft and annual growth 31st December 1997 - 2017

N = 7242


268 285

299

326 335 353

369 393

417 430

473 485

545 562

610 602

633 635 642

699

729

200

300

400

500

600

700

800

19

97

19

98

19

99

20

00

20

01

20

02

20

03

20

04

20

05

20

06

20

07

20

08

20

09

20

10

20

11

20

12

20

13

20

14

20

15

20

16

20

17

pm

p


Prevalence of CKD patients with functioning graft cumulative per million population end of each year 1997 - 2017

-400 -300 -200 -100 0 100 200 300 400 500 600

8081828384858687888990919293949596979899

0123456789

1011121314151617

Number

Yea

rs

Lost grafts Transplantations

Renal transplantation activity 1980 - 2017

2017: 104 patients died with functioning graft; 120 transferred to HD / 8 transferred to PD


Documents

Gabinete do Registo da Doença Renal Crónica da Sociedade ... · Sociedade Portuguesa de Nefrologia . Gabinete de Registo da SPN, 2016 – Fernando Macário Portuguese Society of