gabinete do registo da doença renal crónica sociedade ... · gabinete do registo da doença renal...

Gabinete do Registo da Doença Renal Crónica

da

Sociedade Portuguesa de Nefrologia

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

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 MacárioPortuguese Registry of Dialysis and Transplantation 2018

Abbreviators

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

Portuguese Registry of Dialysis and Transplantation 2018

Questionnaires for Hemodialysis (HD),

Peritoneal Dialysis (PD) and Kidney Transplantation

124 Hemodialysis Centers

25 Peritoneal Dialysis Units

8 adult and 1 pediatric kidney transplantation

centers

100% response rate



New patients starting dialysis or submitted to renal transplantation during 2018 (n=2634)

0

500

1000

1500

2000

2500

HD PD TX

2378

229

27

843

164

952

46

578

105 9

Nº

of

patients

All 18 to 65 years 65 to 80 years > 80 years < 15 years



0

2 000

4 000

6 000

8 000

10 000

12 000

14 000

HD PD TX

12 227

787

7 716

4 581

567

4901

191

2745

29

Nº

pa

tien

ts

Total < 65 years 65 a 80 years > 80 years

Total number of pts – 20730

Prevalence – 2014,38 pmp

Nº of KTx pt / NºD pt = 0,59

Mean age HD + PD = 67,2 years

Patients treated by dialysis or with functioning kidney transplant 31st December 2018


Incident patients accepted for RRTduring 2018

255,95 253,33231,08

22,252,62

pm

p

All HD + PD HD PD KTx


176

195190

198 200204

215

204

230227

231 232235,2

224,4

218,14

230,56234,86

225,08

233,73

227,07

253,33

98 99 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

pm

pIncident patients accepted for dialysis

HD and PD per million population 1998 - 2018


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

253,33

126,40

637,14

908,97

231,08

104,98

607,77

893,51

22,25 21,42 29,37 15,46

HD + PD HD PD

Incident patients accepted for dialysisHD and PD per million population by age group during 2018


IncidenceHow do we compare?


vol 2 Figure 11.1 Geographic variation in the incidence rate of treated ESRD (per million population), by country, 2016

2018 Annual Data Report Volume 2 ESRD, Chapter 11


Prevalent patients on RRT by modality31st December 2018

2014,38

1264,6 1188,12

76,47

749,78

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

Global < 65years

65 a 80years

> 80years

1264,3

633,2

3270,6

4286,7

1187,8

563,0

3148,7

4241,9

76,5 70,2 121,9 44,8

pm

p

HD + DP HD DP

Prevalence of CKD patients treated by dialysisper million population by age group in 2018


Incident and prevalent pediatric patients on dialysisHD and PD per million population 2018

0,00

5,00

10,00

15,00

Incidence Prevalence

7,07

16,67

2,53

7,07

4,55

9,60

pm

p

HD + PD HD PD


1000

3000

5000

7000

9000

11000

13000

98 99 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

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%

2,7%

1,5%

3,7%

3,2%

1,4%

1,5%

1,4%

2,14%

Patients on dialysis and annual growthend of each year 1998 - 2018


626675

701 716744 760

804834

870902

924961

10161052 1068

11161159

11821212

12361264

500

600

700

800

900

1000

1100

1200

1300

98 99 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

pm

pPrevalent patients on dialysis

per million population end of each year 1998 - 2018


1410

1507

1578

1662 1670

17491794

1824

1911

1965

1200

1300

1400

1500

1600

1700

1800

1900

2000

8 9 10 11 12 13 14 15 16 17 18

pm

pPrevalent patients on RRT

per million population end of each year 1998 - 2018

2014


PrevalenceHow do we compare?


vol 2 Figure 11.9 Prevalence of treated ESRD (per million

population), by country, 2016



Incident patients starting PD vs HD1998 - 2018

98 99 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

HD 1655 1833 1800 1939 1956 2016 2129 2038 2273 2286 2285 2300 2312 2143 2084 2210 2233 2106 2166 2113 2378

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

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

PD HD


98 99 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

HD 5989 6455 6701 7071 7370 7559 8077 8392 8708 9037 9303 9646 10152 10409 10540 10977 11350 11514 11738 11985 12227

PD 261 293 311 346 376 398 390 437 481 517 511 571 660 704 742 732 735 751 720 758 787

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

PD HD

Prevalent patients starting PD vs HD1998 - 2018


type of renal replacement therapy modality used by ESRD patientsHow do we compare?


vol 2 Figure 11.12 Percentage distribution of type of renal

replacement therapy modality used by ESRD patients, by country, in

2016



7276 4484863

4951 3392853

0%

20%

40%

60%

80%

100%

HD PD Kidney tx

Man Women

Gender distribution in each modality31st December 2018


2585,8

1501,4

pm

p

Man Women

Prevalence by gender, all RRTper million population 31st December 2018


Diabetes31,5%

Hypertension13,9%

Chronic Gln11,9%

Policystic Disease5,1%Hipoplasia/Displasia

0,6%

Other Known19,3%

Unknown17,8%

Primary renal disease of patients accepted for dialysisHD and PD during 2018

Not available = 9


Diabetes in incident patientsHow do we compare?


vol 2 Figure 11.4 Incidence of treated ESRD due to diabetes as the assigned primary cause of ESRD cause, by country, 2016

(a) Percentage of incident ESRD patients



Diabetes27,8%

Hypertension13,8%

Chronic Gln13,8%

Policystic Disease6,2%

Hipoplasia/Displasia0,7%

Other Known18,5%

Unknown19,2%

Primary renal disease of prevalent patientsHD and PD, 31st December 2018

N = 12762Not available = 220


1655

1833 1800

1939 19562016

21292038

2273 2286 2285 2300 2312

21432084

2210 22332106

22062113

2378

0

500

1000

1500

2000

2500

98 99 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

New patients accepted for hemodialysis1998 - 2018


98 99 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

PD or Ktx to HD 211 178 172 213 268 208 251 274 224 258

Incident 1655 1833 1800 1939 1956 2016 2129 2038 2273 2286 2285 2300 2312 2143 2084 2210 2233 2106 2206 2113 2378

1400

1600

1800

2000

2200

2400

2600

All patients accepted for hemodialysisIncident and returning from other modalities 1998 - 2018

2636


Incident patients accepted for hemodialysisper million population 2008 - 2018

215,21 216,42 217,34

202,90

197,31

210,73

214,15

202,99

212,97

204,96

231,08

180,00

190,00

200,00

210,00

220,00

230,00

240,00

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

pm

p


2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

NO 816 702 737 694 737 716 655 509 537 473 500

YES 1464 1483 1522 1410 1342 1477 1541 1597 1629 1640 1878

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Previous follow-up by nephrology (> 3 months)HD patients 2008 – 2018


Norte Centro Lisboa Sul Açores Madeira Global Hosp Perif

NO 104 109 190 87 6 4 500 147 353

YES 576 392 568 259 40 43 1878 234 1644

576392 568 259

40 431878

234

1644

104109 190 87

6 4500

147

353

0%

20%

40%

60%

80%

100%

Previous follow-up by nephrology (> 3 months)HD patients, by country region and facility type - 2018


202

197

210,7214,15

202,99

212,97

204,96

231,08

186,52 185,3

199,8202,26

190,75

199,17

193,51

218,83

180

190

200

210

220

230

240

2011 2012 2013 2014 2015 2016 2017 2018

pm

p H

D

Inc d0 Inc d91

5,6%

Incident patients accepted for hemodialysis

Day 0 and day 91, 2011-2018

7,7%

5,2%

5,9%

6,5%

6,0%5,6%

5,3%


0

200

400

600

800

1000

HD

5

843

952

578P

ati

en

ts c

ou

nt

< 18 years old (0,2%) 18 a 65 years old (35,4%) 65 a 80 years old (40%) >80 years old (24,4%)

Patients accepted for hemodialysis by age group, during 2018


0

1000

2000

3000

4000

5000

HD

14

45344934

2745

Pat

ien

ts c

ou

nt

< 18 years old (0,1%) 18 a 65 years old (37,1%) 65 a 80 years old (40,4%) >80 years old (22,4%)

Patients treated by hemodialysisby age group , 31st December 2018


Incident and prevalent patients treated by hemodialysisby country region, 2018

0

500

1000

1500

2000

2500

3000

3500

4000

Nort Center South Lisbon Azores Madeira

680501

346

758

46 47

3555

2370

2021

3845

187 249

Incident Patients Prevalent Patients


Incident and prevalent patients treated by hemodialysisper million population by age group, 2018

0,00

1000,00

2000,00

3000,00

4000,00

5000,00

Global < 65years

65 to 80years

> 80years

231,08104,98

607,77893,51

1188,12

563,40

3148,65

4241,85

Incidence Prevalence


5989 6455 67017071

7370 75598077

83928708

90379303

964610152

10409 1054010977

11350 1151411836 11985

12227

0

2000

4000

6000

8000

10000

12000

14000

98 99 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

Pat

ien

ts c

ou

nt

Patients treated by hemodialysis31st of December each year, 1998 – 2018


Hemodialysis growth 2018 vs 2017 (%)31st of December each year

0

2

4

6

8

10

12

14

All Hospital Center

12,5

14

12,2

2 1,7 2

Var

iati

on

201

7/2

01

8 (

%)

Hemodialysis Growth Portugal

Incident pts % Prevalent pts %


Distribution of hemodialysis patients by type of dialysis facility 31st of December 2018

9%

91%

In Hospital In center

N = 12227In Hospital:1146In Center:11081


Patients treated by hemodialysisdistribution by techniques in each age group, 31st of December 2018

0

1000

2000

3000

4000

5000

6000

7000

Low flux HD High flux HD Hemodiafiltration

270

4944

7013

132

1746

2672

87

1985

2861

51

12131480

Nº

pat

ien

ts

Total < 65 years 65 a 80 years >80 years

N = 12227low flux 2,2% (2,4% in 2017)


946 761 874 629 405 346 314 313 304 323 270

52695307

48434726 5000 5080

4076 4013 41175166 4944

3088 35744435

5054 5132 55516960 7188 7317

6496 7013

0%

20%

40%

60%

80%

100%

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Nº

pat

ien

ts

Low flux High flux Hemodialfiltration

Patients treated by hemodialysisdistribution by techniques, 31st Dec. 2008 - 2018


48 0 11 115

96

270

195

75

1618938

416

1848

91

33

4944

510

4434

18891429

1594

1885

216

7013

441

6572

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

N = 12227 by end of December 2018

Patients treated by hemodialysisdistribution by techniques by region and facility type, 31st Dec. 2018


Mean Age of patients treated by hemodialysis31st of December 2008 – 2018

64,3

65,02

65,99

66,4966,8 66,9

67,1767,47

67,6867,89 68,02

62

63

64

65

66

67

68

69

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Mea

n a

ge


55

60

65

70

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Islands 60,8 61,9 61,9 62,4 60,3 62,4 62,6 62,4 63,6 65,0 64,2

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

North 63,7 64,8 65,8 66,3 66,7 66,8 66,8 67,2 67,4 67,7 68,1

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

Centre 66 68 68,2 68 68,7 69,1 69,5 69,5 69,7 69,9 69,8

Mea

n a

geMean Age of patients treated by hemodialysis

by country region, 31st of December 2008 – 2018


Diabetes32,5%

Hypertension14,2%

Chronic Gln10,3%


0,3%

Other Known19,3%

Unknown18,2%

Primary renal disease of patients accepted for hemodialysisduring 2018

N = 2378


Etiology of All patients accepted for hemodialysisduring 2018

Diabetes29,3%

Hypertension12,8%

Chronic Gln9,3%


Hipoplasia/Displasia0,3%Other Known

17,4%

Unknown16,4%

Tx/DP Failure9,8%

N = 2636


DM28,1%

HTA13,9%

GNC12,8%

DRPQA5,8%hip/displasia

0,7%

other Known19,2%

unknwon18,7%

Not available0,8%

Primary renal disease of prevalent hemodialysis patients31st December 2018

N = 1219433 not available


Diabetes as primary renal disease in HD patientsIncident and prevalent (%) 2008 - 2018

3132

33,632,6

32 32,233

34,6

33 33,432,5

25 25

26,927,7 28 28,2 28,2 28,7 29,1 28,7

28,1

20

25

30

35

40

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

% D

iab

etes

Incident Pt Prevalent Pt


Viral status in HD prevalent patients31st December 2018

94,27%

1,18%

2,99%

1,56%

Neg Hbs Ag + HCV Ab + HIV Ab +N = 12227


Hepatitis C viral status in HD prevalent pts31st December 2016 – 2017 - 2018

0

50

100

150

200

250

300

HCV Ab+/RNA+ HCV Ab+/RNA- Seroconv to RNA - Incid HCV +

2016 197 205 120 15

2017 149 128 119 15

2018 99 266 82 16

2016 2017 2018


Vascular access


Vascular access of HD incident patientsduring 2018

AVFistula39,1%

Graft1,9%

Tunneled catheter51,6%

Non-tunneled cat.7,3%

N = 236612 unavailable


2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Non-tunneled cat. 296 282 219 188 163 143 163 81 103 117 173

Tunneled cat. 864 940 1034 1033 1007 1101 1088 1068 1093 1094 1222

Graft 109 111 117 71 61 61 60 74 59 57 45

AVFistula 990 895 931 844 844 870 912 872 940 862 926

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Vascular access of HD incident patients2008 – 2018


Catheter rate (%) in the first HD session of incident patients 2008 – 2018

51,4

54,854,5

57,2

56,4

57,2

56,3

54,854,5

56,9

58,6

46

48

50

52

54

56

58

60

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018


53,7%

30,5% 34,8% 36,4% 43,4%

4,3%

39,1%27%

41,4%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

North Centre Lisbon South Azores Madeira Global InHospital

In Center

AVFistula Graft Tunneled Catheter Non-tunneled Cat.

Vascular access of HD incident patientsby country region and facility type

N = 236612 not

available


Vascular access of HD prevalent patients31st December 2018

AVFistula73,5%

Graft9,0%

Tunneled catheter17,3%

Non-tunneled cat.0,2%



2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Non-Tunneled Cat 76 39 42 25 16 23 15 24 2 10 35

Tunneled Catheter 1572 1769 1953 1905 1889 1834 1770 1804 1895 1971 2109

Graft 1191 1256 1365 1402 1349 1358 1317 1273 1239 1216 1101

AVFistula 6464 6538 6788 7077 7257 7750 8202 8434 8598 8782 8978

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Vascular access of HD prevalent patients31st December, 2008 - 2018


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

North Centre Lisbon South Azores Madeira Global In Hospital In Center

AVFistula Graft Tunneled Catheter Non-tunneled Cat.

83,9%73,8%

68,4%67,9% 71,1%

51%

73,5%

60%

74,8%

Vascular access of HD prevalent patientsby country region and facility type, 31st of December 2018



Vascular access of prevalent patients (%)31st December, 2008 - 2018

69,5 68,1 66,9 68 69 70,772,6 73,1 73,3 73,3 73,5

12,8 13,1 13,5 13,5 12,8 12,4 11,7 11 10,6 10,2 9

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

0

10

20

30

40

50

60

70

80

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

% o

f p

ati

en

ts

AVFistula Graft Catheter


AV Fistula rate of prevalent patients (%)31st December, 2008 - 2018

69,5

68,1

66,9

6869

70,7

72,673,1 73,3 73,3 73,5

60

62

64

66

68

70

72

74

76

78

80

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

% o

f p

atie

nts


12,813,1

13,5 13,5

12,812,4

11,7

1110,6

10,2

9

8

9

10

11

12

13

14

15

16

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

% o

f p

atie

nts

Graft rate of prevalent patients (%)31st December, 2008 - 2018


17,7

18,8

19,7

18,518,1

16,9

15,8 15,816,2 16,5

17,5

10

12

14

16

18

20

22

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

% o

f p

atie

nts

Catheter rate of prevalent patients (%)31st December, 2008 - 2018


Catheter rate of prevalent patients (%)31st December 2018

72,0

4,1

0,0

10,0

20,0

30,0

40,0

50,0

60,0

70,0

80,0

17,5%

42 centers above 20% cat rate19 centers below 10% cat rateNational rate = 17,5%Standard deviation = 3,6


72,0

5,4

0,0

10,0

20,0

30,0

40,0

50,0

60,0

70,0

80,0


Catheter rate of prevalent patients (%)In Hospital HD patients - 2018

33,6%


Catheter rate of prevalent patients (%)In Center HD patients - 2018

40,8

15,8

4,1

0,0

5,0

10,0

15,0

20,0

25,0

30,0

35,0

40,0

45,0



Mortality - hemodialysis


< 65 years 65 - 80 years >80 years

Prevalent 4548 4932 2744

Died 297 629 734

297

629

734

Deaths in hemodialysisby age group in 2018

* 82,1% of 1660 patients that died in

2018 were more than 65 years old and

44,2% more than 80 years

* 7,6% of deaths occurred during the

first 90 days after starting dialysis

* Mortality in the first 90 days was

4,78% (5,05% em 2017)


Death causes in HD patientsduring 2018

Cardiovascular24,8%

Sudden death8,5%

Infection (related with VA)1,7%

Infection (not related with VA)

21,6%Malignancy

11,5%

Cachexia8,0%

Others known13,4%

Unknown10,4%

N=1660


Deaths in hemodialysis2011 - 2018

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

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


Cardiovascular and Infection deaths in hemodialysis (%)2008 - 2018

31,8

29,828,5

27,728,6

26,9

24,2 24,4 24,7 24,5 24,8

17,9 17,916,9

22,022,9

20,7

24,0 23,422,2

23,021,6

10,0

15,0

20,0

25,0

30,0

35,0

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

CV

Inf (not rel VA)


31,8

29,828,5

27,728,6

26,9

24,2 24,4 24,7 24,5 24,8

23,222,6 22,2

25,1

26,7

23,2

25,8

24,325,3

23,3

10,0

15,0

20,0

25,0

30,0

35,0

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

CV

Inf (all)

Cardiovascular and Infection deaths in hemodialysis (%)2008 - 2018


Death causes during the first 90 days of HD2018

Cardiovascular23,8%

Sudden death11,1%

Infection (related with VA)

2,4%

Infection (not related with VA)

17,5%

Malignancy17,5%

Cachexia7,9%

Others known5,6%Unknown

14,3%

N=126


Patients movement in 2018

0

100

200

300

400394

5469

94 99

159

Nu

mb

er o

f p

ts

Out = 611 ; In = 258


IN OUT

First treatment 2378 Deaths 1660

Transplant failure 159 Transplanted 394

PD into HD 99 HD into PD 54

Stop treat. or recovery

163

GROSS MORTALITY RATE = 13,78%

HD patients movement in 2018


National gross mortality rate = 13,78%(90 day mortality = 4,78%)

Hemodialysis in hospital 20,66%(90 day mortality = 6,5%)

Hemodialysis in center 13,10% (90 day mortality = 4,4%)

Mortality rates – hemodialysis

2018


24,51

21,31 20,95

29,44

21,3920,03

21,4122,14

20,79

19,13

20,66

13,28 13,2412,35 11,82

12,76 12,3911,49

12,49 12,36 12,4213,1

14,45 14,0113,24 13,79 13,65 13,18

12,4913,28 13,09 13,03

13,78

8

10

12

14

16

18

20

22

24

26

28

30

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Gro

ss m

ort

alit

y ra

te (

%)

HD in Hospital HD in Center All pts

Gross mortality rate in hemodialysis

2008 - 2018


14,4514,01

13,24

13,79 13,6513,18

12,49

13,28 13,09 13,03

13,78

10

11

12

13

14

15

16

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Gro

ss m

ort

alit

y ra

te (

%)

All patients


2008 - 2018


13,28 13,24

12,35

11,82

12,7612,39

11,49

12,49 12,36 12,42

13,1

10

11

12

13

14

15

16

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Gro

ss m

ort

alit

y ra

te (

%)

HD in Center


in center treated patients, 2008 - 2018


Gross mortality rate

Impact of deaths until day 90, 2018

13,7813,1

20,66

12,74 12,22

18

7

9

11

13

15

17

19

21

23

All In Center In Hospital

Gro

ss m

ort

alit

y ra

te (

%)

Mortality since d1 Mortality since d91

4,39% died until d90

6,56% died until d90

4,7% died until d90


Mean Age Mortality

since d1

Mortality

since d91

Deaths until d90 (% of incident)

Global 68,02 13,78% 12,74% 4,75%

North 68,1 12,99% 11,51% 6,93%

Center 69,8 15,78% 15.01% 2,98%

South 68,9 13,34% 12,6% 3,93%

Lisbon 65 13,69% 12,97% 3,18%

Azores 63,8 13,45% 5,6% 26,92%

Madeira 64,4 12,20% 11,79% 2,00%

Gross mortality rates – hemodialysis

since d1 and d91 by country region, 2018


20,8%(2542)

79,2%

YES NO

Waiting list for renal transplantationHemodialysis patients, 2018


13,5%

7,3%

79,2%

Normal and Urgent Temporary out No

Waiting list for renal transplantationHD patients, Active and temporary contraindication - 2018


103108

93101

118

102

135

116

149 147

170

229

190

227220

208216

229

215

228 229

60

80

100

120

140

160

180

200

220

240

98 99 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

New patients starting peritoneal dialysis1998 - 2018


16,01

21,55

17,86

21,520,8

19,820,7

22,1

20,76

22,12 22,25

5

10

15

20

25

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

pm

p

Incident patients accepted for peritoneal dialysisper million population 2008 - 2018


88,2%

11,8%

Yes NoN = 229

Previous follow-up by nephrology (> 3 months)PD patients, 31st of December 2018


261293

311346

376398 390

437

481517 511

571

660

704742 732 735

751720

756787

150

250

350

450

550

650

750

98 99 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

Patients treated by peritoneal dialysisCount at 31st of December each year, 1998 – 2018


N = 229

Diabetes19,2%

Hypertension9,6%

Chronic GN27,1%



Other Known17,9%

Unknown12,2%

Primary renal disease of patients accepted for peritoneal dialysisduring 2018


Diabetes15,5% Hypertension

7,8%

Chronic GN26,7%


2,3%

Other Known20,3%

Unknown16,0%

Primary renal disease of prevalent peritoneal dialysis patients31st December 2018

N = 787


0

50

100

150

200

250

300

350

400

450

CAPD APD

415

372

135

85

22 73

16

Pat

ien

ts c

ou

nt

Total > 65 years > 80 years < 18 years

N = 787APD:47,2%

Age>65 years:27,9%; Age>80years:3,6%

Patients treated by peritoneal dialysisManual vs automated, 31st of December 2018


787

415372

0

100

200

300

400

500

600

700

800

900

Total CAPD APD

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Patients treated by peritoneal dialysisManual vs automated, 31st December 1998 - 2018


36,8

44,4

53,1

58,160,6

63,1 63,1

56,8

71,1

6461,1

53,2 52,149,7

41,3 41,5

47,543,9 43,8

41,7

47,2

0

10

20

30

40

50

60

70

80

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2106 2017 2018

% o

fp

atie

nts

Automated Peritoneal Dialysis usage (%)31st December 1998 - 2018


0

50

100

150

200

250

300

North Center South Lisbon Islands

266

143

78

234

66

Nu

mb

ero

f Pa

tien

ts

2010 2011 2012 2013 2014 2015 2016 2017 2018

Patients treated by peritoneal dialysisby region, 31st of December 2010 to 2018

N = 787 (2018)


50,3

50,9

51,5

50,1

52,2

53,7 53,9

54,5 54,554,8

55,1

47

48

49

50

51

52

53

54

55

56

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Mea

nag

e (y

ears

)

Mean Age of patients treated by peritoneal dialysis31st of December 2008 – 2018


95,55%

1,78%

1,40%

1,27%

Neg HbsAg + AntiVHC + AntiHIV +

Viral status in PD prevalent patients31st December 2018

N = 787


IN OUT

New patients 229 Death 46

KTr failure 15 Transplant 74

HD to PD 53 PD to HD 123

Suspension 7

Renal Recovery 7

Mortality rate = 5,22 % (90 d mortality = 2,7%)

PD patients movement in 2018


8,93

7,09

5,62

6,79

6,73

5,54

5,425,33

7

5,16

5,22

4

5

6

7

8

9

10

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Gro

ssm

ort

alit

yra

te(%

)

Gross mortality rate in peritoneal dialysis

2008 - 2018


Death causes in PD patients2018

CardioVasc44,2%

Sudden death14,0%

Infection (PD related)14,0%

Infection ( Not PD related)11,6%

Neoplasia9,3%

Cachexia4,7%

Others Known2,3%

N = 46

8 patients died until day 90;

2,7% of incidente patients and

17% of all deaths


Reasons for PD withdraw2018

N = 114

Infection33,3%

UF failure/Inadequacy28,9%

Mechanical problems17,5%

Non compliance8,8%

Others11,4%


Peritonitis episodes2018

N = 273

0,31 episodes / patients-2018

0,50,48

0,45 0,460,43

0,45

0,41

0,370,35

0,29 0,31

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Per

ito

nit

is r

ate


49,3%

50,7%

YES NO

PD patients in waiting list for renal transplantation2018


39,0%

10,3%

50,7%

Normal and Urgent Temporary out No

PD patients in waiting list for renal transplantationActive ant temporary contraindication for transplantation


826 30

69 63

99 106

182199

260 256

304

367

286

346370

400382

309

367 358 359

398

355

436

380393

480

525

593573

530

429448 448

485513

527505

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 18

Ren

al T

ran

spla

nt

cou

nts

per

yea

r

Years

Renal Transplants performed1980-2018

Total = 13164


Renal transplantation activity characterization2018

0

100

200

300

400

500

Dec

ease

d d

on

or

Dec

ease

d d

on

or

/R

ece

pto

r <1

8y

Dec

ease

d d

on

or

/R

ece

pto

r>6

5y

Livi

ng

do

no

r

Livi

ng

do

no

r /

Rec

epto

r <1

8Y

Livi

ng

do

no

r /

Re

cep

tor

>65y

446

7

48 59

2 5

Nº

of P

atie

nts

27 pre-emptive


Portuguese Transplant Centers Activity2018

0

20

40

60

80

100

120

HGSA HSMaria HG Orta CHLO StC HS João HCCabral

HSM-Ped CHUC CVP

77

65

21

42

69

58

4

108

2

30

70

9 6 4 2 1 0

9

0 0 0 0

24

0 0 00 0 0 0 0 0 0 0 00 0 0 1 0 0 0 0 00 0 0 0 0 2 0 0 0

Pat

ient

num

ber

s

Título do EixoDeceased donor Living donor Kidney and Pancreas Kidney and Liver Kidney and Heart Pacreas after Kidney

446 tx deceased donor59 (11,6%) live donor35 multi-organ transplantstotal = 505


31

3735 34

38

34

41

3638

45,3

49,45

55,853,9

50,2

40,642,7 43

46,7549,53

51,1249,07

0

10

20

30

40

50

60

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

2018

pm

p

Renal Transplants Performedper million population, 2008 - 2018


Renal Transplanted Patients

Previous renal replacement therapy, 2015-2018

N = 505 (2018)

375

65

17

377

101

25

414

82

31

398

80

27

0

50

100

150

200

250

300

350

400

450

Hemodialysis Peritoneal Dialysis Pre-emptive

2015

2016

2017

2018


N =505

Diabetes17,6%

Hypertension10,7%

Chronic GN32,5%



Other Known20,3%

Primary renal disease of renal transplanted patientsduring 2018


Incidence of transplantationHow do we compare?


Patients with functioning graft and annual growth31st December 1998 - 2018

2843 29893256

34723673

38614140

4408 4538

5013 5151

57945976

6440 63596636 6618 6681

72427518

7716

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

98 99 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

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%2,6%

3,8%8,4%

0,9%

4,3%

Portuguese Registry of Dialysis and Transplantation 2018 N = 7716

285299

326 335353

369393

417 430

473 485

545562

610 602633 635 642

699729

749

200

300

400

500

600

700

800

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

20

18

pm

p

Prevalence of CKD patients with functioning graftcumulative per million population end of each year 1998 - 2018


Renal transplantation: living vs deceased donor

2018

9,7%

90,3%

Living donor Deceased donor N = 7716


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

8081828384858687888990919293949596979899

0123456789

101112131415161718

Number

Yea

rs

Lost grafts Transplantations

Renal transplantation activity1980 - 2018

2018: 101 patients died with functioning graft;

152 transferred to HD / 13 transferred to PD


Gabinete do Registo da Doença Renal Crónica

da

Sociedade Portuguesa de Nefrologia

gabinete do registo da doença renal crónica sociedade ... · gabinete do registo da doença renal...

Documents