En Argentina, el registro de pacientes al ingreso o egreso a diálisis es de carácter obligatorio, lo que permite conocer la mortalidad y la sobrevida asociada al tipo de modalidad dialítica, ...hemodiálisis convencional (HD), diálisis peritoneal (DP) y hemodiafiltración on line (HDF-OL). Estudio retrospectivo, utilizando el registro argentino de diálisis y trasplante. Se comparó la mortalidad y la sobrevida de los pacientes en HDF-OL y DP con la de los pacientes en HD, siendo esta última la referente en la estandarización. Siendo que la HDF-OL comenzó a registrarse en el 2014, se tomó como cohorte aquella comprendida entre el 2014 al 2022. La modalidad dialítica de primera elección al ingreso a diálisis es la HD, representando el 91.5% de los pacientes incidentes. La DP representa el 8.5% en 2022. En el 2014 se comenzaron a registrar los pacientes en hemodiafiltración online (HDF-OL), llegando a representar al 6.3% de los incidentes. La HDF-OL se asoció a una reducción de la mortalidad del 39%, y una reducción del 23% para la DP, en comparación con HD convencional. Comenzar en DP o en HDF-OL estuvo asociado a una disminución del riesgo relativo de muerte entre el 35 y el 48% cuando se compara con comenzar en HD, en la población incidente en diálisis crónica en Argentina. Nuestro registro muestra el efecto beneficioso de la HDF-OL en comparación con la HD, cabe destacar que a diferencia de otros estudios llevados a cabo hasta la fecha, se ha incluido en dicho análisis a la DP, la cual muestra beneficios algo menores que la HDF-OL pero superiores a la HD.
Introducción: Existen escasos reportes de sobrevida a largo plazo en los pacientes en diálisis crónica en Latinoamérica. Materiales y métodos: Estudio de cohorte retrospectiva del Registro Argentino ...de Diálisis Crónica. Modelo de riesgo proporcional de Cox. Resultados: 108,498 pacientes ingresaron en diálisis crónica (DC) entre 2004 y 2020. Sobrevida al año del 78.7%, a los 5 años del 40.2% y a los 16 años del 4.4%. Mediana de sobrevida: 45.3 meses. Las siguientes variables al comienzo del tratamiento se asociaron a peor pronóstico en el corto y mediano plazo: edad al ingreso (4.1% de mayor riesgo de muerte por cada año de aumento en ella), nefropatía diabética, insuficiencia cardiaca, enfermedad cerebrovascular, insuficiencia vascular periférica, arritmia cardiaca, angina persistente o infartos de miocardio, enfermedad pulmonar crónica, neoplasia en los últimos 5 años, albuminemia menor a 3.5 g/dl, iniciar DC con hematocrito menor al 27%, consumo de tabaco en los 10 años previos al ingreso, ser portador del virus del SIDA y el año de ingreso a DC son factores significativamente predictores de mayor riesgo. Conclusiones: La sobrevida en diálisis está asociada a las comorbilidades al ingreso y el seguimiento del paciente en estadios mas tempranos de enfermedad renal crónica.
The Latin American Dialysis and Renal Transplant Registry (RLADTR) was founded in 1991; it collects data from 20 countries which are members of Sociedad Latinoamericana de Nefrología e Hipertension. ...This paper presents the results corresponding to the year 2010. This study is an annual survey requesting data on incident and prevalent patients undergoing renal replacement treatment (RRT) in all modalities: hemodialysis (HD), peritoneal dialysis (PD) and living with a functioning graft (LFG), etc. Prevalence and incidence were compared with previous years. The type of renal replacement therapy was analyzed, with special emphasis on PD and transplant (Tx). These variables were correlated with the gross national income (GNI) and the life expectancy at birth. Twenty countries participed in the surveys, covering 99% of the Latin American. The prevalence of end stage renal disease (ESRD) under RRT in Latin America (LA) increased from 119 patients per million population (pmp) in 1991 to 660 pmp in 2010 (HD 413 pmp, PD 135 pmp and LFG 111 pmp). HD proportionally increased more than PD, and Tx HD continues to be the treatment of choice in the region (75%). The kidney Tx rate increased from 3.7 pmp in 1987 to 6.9 pmp in 1991 and to 19.1 in 2010. The total number of Tx's in 2010 was 10 397, with 58% deceased donors. The total RRT prevalence correlated positively with GNI (
0.86; P < 0.05) and life expectancy at birth (
0.58; P < 0.05). The HD prevalence and the kidney Tx rate correlated significantly with the same indexes, whereas the PD rate showed no correlation with these variables. A tendency to rate stabilization/little growth was reported in the most regional countries. As in previous reports, the global incidence rate correlated significantly only with GNI (
0.63; P < 0.05). Diabetes remained the leading cause of ESRD. The most frequent causes of death were cardiovascular (45%) and infections (22%). Neoplasms accounted for 10% of the causes of death. The prevalence of RRT continues to increase, particularly in countries with 100% public health or insurance coverage for RRT, where it approaches rates comparable to those displayed by developed countries with a better GNI. The incidence also continues to increase in both countries that have not yet extended its coverage to 100% of the population as well as in those that have an adequate program for timely detection and treatment of chronic kidney disease (CKD) and its associated risk factors. PD is still an underutilized strategy for RRT in the region. Even though renal Tx is feasible, its growth rate is still not as fast as it should be in order to compensate for the increased prevalence of patients on waiting lists. Diagnostic and prevention programs for hypertension and diabetes, appropriate policies promoting the expansion of PD and organ procurement as well as transplantation as cost-effective forms of RRT are needed in the region. Regional cooperation among Latin American countries, allowing the more developed to guide and train others in starting registries and CKD programs, may be one of the key initiatives to address this deficit.
Poor socioeconomic status in the patient population is one of the causes of the lack of primary and secondary prevention of chronic kidney disease and negatively affects the survival of patients on ...chronic haemodialysis (HD).
To confirm whether the low or absent income of the incident population on HD is a factor of poor prognosis.
We used the incident HD population of the Argentine Registry of Chronic Dialysis. Follow-up lasted 12 months, performing an intention to treat analysis. We applied the Cox model to assess the association between income and survival of patients after adjusting for age, sex, diabetes, comorbidities, initial laboratory results, and first vascular access.
We analysed 13466 adult patients (age at onset: 60.4 ± 15.6 years; 57.2% were male, and 39.2% diabetic) who were assigned to 2 groups: 1) "no income" group, 5661 patients (age at onset: 60.3 ± 15.4 years; 53.1% were male and 41.4% diabetic), 2) "with income" group, 7805 patients (age at onset, 60.5 ± 15-8 years; 60.1% were male and 37.5% diabetic). The "no income" group had a hazard ratio of 1.19 (95% confidence interval CI: 1.11-1.28) in the univariate analysis, 1.23 (95% CI: 1.14-1.32 ) considering age and gender, 1.22 (95% CI: 1.13-1.31) by adding diabetes mellitus, 1.26 (95% CI: 1.18-1.36) by adding comorbidities, 1.25 (95% CI: 1.16- 1.35) by adding the initial laboratory results, and 1.24 (95% CI: 1.15- 1.33) if temporary vascular access is included. All models resulted in a significance of P=.000.
Low or no income of patients at the time of entry into HD is an independent risk factor for immediate lower survival.
In 2008, 563,294,000 people were living in Latin America (LA), of which 6.6% were older than 65. The region is going through a fast demographic and epidemiologic transition process, in the context of ...an improvement in socio-economic indices. The Latin American Dialysis and Renal Transplant Registry has collected data since 1991, through an annual survey completed by 20 affiliated National Societies. Renal replacement treatment (RRT) prevalence and incidence showed an increase year by year. The prevalence rate (in all modalities) correlated with the World Bank country classification by income and the epidemiologic transition stage the countries were experiencing. RRT prevalence and kidney transplantation rates correlated significantly with gross national income (GNI), health expenditure in constant dollars (HeExp), % older than 65, life expectancy at birth, and % of the population living in urban settings. Kidney transplantation increased also, year by year, with more than 50% of transplants performed using kidneys from deceased donors. Double transplants were performed in six countries. RRT prevalence and incidence increased in LA, and are associated with indexes reflecting higher and more evenly distributed national wealth (GNI and HeExp), and the stage of demographic and epidemiological transition.
Although scoring comorbidities for patients beginning chronic hemodialysis has proved significant and has led researchers to develop several indexes, none of them has been extensively accepted. The ...aim of this study was to: 1) develop a prognostic index for patients entering renal replacement therapy; and 2) identify which one of the available scores better predicts one-year survival.
Records from 5,360 incident dialysis-requiring ESRD individuals were studied and a novel comorbidity index (NI) was developed. The agreement of this NI with the Charlson age-comorbidity, Kahn-Wright, ACPI, and Hemmelgarn indexes was assessed to identify which one better predicts one-year survival. The Cox proportional hazard regression with time-dependent covariates was used to analyze survival and the area under the receiver operating characteristic (ROC) curve was calculated to assess the ability of this score to discriminate between prognoses and to compare this NI with indexes already in use.
16 of the original 19 predictor variables displayed hazard ratios =1.2. Although the area under the ROC curves for all the indexes compared were significantly different from 0.5, the NI showed better performance characteristics (0.74 vs. 0.70 for Charlson's, 0.68 for ACPI, 0.67 for Khan-Wright's and 0.63 for Hemmelgarn's). Compared with the Charlson score, the z statistic was 7.78 (p<0.001). One-year survival estimate for the high-risk group was 43% with the NI and ranged from 66% to 72% when assessed through other indexes.
We recommend the use of this NI because it better predicts the one-year survival probability of incident hemodialysis-requiring ESRD individuals.
A significant increase in the number of patients starting chronic hemodialysis (HD) with an estimated glomerular filtration rate (eGFR)≥10 mL/min/1.73 m(2) was observed in Argentina between 2004 and ...2009.
In order to study this topic, we calculated the mortality hazard ratios (HR) in a cohort of incident HD individuals from the Argentine Registry of Chronic Dialysis Registro Argentino de Diálisis Crónica (2004-2009), grouped according to the initial eGFR (0-4.9, 5-9.9, 10-14.9 and ≥15 mL/min/1.73 m(2) ; reference group 0-4.9) estimated by CKD-EPI; in three cohorts: "total population", "healthy" (<65 years, without diabetes or comorbidities) and "planned entry" (with permanent vascular access).
After adjusting the population (n=16,931) for age, gender, coexisting conditions, serum albumin, income, and temporary vascular access a HR of 1.19 (95%CI:1.07-1.33) was observed in the group with eGFR≥15 mL/min/1.73 m(2). In the cohort of 3,897 "healthy" after adjusting for the same co-variates, HRs of 1.44 (95%CI: 1.08-1.65) and 1.65 (95%CI: 1.06-2.55) were obtained for the groups with baseline eGFR values of 10-14.9 and ≥15 mL/min/1.73 m(2), respectively. In "planned entry" patients (n=6,280), after adjusting for age, gender, co-morbidities, serum albumin and income, HRs in all groups were not significantly different as compared to the control group.
HD initiation with eGFR>10 mL/min/1.73 m(2) shows no survival advantage. The higher mortality in the group with >eGFR starting dialysis looks like an "artifact" related to higher age, more co-morbidities, low albuminemia and the use of temporary vascular access.
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