Report Finnish Registry for Kidney Diseases. Mortality of transplantation patients. Mortality of RRT patients according to diagnosis

Transcription

1 Finnish Registry for Kidney Diseases Report Deaths/ patient-years 1 1 Mortality of transplantation patients Mortality of RRT patients according to diagnosis Deaths/ patient-years NIDDM Amyloidosis IDDM Other diagnosis Pyelonephritis Polycystic degeneration Glomerulonephritis

2 Finnish Registry for Kidney Diseases Report Contents Finnish Registry for Kidney Diseases Report...ii The Finnish population and its distribution in health care districts in Health care districts and regions in Finland...1 Number of patients in health care districts and regions in 1... Prevalence of RRT in regions in 1... The Finnish population according to age group in... Number of patients according to region and age group in... Prevalence of RRT in health care districts on 1 December... Number of new patients in health care districts in 1... Incidence of RRT in different regions in 1... Net changes in type of treatment in the year... Number of patient-years according to type of treatment in 1... Number of patients according to type of treatment in 1... Number of patient-years according to diagnosis in 1... Number of patients according to diagnosis in 1... Number of new patients according to diagnosis in 1... Mean age of new RRT patients in 1... Number of patient-years according to age group in 1... Number of patient-years according to age group and type of treatment in 1... Number of patients in RRT on 1 December 1... Mean age of patients in RRT on 1 December 1... Mean age of patients at start of dialysis in Immunosuppressive treatment of transplantation patients in Immunosuppressive treatment in 1 of patients who received their first kidney transplant in 1 or earlier...1 Immunosuppressive treatment in 1 of patients who received their first kidney transplant in 1 or later...1 Treatment of high blood pressure among peritoneal dialysis patients in Treatment of high blood pressure among hemodialysis patients in Treatment of high blood pressure among transplantation patients in Systolic and diastolic blood pressure according to type of treatment in...1 Mortality of RRT patients in 1... Mortality of RRT patients according to type of treatment in 1... Mortality of transplantation patients in 1... Mortality of RRT patients according to diagnosis in 1... Causes of death among peritoneal dialysis patients in Causes of death among hemodialysis patients in Causes of death among transplantation patients in 1...1

3 Finnish Registry for Kidney Diseases Report The Finnish Registry for Kidney Diseases annually presents statistics on patients in renal replacement therapy (RRT). By the end of the year, 1 patients in Finland had a kidney transplant and a further 1 1 were receiving dialysis. The number of RRT patients per million inhabitants had increased from the previous year in all health care districts. The number of patients in the entire country had increased by % in one year and % in five years. The annual number of new patients has also continuously increased, being % higher in than in 1. This report includes analyses of RRT patients treatment for high blood pressure and transplantation patients immunosuppressive treatment. The use of treatment for high blood pressure has increased in all treatment groups, and the proportion of patients with hypertension was smaller in the year than five years earlier. RRT patients mortality was also analysed. Mortality has virtually remained unchanged since 1, although patients have gotten older. Data from the Finnish transplantation registry were used for updating the statistics in this report. Helsinki, 1 October 1 Patrik Finne Administrative Director Carola Grönhagen-Riska Chairman of the Board The Board of the Finnish Registry for Kidney Diseases Sirpa Aalto, MSc Ilpo Ala-Houhala, MD Agneta Ekstrand, docent Carola Grönhagen-Riska, professor Patrik Finne, MD Erkki Lampainen, MD Marjatta Linnanvuo-Laitinen, MD Kaj Metsärinne, docent Maija Piitulainen Kai Rönnholm, MD Kaija Salmela, docent Svante Stenman, docent

4 Table 1. The Finnish population and its distribution in health care districts (1 inhabitants) Finnish Registry for Kidney Diseases 1 Health care district Change (%) Helsinki-Uusimaa Varsinais-Suomi Satakunta Kanta-Häme Pirkanmaa Päijät-Häme Kymenlaakso Etelä-Karjala Etelä-Savo Itä-Savo Pohjois-Karjala Pohjois-Savo Keski-Suomi Etelä-Pohjanmaa Vaasa Keski-Pohjanmaa Pohjois-Pohjanmaa Kainuu Länsi-Pohja Lappi Åland Region South South-West West East North Entire country On 1 December, there were.1 million inhabitants in Finland (Table 1). Since 1 the population has increased most in the southern region (.%). In the eastern and northern regions, populations have decreased. At the beginning of the year, the health care districts of Helsinki and Uusimaa fused. The new health care district covers % of the Finnish population. During the past eight years the population has decreased in 1 health care districts and increased in eight districts, the greatest increase occurring in the Helsinki-Uusimaa district. In health care districts with decreasing numbers of inhabitants, the overall age of the population tends to increase, resulting in increased incidence and prevalence of most diseases. The numbers in Figure 1 refer to the health care districts listed in Table 1. In this report region refers to university hospital region. Figure 1. Health care districts and regions in Finland Finnish Registry for Kidney Diseases Western region South-western region Northern region Southern region Eastern region Finnish Registry for Kidney Diseases Report 1

5 Table. Number of patients in health care districts and regions Finnish Registry for Kidney Diseases 1 Health care district Patients in the district Patients/million inhabitants Helsinki-Uusimaa Varsinais-Suomi Satakunta Kanta-Häme Pirkanmaa Päijät-Häme Kymenlaakso Etelä-Karjala Etelä-Savo Itä-Savo Pohjois-Karjala Pohjois-Savo Keski-Suomi Etelä-Pohjanmaa Vaasa Keski-Pohjanmaa Pohjois-Pohjanmaa Kainuu Länsi-Pohja Lappi Åland Region South South-West West East North Entire country 1 1 Figure. Prevalence of RRT in regions Finnish Registry for Kidney Diseases 1 Patients/million inhabitants East South-West South Entire country West North The number of patients in renal replacement therapy (RRT) per million inhabitants by the end of the year had increased in all health care districts from the previous year (Table ). The increase was largest in the health care districts of Etelä-Karjala and Länsi-Pohja (%). In the northern region, the number of RRT patients had increased the most (1%), and in the southern region the least (%) during the past year. The five-year increase was also the largest in the northern region (%). During 1 the prevalence of RRT was highest in the eastern region and lowest in the northern region (Figure ) Finnish Registry for Kidney Diseases Report

6 Table. The Finnish population according to age group (1 inhabitants) (%) Finnish Registry for Kidney Diseases Region 1 (%) Age group (years) 1 (%) (%) (%) Entire country South South-West West East North (1) () (1) () () 1 1 () () () () () 1 () () () () () () () () () () Entire country, (1) () () () 11 Entire country in previous years (1) (1) 1 () () () () 1 () () 1 Table. Number of patients according to region and age group Finnish Registry for Kidney Diseases Region Patients in age group Patients/million in age group 1 y 1 y y y 1 y 1 y y y South South-West West East North Entire country, Entire country in previous years Table presents the age distribution in different regions on 1 December. The proportion of inhabitants older than years was smallest in the southern (1%) and northern (1%) regions. In the other regions this proportion was %. The proportion of 1 -year-olds was larger in the southern region (%) than elsewhere (%). The age distribution of the population overall has remained unchanged during the past three years. The prevalence of RRT in inhabitants older than years was 1 1 in the southern, 1 in the south-western, in the western, 1 in the eastern, in the northern and 1 patients per million inhabitants in the age group in the entire country (Table ). Among 1 -year-olds the prevalence of RRT was similar in all regions. During the past three years the prevalence has increased by % in inhabitants older than years and % in 1 -year-olds. Finnish Registry for Kidney Diseases Report

7 Figure. Prevalence of RRT in health care districts on 1 December Finnish Registry for Kidney Diseases Lappi Entire country patients/million inhabitants Group 1 < patients/million inhabitants Group patients/million inhabitants Group > patients/million inhabitants Länsi-Pohja Pohjois- Pohjanmaa Kainuu 1 Keski- Pohjanmaa Vaasa Etelä-Pohjanmaa Keski-Suomi Pohjois-Savo Pohjois-Karjala Åland Satakunta Varsinais- Suomi 1 Pirkanmaa Kanta-Häme Päijät- Häme Helsinki-Uusimaa Etelä-Savo Itä-Savo Etelä-Karjala Kymenlaakso The health care districts shown on the map are grouped according to the prevalence of RRT at the end of (Figure ). The prevalence was < in seven districts, in eight districts and > patients/million inhabitants in six districts. The borders of the regions are indicated with thick lines. Finnish Registry for Kidney Diseases Report

8 Table. Number of new patients in health care districts Finnish Registry for Kidney Diseases 1 Health care district New patients New patients/million inhabitants on average on average Helsinki-Uusimaa Varsinais-Suomi Satakunta Kanta-Häme Pirkanmaa Päijät-Häme Kymenlaakso Etelä-Karjala Etelä-Savo Itä-Savo Pohjois-Karjala Pohjois-Savo Keski-Suomi Etelä-Pohjanmaa Vaasa Keski-Pohjanmaa Pohjois-Pohjanmaa Kainuu Länsi-Pohja Lappi Åland Region South South-West West East North Entire country Children < 1 y 1 1 Figure. Incidence of RRT in different regions Finnish Registry for Kidney Diseases 1 Patients/million inhabitants (smoothed averages) 1 North East South-West Entire country West South The incidence of RRT is given in Table. During 1 the average incidence was highest in Itä-Savo (1/million inhabitants) and lowest in Etelä-Savo (/million inhabitants). The incidence has increased during the past five years in all regions, the least in the southern region (%) and the most in the northern region (%). Figure gives the incidence in the regions as smoothed averages. In the northern region, the incidence was the lowest in the country until 1, but in it was the highest Finnish Registry for Kidney Diseases Report

9 Figure. Net changes in type of treatment Finnish Registry for Kidney Diseases New patients entering RRT RRT started Patients entering peritoneal dialysis Returned to RRT From abroad 1 Returned to RRT 1 Patients entering hemodialysis Peritoneal dialysis 1 January 1 December Hemodialysis 1 January 1 December 1 Patients in RRT 1 Functioning kidney transplant 1 January December 1 1 RRT stopped Deceased patients Regained function 1 Regained function in Emigrants Emigrants During, new patients entered RRT and one patient returned to RRT (Figure ). There were patients in RRT at the beginning of and 1 by the end of the year. Altogether patients died and dialysis for patients was discontinued because the patients own kidney function resumed. Of the patients who died during the year, had a functioning transplant, were receiving peritoneal dialysis, and 1 were in hemodialysis. Finnish Registry for Kidney Diseases Report

10 Table. Number of patient-years according to type of treatment Finnish Registry for Kidney Diseases 1 Patient-years (%) Type of treatment Peritoneal dialysis Hemodialys Transplantation 1 1 (1.) (.) (1.) 1 1 (.) (.) (1.) 1 (.1) (.) (1.) 1 (.) (.) (.) 1 1 (.) (.) (.) All Increase from previous years (%).... Figure. Number of patients according to type of treatment Finnish Registry for Kidney Diseases 1 Number of patients at end of year Transplantation 1 Hemodialysis Peritoneal dialysis Since 1 the number of patient-years in RRT has increased % per year, for an overall increase of % (Table ). The number of patient-years in hemodialysis has increased the most, % since 1. The proportion of patient-years has increased. percentage units in hemodialysis and decreased. percentage units in peritoneal dialysis. The proportion of patient-years in transplantation patients has remained almost constant (. 1.%). The number of transplantation and hemodialysis patients has increased by % and 1%, respectively, over the past years, whereas the number of patients in peritoneal dialysis has remained virtually unchanged (Figure ). Finnish Registry for Kidney Diseases Report

11 Table. Number of patient-years according to diagnosis Finnish Registry for Kidney Diseases 1 Patient-years (%) Diagnosis Glomerulonephritis IDDM Polycystic degeneration Pyelonephritis NIDDM Undefined kidney disease Amyloidosis Nephrosclerosis Other systemic diseases Urinary tract obstruction Congenital diseases Congenital nephrosis, Finnish type Tubulointerstitial nephritis Other kidney diseases Malignancies Metabolic diseases 1 1 (.) (1.) (.) (.) (.) (.) (.) (.) (.) (.) (.) (1.) (.1) (.) (.) (.) (.) (1.) (.) (.1) (.) (.) (.) (.) (.) (.) (.) (1.) (.1) (.) (.) (.) (.) (1.) (1.) (.) (.) (.) (.) (.) (.) (.) (.1) (1.) (.) (.) (.) (.) (.) (1.) (1.) (.) (.) (.) (.1) (.) (.1) (.) (.) (1.) (1.) (1.) (.) (.) (.) (.) (1.) (.) (.) (.) (.) (.) (.) (.) (.) (1.) (1.) (1.) (.) (.) All Figure. Number of patients according to diagnosis Finnish Registry for Kidney Diseases 1 Number of patients at end of year Glomerulonephritis IDDM and NIDDM together Other defined diagnoses IDDM Polycystic degeneration Pyelonephritis NIDDM Undefined kidney disease Amyloidosis Table shows the number of patient-years according to diagnosis during 1. Glomerulonephritis was clearly the most common diagnosis, although its proportion of all patient-years has decreased. percentage units over the past five years. The second most common diagnosis was insulin-dependent diabetes mellitus (IDDM) (.%). Non- IDDM (NIDDM) was the fifth most common diagnosis with its number of patient-years doubling in five years. The six most common diagnoses constitute % of all patient-years. The number of RRT patients at the end of the year is shown according to diagnosis in Figure. Glomerulonephritis has been the most common diagnosis since 1, and IDDM the second most common diagnosis since 1. The group other defined diagnoses includes nephrosclerosis, other systemic diseases, urinary tract obstruction and tubulointerstitial nephritis (see also Table ). Finnish Registry for Kidney Diseases Report

12 Figure. Number of new patients according to diagnosis Finnish Registry for Kidney Diseases 1 Annual number of new patients 1 IDDM and NIDDM together 1 Other defined diagnoses NIDDM IDDM Glomerulonephritis Polycystic degeneration Undefined kidney disease Amyloidosis Pyelonephritis Age (years, smoothed averages) Figure. Mean age of new RRT patients Finnish Registry for Kidney Diseases 1 Hemodialysis Peritoneal dialysis Figure shows, as smoothed averages, the annual number of new RRT patients according to diagnosis. Diabetes has been the most common disease causing chronic uremia since 1, and since 1 the number of new diabetes patients in RRT has increased by %. The annual numbers of new RRT patients with glomerulonephritis (%), polycystic degeneration (%) and amyloidosis (%) have also increased over the past years. The annual number of new pyelonephritis patients has not changed considerably for more than years. The age of new hemodialysis patients has increased faster than that of new peritoneal dialysis patients (Figure ). In the age of new hemodialysis and peritoneal dialysis patients was on average and years, respectively. Finnish Registry for Kidney Diseases Report

13 Table. Number of patient-years according to age group Finnish Registry for Kidney Diseases 1 Age group (years) Patient-years (%) (.) (.) (.) (.) 1 1 (.) (.) (.) (.) (.) (.) (.) (.) (.) (.1) (.) (.) (.) (.) (1.) (.) All Table. Number of patient-years according to age group and type of treatment Finnish Registry for Kidney Diseases 1 Age group (years) Patient-years (%) Peritoneal dialysis Hemodialysis Transplantation (.) (.) (.) (.) 1 (.) (.1) (.) (.) 1 (.) (.) (.) (.) 1 1 (.) (1.) (.) (.) (.) (.) (.) (.) 1 1 (.) (1.) (1.) (1.) All The proportion of patient-years of 1 -year-olds has decreased. percentage units during the past five years (Table ). Correspondingly, the proportion of patient-years of patients older than years has increased.1 percentage units and it was % in. During the past five years the proportion of patient-years of 1 -year-olds and patients older than years has decreased and increased, respectively, in all treatment groups (Table ). In the proportion of patient-years of peritoneal dialysis, hemodialysis and transplantation patients older than years was %, % and 1%, respectively. Finnish Registry for Kidney Diseases Report

14 Figure. Number of patients in RRT on 1 December Finnish Registry for Kidney Diseases 1 Patients at end of year Figure. Mean age of patients in RRT on 1 December Finnish Registry for Kidney Diseases 1 Age (years, smoothed averages) Hemodialysis Peritoneal dialysis Transplantation The number of patients in RRT has increased continuously since 1 (Figure ). In 1 the number of patients increased on average.% per year. During the past years the average age of hemodialysis, peritoneal dialysis and transplantation patients has increased 1, 1 and years, respectively (Figure, smoothed averages; corresponding numbers of patients are shown in Figure ). Finnish Registry for Kidney Diseases Report

15 Figure 1. Mean age of patients at start of dialysis Finnish Registry for Kidney Diseases 1 Mean age at start of dialysis c) Patients who have not received a kidney transplant a) All patients b) Patients who have received a kidney transplant Figure 1 shows the average age at start of dialysis for a) all patients, b) patients who have received a kidney transplant, and c) patients who have not received a kidney transplant. Patients who never received a kidney transplant were more than years older at start of dialysis than those who received a transplant. Patients younger than 1 years were excluded from the analysis. Figure 1. Immunosuppressive treatment of transplantation patients Finnish Registry for Kidney Diseases 1 St + Aza + CyA St + Aza, St + CyA or Aza + CyA Myc in various combinations Other 1 % % 1% n = % % n = 1 1 % % 1% n = 1 1 % % n = % % % % n = 1 Aza = azathioprine CyA = cyclosporin Myc = mycophenolate St = steroids Tac = tacrolimus Tac in various combinations without Myc (1%) Myc + Tac in combinations Transplantation patients most common immunosuppressive treatment in 1 was the combination of steroids, azathioprine and cyclosporin (Figure 1). In 1 a tacrolimus trial was conducted, with patients receiving this treatment. Tacrolimus was often used in combination with mycophenolate. This explains the large proportion of patients receiving mycophenolate in 1 in Figure 1. The Finnish Registry for Kidney Diseases did not register use of tacrolimus before. 1 Finnish Registry for Kidney Diseases Report

16 Figure 1. Immunosuppressive treatment of patients who received their first kidney transplant in 1 or earlier Finnish Registry for Kidney Diseases 1 Myc in various combinations Aza + CyA St + Aza + CyA St + Aza St + CyA Other 1 % 1% % n = 1 1 % 1% % n = 1 1 % % % n = 1 1 % 1% % n = 1 % 1% 1% n = 1 Aza = azathioprine CyA = cyclosporin Myc = mycophenolate St = steroids Tac = tacrolimus Tac in various combinations without Myc (.%) Myc + Tac in combinations (1%) Figure 1. Immunosuppressive treatment of patients who received their first kidney transplant in 1 or later Finnish Registry for Kidney Diseases 1 Aza + CyA St + CyA Myc in various St + Aza + CyA St + Aza combinations 1 % % % n = % % % n = 1 % % 1% n = 1 % % % n = % % 1% n = Tac in various combinations without Myc Myc + Tac in combinations Other The distribution of various immunosuppressive treatments for all transplantation patients at the end of the years 1 is shown separately for patients receiving their first transplant in 1 or earlier (Figure 1) and those receiving it in 1 or later (Figure 1). Combinations of two drugs were much more common and combinations of three drugs (steroids, azathioprine and cyclosporin) much rarer among those receiving a transplant in 1 or earlier. Those who received a transplant in 1 or later were more often given mycophenolate and tacrolimus. At the end of, % of all transplantation patients were using mycophenolate. Mycophenolate was used in combination with steroids (%), azathioprine (%), cyclosporin (%) and tacrolimus (1%). Finnish Registry for Kidney Diseases Report 1

17 Figure. Treatment of high blood pressure among peritoneal dialysis patients Finnish Registry for Kidney Diseases 1 Treatment of high bloodpressure No treatment of high blood pressure 1 1% % n = % % n = 1 % % n = 1 % % n = % % n = Proportion of patients Figure. Treatment of high blood pressure among hemodialysis patients Finnish Registry for Kidney Diseases 1 1 Treatment of high bloodpressure % No treatment of high blood pressure % n = % % n = 1 % 1% n = 1 1% % n = % % n = 1 Proportion of patients Figure 1. Treatment of high blood pressure among transplantation patients Finnish Registry for Kidney Diseases 1 1 Treatment of high bloodpressure % No treatment of high blood pressure 1% n = 1 % % n = 1 1 % 1% n = 1 1 % % n = 1 1 % 1% n = 1 Proportion of patients The treatment frequency of high blood pressure has increased for peritoneal dialysis (Figure ), hemodialysis (Figure ) and transplantation patients (Figure 1). This is probably due to more rigorous treatment goals (Figure 1). Treatment frequency was highest in transplantation and lowest in peritoneal dialysis patients. In dialysis patients, the high frequency may be partially due to hypervolemia. In treatment of high blood pressure was reported for % of the RRT patients. 1 Finnish Registry for Kidney Diseases Report

18 Figure 1. Systolic and diastolic blood pressure according to type of treatment Finnish Registry for Kidney Diseases 1 Blood pressure (mmhg) N (1) = N () = Proportion* (1) = Proportion* () = % % % % % % % % % % % 1% Peritoneal dialysis Peritoneal dialysis Transplantation Hemodialysis Transplantation Hemodialysis Treatment of high blood pressure No treatment of high blood pressure *Proportion of patients with diastolic blood pressure exceeding mmhg or systolic blood pressure exceeding 1 mmhg In blood pressure was lower in peritoneal dialysis, hemodialysis and transplantation patients receiving no treatment for high blood pressure (p <.1) (Figure 1). The proportion of all RRT patients with blood pressure exceeding 1/ mmhg has during the past five years decreased from 1% to % in those receiving and from % to % in those not receiving treatment for high blood pressure. In patients receiving treatment, this change was observed only in transplantation patients, whereas in nonreceivers it was observed also among dialysis patients. Finnish Registry for Kidney Diseases Report 1

19 Figure. Mortality of RRT patients Finnish Registry for Kidney Diseases 1 Deaths/1 patient-years Figure 1. Mortality of RRT patients according to type of treatment Finnish Registry for Kidney Diseases 1 Deaths/1 patient-years Hemodialysis Peritoneal dialysis Transplantation PD HD Tx deaths; patient-years ; ; ; 1; 1 ; ; ; 1 ; ; ; 1 1; 1 ; 1 ; 1 1; ; 1 In Figures to, mortality is given as a smoothed average of the number of deaths/thousand patient-years. The mortality of all RRT patients has remained fairly constant since 1 (Figure ). In the s, mortality was on average deaths/thousand patient-years. The mortality of peritoneal dialysis patients decreased rapidly at the beginning of the 1s; in the s, it was on average deaths/thousand patient-years (Figure 1). Apparently patients with a worse prognosis were selected for peritoneal dialysis. When continuous ambulatory peritoneal dialysis was introduced mortality decreased. Hemodialysis patients mortality has not changed considerably in years; in the s it was on average deaths/thousand patientyears. Finnish Registry for Kidney Diseases Report

20 Figure. Mortality of transplantation patients Finnish Registry for Kidney Diseases 1 Deaths/1 patient-years Figure. Mortality of RRT patients according to diagnosis Finnish Registry for Kidney Diseases 1 Deaths/1 patient-years NIDDM Amyloidosis IDDM All other diagnoses Pyelonephritis Polycystic degeneration Glomerulonephritis The mortality of transplantation patients decreased in the 1s and has thereafter remained consistently below deaths/thousand patient-years (Figure ). Figure shows mortality according to diagnostic group. NIDDM and amyloidosis are associated with higher mortality than other kidney diseases. Finnish Registry for Kidney Diseases Report

21 Figure. Causes of death among peritoneal dialysis patients. Finnish Registry for Kidney Diseases 1 Cardio- and cerebrovascular causes Infection Kidney disease Other 1 1 n = 1 n = 1 n = 1 n = n = Proportion of patients (%) Figure. Causes of death among hemodialysis patients. Finnish Registry for Kidney Diseases 1 Cardio- and cerebrovascular causes Infection Kidney disease Other 1 n = 1 n = 1 1 n = 1 n = 1 n = 1 Proportion of patients (%) Figure. Causes of death among transplantation patients. Finnish Registry for Kidney Diseases 1 Cardio- and cerebrovascular causes Infection Kidney disease Other 1 n = 1 n = 1 1 n = n = n = Proportion of patients (%) Figures to give causes of death for peritoneal dialysis, hemodialysis and transplantation patients. In 1, cardio- and cerebrovascular and other diseases caused a larger proportion of deaths in transplantation patients than in dialysis patients. Despite immunosuppressive treatment, infection was a much rarer cause of death in transplantation patients than in dialysis patients. In transplantation patients, the proportion of other causes of death increased percentage units in five years. Malignancies caused 1% of transplantation patients deaths, and this proportion remained unchanged during 1. In dialysis patients, the corresponding proportion was only %. 1 Finnish Registry for Kidney Diseases Report

22 Finnish Registry for Kidney Diseases Report Rovaniemi University hospital Central hospital Other hospital Other dialysis station Kemi Pudasjärvi Oulu Oulaskangas Kokkola Pietarsaari Vaasa Seinäjoki Karstula Kajaani Iisalmi Kuopio Joensuu Mariehamn Virrat Kihniö Mänttä Hämeenkyrö Pori Vammala Tampere Valkeakoski Urjala Hämeenlinna Lahti Loimaa Turku Hyvinkää Jyväskylä Varkaus Savonlinna Mikkeli Imatra Lappeenranta Kotka Tammisaari Porvoo Helsinki Finnish Registry for Kidney Diseases Pohjoinen Hesperiankatu A FIN- Helsinki Suomi Phone +-- Fax +-- Salme.Salkola@musili.fi Patrik.Finne@hus.fi Suomen munuaistautirekisteri Pohjoinen Hesperiankatu A FIN- Helsinki Suomi Puh +-- Faksi +-- Sähköposti Salme.Salkola@musili.fi Patrik.Finne@hus.fi Oy Nord Print Ab Helsinki 1 Helsingfors ISSN 1