Report Finnish Registry for Kidney Diseases. Probability of survival 1. Age at start of RRT: years

Transcription

1 Finnish Registry for Kidney Diseases Report 22 Probability of survival p<. Age at start of RRT: 2 years 22 2 Years in RRT

2 Finnish Registry for Kidney Diseases Report 22 Contents Finnish Registry for Kidney Diseases Report 22...ii Board of the Finnish Registry for Kidney Diseases...iii The Finnish population and its distribution in healthcare districts (2 22)... Healthcare districts and regions in Finland... The Finnish population according to region, age group, and gender (22)...2 Standardized incidence of RRT in regions (2 22)...2 Number of new RRT patients and incidence of RRT by healthcare district and region ( 22)...3 Standardized incidence of RRT in regions days after start of RRT (2 22)...3 Incidence of RRT according to diagnosis (6 22)... International comparison of incidence of RRT in 2... Patients in RRT at end of year according to healthcare district and region ( 22)...6 Patients in RRT at end of 22 according to region, age group, and gender (22)... Standardized prevalence of RRT in regions (2 22)... Prevalence of RRT in healthcare districts on 3 December Prevalence of RRT at end of year according to type of treatment (6 22)... Prevalence of RRT at end of year according to diagnosis (6 22)... International comparision of prevalence of RRT on 3 December 2... Net changes in type of treatment (22)... Mortality of RRT patients by region ( 22)...2 Standardized mortality of RRT patients in regions (2 22)...2 Standardized mortality of RRT patients in regions (patients who died before days after start of RRT were excluded from analysis) (2 22)...2 Number of patient-years according to diagnosis ( 22)...3 RRT patients probability of survival according to RRT start period and age group (6 22)... Effect of different variables on RRT patients survival ( 22)... Multivariate model of RRT patients survival ( 22)...6 Kt/V of patients receiving peritoneal dialysis or hemodialysis ( 22)... Serum creatinine according to type of treatment ( 22)... Serum albumin according to type of dialysis ( 22)... Ionized calcium in plasma according to type of dialysis ( 22)... Serum phosphate according to type of dialysis ( 22)... Blood pressure according to type of treatment ( 22)... Pulse pressure according to type of treatment ( 22)... Serum cholesterol according to type of treatment ( 22)...2 Serum LDL cholesterol according to type of treatment ( 22)...2 Serum triglycerides according to type of treatment ( 22)...2 Serum HDL cholesterol according to type of treatment ( 22)...2 Serum CRP according to type of treatment (22)...22 Index of Reports

3 Finnish Registry for Kidney Diseases Report 22xxxxxxxxx The Finnish Registry for Kidney Diseases Report 22 provides demographic data on renal replacement therapy (RRT) in Finland to the end of the year 22. The earlier trend continues, with the prevalence of RRT increasing throughout the country; i.e. the number of dialysis and kidney transplantation patients per capita is on the rise. The incidence of RRT, by contrast, has not increased during the past five years, and in an international comparison, the incidence in Finland was the second lowest (see p. ). The prevalence is also low in relation to other countries (see p. ). The proportion of patients on peritoneal dialysis has clearly decreased: in 2, % of all RRT patients were receiving peritoneal dialysis, whereas the proportion in 22 was only %. During the same period the proportion of hemodialysis patients increased from 2% to 33%, while the proportion of patients with a kidney transplant remained stable at 6 62%. RRT patients age- and gender-standardized mortality has decreased by 26% over the past ten years; in 22, it was deaths/ patient-years (see p. 2). The age-specific survival of RRT patients has also improved markedly. In 6, only % of 2- to -year-olds survived five years after the start of RRT. In, the corresponding proportion was 6%, and in 22, it was 6% (see p. ). This report presents analyses of factors predicting survival in RRT. High age, low serum albumin concentration, and high serum concentrations of phosphate and creatinine correlate with poor prognosis (see pp. and 6). Diagnosis of kidney disease is another important prognostic factor. Laboratory data of all RRT patients are reported yearly to the Finnish Registry for Kidney Diseases. On pages 22, the laboratory variables for 22 and (or if a variable was not reported in ) are shown according to type of treatment. The Finnish Registry for Kidney Diseases is financed by Finland s Slot Machine Association (RAY). Stockmann Foundation, MCP Medicare, Janssen-Cilag, and Baxter have sponsored the renewal of database software. Statistics in this report were updated using data obtained from the Registry for follow-up of kidney transplantation patients, which is maintained by the Kidney Transplantation Unit of Helsinki University Central Hospital. The Board of the Finnish Registry for Kidney Diseases thanks all supporters and participating hospitals for fruitful cooperation. Helsinki, 6 October 23 Patrik Finne Administrative Director Carola Grönhagen-Riska Chairman of the Board

4 Board of the Finnish Registry for Kidney Diseases Sirpa Aalto, MSc Ilpo Ala-Houhala, Docent Patrik Finne, MD Carola Grönhagen-Riska, Professor Rauni Jukkara Erkki Lampainen, MD Marjatta Linnanvuo, MD Kaj Metsärinne, Docent Maija Piitulainen Kai Rönnholm, MD Kaija Salmela, Docent Risto Tertti, MD

5 Table. The Finnish population and its distribution in healthcare districts Finnish Registry for Kidney Diseases 2 22 Healthcare district ( inhabitants) 2 Year 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 3 December 22, there were.26 million inhabitants in Finland (Table ). During the past ten years the population has increased rapidly in the southern region. In the eastern and northern regions, the populations have correspondingly decreased. Since 2, the populations have increased in seven healthcare districts and decreased in.xxxxxxxxx The numbers in Figure refer to the healthcare districts listed in Table. In this report, region refers to a university hospital region. Figure. Healthcare districts and regions in Finland Finnish Registry for Kidney Diseases 22 Northern region 2 2 Western region South-western region Southern region Eastern region Finnish Registry for Kidney Diseases Report 22

6 Table 2. The Finnish population according to region, age group, and gender Finnish Registry for Kidney Diseases 22 Region Age group (years) (%) 2 (%) 6 (%) 6 (%) > (%) Entire country South Men Women Total 2 2 (2) (22) (2) (3) (3) (36) (2) (2) (2) 2 () () () 3 6 () () (6) () () () South-West Men Women Total 3 63 (2) (22) (23) 3 22 (33) (3) (32) 2 (2) (2) (2) () () () 3 6 () () () () () () West Men Women Total 3 23 (2) (23) (2) 2 36 (33) (3) (32) (2) (2) (2) 6 () () () () () () 6 () () () East Men Women Total 3 23 (2) (23) (2) (32) (2) (3) 26 2 (3) (2) (2) () () () 22 6 () () () 22 3 () () () North Men Women Total (2) (26) (2) 2 22 (33) (3) (32) (2) (26) (2) () () () 6 2 () () (6) () () () Entire country Men Women Total (2) (23) (2) 6 2 (3) (32) (33) 2 3 (2) (2) (2) 2 () () () () () () () () () Table 2 shows the distribution of the Finnish population according to region, age, and gender. In the southern region, the proportion of 2- to 6-year-olds was the largest (63%) and that of inhabitants older than 6 years was the smallest (3%). In the other regions, the average corresponding proportions were % and %. In Figure 2, the incidence of renal replacement therapy (RRT, i.e. dialysis and kidney transplantation) in 2 22 is shown regionally as smoothed averages. The incidence rates are age- and gender-standardized using the Finnish population on 3 December 22 as a reference population. The population changes in 2 22 have been considered. Standardization removes the effect of age and gender on the regional differences in incidence rates. In the entire country, the incidence has remained virtually unchanged since. Figure 2. Standardized incidence of RRT in regions Finnish Registry for Kidney Diseases 2 22 Standardized incidence/million inhabitants East South-West West Entire country North South Year 2 Finnish Registry for Kidney Diseases Report 22

7 Table 3. Number of new RRT patients and incidence of RRT by healthcare district and region Finnish Registry for Kidney Diseases 22 Healthcare district Number of new RRT patients Incidence of RRT/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 < y The number of new RRT patients and the incidence of RRT are shown according to healthcare district and region in Table 3. In the entire country, the incidence has increased 2% during the past five years. In the south-western, western, and northern regions, the incidence was 6% greater in 22 than in. In the southern region, the incidence had decreased by 2%, and in the eastern region by 6%. In 22, the average incidence was largest in the eastern region and smallest in the southern region. In the healthcare districts, the five-year average incidence was 6 3 new RRT patients/million inhabitants. In Figure 3, the age- and gender-standardized incidence of RRT days after start of RRT is shown regionally as smoothed averages. The Finnish Registry for Kidney Diseases does not store data on patients who have regained renal function before days after start of RRT. In Figure 3, data on patients who have died or moved abroad within days after start of RRT have also been excluded.xxxxxx Figure 3. Standardized incidence of RRT in regions days after start of RRT Finnish Registry for Kidney Diseases 2 22 Standardized incidence/million inhabitants 6 West South-West East Entire country North South Year Finnish Registry for Kidney Diseases Report 22 3

8 Figure. Incidence of RRT according to diagnosis Finnish Registry for Kidney Diseases 6 22 Incidence/million inhabitants 3 IDDM and NIDDM together NIDDM Other defined diagnoses IDDM Glomerulonephritis Undefined kidney disease Polycystic degeneration Amyloidosis Pyelonephritis 6 2 Year The incidence of RRT according to diagnosis is shown as smoothed averages in Figure. Insulin-dependent diabetes mellitus (IDDM) and Non-IDDM (NIDDM) are the most common diseases causing chronic uremia. In 22, % of all new RRT patients were diabetes patients; in 2, the corresponding proportion was 2%. The rate of new glomerulonephritis patients has remained virtually unchanged during the past ten years. The group other defined diagnoses includes nephrosclerosis, other systemic diseases, urinary tract obstruction, congenital diseases, and tubulointerstitial nephritis. Finnish Registry for Kidney Diseases Report 22

9 Figure. International comparison of incidence of RRT in 2 Finnish Registry for Kidney Diseases 2 United States Japan Germany Belgium, French-speaking Greece Belgium, Dutch-speaking Spain, Catalonia Spain, Valencia Denmark Austria Sweden Spain, Basque region UK, Scotland The Netherlands Norway UK, England/Wales Finland Iceland Incidence of RRT/million inhabitants Figure shows the incidence of RRT in 2 in countries reporting to the ERA-EDTA Registry ( and in Germany, Japan, and the United States (USRDS, Report 23). The incidence of RRT in Finland was the second lowest. In Denmark and Sweden, the incidence had increased faster than in Finland. In 2, the incidence rates in Denmark and Sweden were % and % larger than in Finland, respectively, while one year earlier the corresponding figure was 36% for both countries. Finnish Registry for Kidney Diseases Report 22

10 Table. Patients in RRT at end of year according to healthcare district and region Finnish Registry for Kidney Diseases 22 Healthcare district Number of RRT patients Prevalence of RRT/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 The number of RRT patients and the prevalence of RRT on 3 December 22 are shown in Table. In 22, the prevalence was higher than in in all healthcare districts but one. In the entire country, the prevalence has increased by 23% since. On 3 December 22, the prevalence was highest in the south-western region and lowest in the western region. During the past five years the prevalence has increased the most in the northern region (3%) and the least in the western region (%). 6 Finnish Registry for Kidney Diseases Report 22

11 Table. Patients in RRT at end of 22 according to region, age group, and gender Finnish Registry for Kidney Diseases 22 Region Number of RRT patients Prevalence of RRT/million inhabitants y 2 y 6 y 6 y > y All y 2 y 6 y 6 y > y All South Men Women Total South-West Men Women Total West Men Women Total East Men Women Total North Men Women Total Entire country Men Women Total Figure 6. Standardized prevalence of RRT in regions Finnish Registry for Kidney Diseases 2 22 Standardized prevalence/million inhabitants 6 6 South-West East South Entire country North West The number of RRT patients in the regions on 3 December 22 is shown according to age group and gender in Table. In the entire country, prevalence was 2% higher among men than women. Prevalence was highest in 6- to - year-olds ( patients/million age-matched inhabitants) and lowest in those younger than 2 years ( patients/million age-matched inhabitants). In Figure 6, the prevalence rates for 2 22 are ageand gender-standardized using the Finnish population on 3 December 22 as a reference population. The population changes during this period have been considered. Standardization removes the effect of age and gender on the regional differences in prevalence rates Year Finnish Registry for Kidney Diseases Report 22

12 Figure. Prevalence of RRT in healthcare districts on 3 December 22 Finnish Registry for Kidney Diseases 22 Lappi 6 patients/million inhabitants Entire country 636 patients/million inhabitants Group < patients/million inhabitants Group 2 6 patients/million inhabitants Group3 >6 patients/million inhabitants Länsi- Pohja Pohjois- Pohjanmaa 62 Kainuu Vaasa Keski- Pohjanmaa 3 Etelä- Pohjanmaa 2 Keski-Suomi Pohjois-Savo Pohjois-Karjala 6 Åland 66 Satakunta Varsinais- Suomi 6 Pirkanmaa 63 Kanta- Häme 2 Helsinki- Uusimaa 62 Päijät- Häme Etelä-Savo Kymenlaakso 3 Etelä- Karjala 62 Itä-Savo 6 The healthcare districts shown on the map are grouped according to the prevalence of RRT at the end of 22 (Figure ). The prevalence was < in seven districts, 6 in seven districts, and >6 patients/million inhabitants in seven districts. The borders of the regions are indicated with thick lines. Finnish Registry for Kidney Diseases Report 22

13 Figure. Prevalence of RRT at end of year according to type of treatment Finnish Registry for Kidney Diseases 6 22 Prevalence/million inhabitants 6 6 Peritoneal dialysis Hemodialysis Transplantation 6 Year 2 Figure. Prevalence of RRT at end of year according to diagnosis Finnish Registry for Kidney Diseases 6 22 Prevalence/million inhabitants 6 2 IDDM and NIDDM together Glomerulonephritis Other defined diagnoses IDDM Polycystic degeneration 6 2 Pyelonephritis NIDDM Undefined kidney disease Amyloidosis 6 Year 2 Figure shows prevalence of RRT according to type of treatment. The numbers of hemodialysis patients and patients with a kidney transplant have increased continuously since 6. During the past ten years the number of patients on peritoneal dialysis has remained unchanged.xxxxxxxxxx Prevalence of RRT according to diagnosis is shown as smoothed averages in Figure. Until 2, glomerulonephritis was the most common cause of chronic uremia, but at the end of 22 the most common kidney diagnosis of RRT patients was diabetes (prevalence rate 63/million inhabitants). At the end of 22, 26% of all RRT patients had diabetes; ten years earlier this proportion was 2%. The group other defined diagnoses includes nephrosclerosis, other systemic diseases, urinary tract obstruction, congenital diseases, and tubulointerstitial nephritis.xxxxx Finnish Registry for Kidney Diseases Report 22

14 Figure. International comparison of prevalence of RRT on 3 December 2 Finnish Registry for Kidney Diseases 2 Japan United States Spain, Catalonia Spain, Valencia Germany Spain, Basque region Belgium, Dutch-speaking Greece Belgium, French-speaking Austria Sweden Denmark UK, Scotland The Netherlands Finland Norway UK, England/Wales Iceland Prevalence of RRT/million inhabitants Figure displays the prevalence of RRT in 2 in countries reporting to the ERA-EDTA Registry ( and in Germany, Japan, and the United States (USRDS, Report 23). The prevalence rate in Finland was the fourth lowest. In Norway, the prevalence rate was only marginally lower than in Finland. In Denmark and Sweden, the prevalence rates were % and 2% higher than the Finnish rate, respectively. International incidence rates are shown in Figure. Finnish Registry for Kidney Diseases Report 22

15 Figure. Net changes in type of treatment Finnish Registry for Kidney Diseases 22 New patients entering RRT RRT started Patients entering peritoneal dialysis 3 Returned to RRT From abroad Returned to RRT 2 Patients entering hemodialysis 36 Patients in RRT Peritoneal dialysis January 2 3 December 2 Treatment stopped 3 2 Functioning kidney transplant January 3 December 6 Hemodialysis January 6 3 December 3 Treatment stopped RRT stopped Deceased patients Regained function Regained function in Emigrants Emigrants During 22, new patients entered RRT (Figure ). In addition, two patients returned to RRT and four patients came from abroad. In all, 3 patients were receiving RRT at the beginning of the year. Altogether 33 patients died and dialysis for eight patients was discontinued because the patients own kidney function resumed. Of those who died, 66 had a functioning transplant, were receiving peritoneal dialysis, and were on hemodialysis. The RRT of 2 uremic patients was discontinued, and all of these died during 22. In addition, two uremic patients whose RRT was discontinued in 2 died in 22 (not shown in Figure ). A kidney transplant was received by patients. Finnish Registry for Kidney Diseases Report 22

16 Table 6. Mortality of RRT patients by region Finnish Registry for Kidney Diseases 22 Region Deaths/ patient-years Deaths/ patient-years ) South South-West West East North Entire country ) Patients who died before days after start of RRT were excluded from analysis Figure 2. Standardized mortality of RRT patients in regions Finnish Registry for Kidney Diseases 2 22 Deaths/ patient-years 6 Figure 3. Standardized mortality of RRT patients in regions (patients who died before days after start of RRT were excluded from analysis) Finnish Registry for Kidney Diseases 2 22 Deaths/ patient-years West 2 East Entire country North South South-West 6 2 West East Entire country South North South-West Year Year RRT patients mortality according to region is presented in Table 6. Regional differences in mortality have been speculated to be partially caused by hospitals different practices of reporting patients who die after a short period in dialysis to the Finnish Registry for Kidney Diseases. Table 6 shows the mortality of patients who have been in RRT at least days separately. The average mortality in 22 was highest in the western region and lowest in the southwestern region. In Figures 2 and 3, mortality in the regions is shown as smoothed averages. The regional mortality rates for 2 22 have been age- and gender-standardized using all patient-years in 22 as a reference population. The changes in age and gender distribution in this ten-year period have been considered. In the entire country, the standardized mortality rate was 26% lower in 22 than in 2. When patients who died within days from start of RRT were excluded (Figure 3), the standardized mortality rate was 2% lower in 22 than in 2. 2 Finnish Registry for Kidney Diseases Report 22

17 Table. Number of patient-years according to diagnosis Finnish Registry for Kidney Diseases 22 Diagnosis Patient-years (%) 22 Change (%) 22 Glomerulonephritis IDDM Polycystic degeneration Pyelonephritis NIDDM Undefined kidney disease Nephrosclerosis Amyloidosis Urinary tract obstruction Congenital diseases Other systemic diseases Congenital nephrosis, Finnish type Other kidney diseases Tubulointerstitial nephritis Malignancies Metabolic diseases (2.) (.) (.) (.) (.) (3.) (3.) (.3) (3.) (3.2) (3.) (.) (.6) (2.) (.) (.3) (2.) (.2) (2.) (.) (.) (.) (3.) (3.) (3.) (3.) (3.) (.) (.) (.) (.6) (.) All 2 () 3262 () 3 The number of patient-years in and 22 according to the diagnosis of different kidney diseases is shown in Table. The number of patient-years indicates patients time in RRT during the year. Glomerulonephritis is the most common diagnosis when IDDM and NIDDM are considered as separate diagnoses. The proportion of glomerulonephritis has decreased constantly since. IDDM is the second most common diagnosis. The proportion of patient-years due to NIDDM has increased considerably, in 22 ranking as the fifth most common diagnosis. The proportion of polycystic degeneration has increased and that of pyelonephritis decreased. Overall, the number of patientyears has increased by 3% since. Finnish Registry for Kidney Diseases Report 22 3

18 Figure. RRT patients probability of survival according to RRT start period and age group Finnish Registry for Kidney Diseases 6 22 Probability of survival. 22 Age at start of RRT: y Probability of survival. Age at start of RRT: 6 y p<. 2 Years in RRT p< Years in RRT 3 3 Probability of survival. Age at start of RRT: 2 y Probability of survival. Age at start of RRT: >6 y p< p=. 3 3 Years in RRT Years in RRT Figure displays RRT patients probability of survival according to RRT start period and age group. The age groups were included to eliminate the effect of age on survival probability. However, the average age within the age groups was also affected by RRT start period: in the age group of patients younger than 2 years, the average age at start of RRT has decreased over the years, whereas in the other age groups, the average age has increased (p<.). Despite this, the survival probabilities for all age groups have improved since 6. Finnish Registry for Kidney Diseases Report 22

19 Table. Effect of different variables on RRT patients survival Finnish Registry for Kidney Diseases 22 Variable (before start of RRT) Change (increase) P-value Relative risk % confidence interval N Age Serum albumin Diagnosis Serum creatinine Serum phosphate Serum triglycerides Diastolic blood pressure Weight Hematocrit Length Body-mass index Serum C-reactive protein (CRP) Hemoglobin Systolic blood pressure First treatment (HD vs PD) Serum HDL cholesterol Serum cholesterol Serum urea Glycosylated hemoglobin-a c Plasma ionized calcium Pulse pressure Serum LDL cholesterol Gender (female vs male) y g/l Glomerulonephritis Polycystic deg. IDDM NIDDM Pyelonephritis Amyloidosis Other defined Undefined µmol/l mmol/l mmol/l mmhg kg % cm kg/m 2 mg/l g/l mmhg mmol/l mmol/l mmol/l %. mmol/l mmhg mmol/l <. <. <.. <. <..2 <...26 <. < (reference) (..6) (.3.) (..) (. 3.6) (.6 3.) (.36.3) (.3 3.2) ( ) (. 2.) (..) (.2.2) (..) (..) (..) (.6.) (..) (..) (..6) (..2) (..) (.2.3) (.6.2) (.2.) (..6) (..) (..) (..) (..) (..) In Table, the Cox regression method was employed to calculate the effect of different variables on patients survival in RRT. The relative risk was adjusted for age. The variables were sorted in order of importance so that the most significant ones (according to p-value) were listed first. The diagnosis is a group variable in which glomerulonephritis was used as a reference group (relative risk = ) with which other groups were compared. Finnish Registry for Kidney Diseases Report 22

20 Table. Multivariate model of RRT patients survival Finnish Registry for Kidney Diseases 22 Variable (before start of RRT) Change (increase) P-value Relative risk % confidence interval Age Serum albumin Diagnosis of kidney disease Serum phosphate Serum creatinine y g/l Glomerulonephritis Polycystic degeneration IDDM NIDDM Pyelonephritis Amyloidosis Other defined diagnosis Undefined diagnosis mmol/l µmol/l <. <. <..66 <. <..3 <.. <. <. < (reference) (..6) (..6) (..6) (.3 3.) (. 2.) (..36) ( ) (.2 2.3) ( ) (.2.) (.6.) N = 22 A backward stepwise selection procedure was used to select the variables in Table. All variables that were significant (p<.) in Table (excluding triglycerides because of the small number of patients) were included in the multivariate modeling. The final model included, in descending order of importance, age, serum albumin, diagnosis of kidney disease, serum phosphate, and serum creatinine. 6 Finnish Registry for Kidney Diseases Report 22

21 Figure. Kt/V of patients receiving peritoneal dialysis or hemodialysis Finnish Registry for Kidney Diseases 22 Kt/V Figure 6. Serum creatinine according to type of treatment Finnish Registry for Kidney Diseases 22 Serum creatinine (µmol/l) N = 32 Peritoneal dialysis (weekly Kt/V) N = Peritoneal dialysis Hemodialysis Hemodialysis Transplantation Figures to 26 show laboratory and other variables reported by the hospitals annually for all RRT patients. Dialysis patients Kt/V values in and 22 are presented in Figure. The values of patients on hemodialysis and peritoneal dialysis are calculated differently so they cannot be compared. In addition, the reporting hospitals use different calculation methods. However, the Kt/V values appear to have remained unchanged since. Dialysis patients concentration of serum creatinine was somewhat smaller at the end of 22 than in (Figure 6). Among transplantation patients, the concentration of serum creatinine has remained virtually unchanged. Finnish Registry for Kidney Diseases Report 22

22 Figure. Serum albumin according to type of dialysis Finnish Registry for Kidney Diseases 22 Albumin (g/l) Dialysis patients concentration of serum albumin at the end of and 22 is shown in Figure. The level of serum albumin has not changed within the past five years. Both in and 22, hemodialysis patients had a higher concentration of serum albumin than patients on peritoneal dialysis (p<.). The concentration of ionized calcium in plasma has remained constant since (Figure ). No differences were present between patients on hemodialysis and those on peritoneal dialysis. The concentration of serum phosphate was somewhat higher among hemodialysis than among peritoneal dialysis patients in both (p<.) and 22 (p<.2) (Figure ). For both groups, phosphate concentration was lower in 22 than in. N = Peritoneal Hemodialysis dialysis Figure. Ionized calcium in plasma according to type of dialysis Finnish Registry for Kidney Diseases 22 Plasma ionized calcium (mmol/l). Figure. Serum phosphate according to type of dialysis Finnish Registry for Kidney Diseases 22 Serum phosphate (mmol/l) ,6 N = Peritoneal dialysis N = Peritoneal dialysis 22 Hemodialysis Hemodialysis Finnish Registry for Kidney Diseases Report 22

23 Blood pressure (mmhg) Figure 2. Blood pressure according to type of treatment Finnish Registry for Kidney Diseases N = Peritoneal dialysis 2 Hemodialysis Hemodialysis Transplantation Figure 2. Pulse pressure according to type of treatment Finnish Registry for Kidney Diseases 22 Pulse pressure (mmhg) RRT patients blood pressure has remained virtually unchanged since (Figure 2). At the end of 22, systolic blood pressure of hemodialysis patients was higher than that of peritoneal dialysis patients (p<.) or transplantation patients (p<.). Diastolic blood pressure was somewhat lower among hemodialysis patients than other patients (p<.). Pulse pressure is the difference between systolic and diastolic blood pressure (Figure 2). Within the various treatment groups, the pulse pressure did not change considerably since. Hemodialysis patients had a higher pulse pressure than peritoneal dialysis (p<.) and transplantation (p<.) patients. 2 N = Peritoneal dialysis 2 Transplantation Finnish Registry for Kidney Diseases Report 22

24 Figure 22. Serum cholesterol according to type of treatment Finnish Registry for Kidney Diseases 22 Serum cholesterol (mmol/l) 2 Figure 23. Serum LDL cholesterol according to type of treatment Finnish Registry for Kidney Diseases 22 Serum LDL cholesterol (mmol/l) N = Peritoneal dialysis Transplantation N = Peritoneal dialysis Hemodialysis Hemodialysis Transplantation S-LDL is calculated according to Friedewald s formula: S-LDL = S-kol S-HDL S-trigl/2.2 Figures 22 2 present RRT patients concentrations of serum lipids at the end of and 22. In both years, the concentration of total cholesterol was higher in transplantation patients than in dialysis patients (p<.) (Figure 22). Since, the concentration of total cholesterol has decreased in all treatment groups. The main explanation for this is that the concentration of LDL cholesterol has dropped in all of these groups (Figure 23). 2 Finnish Registry for Kidney Diseases Report 22

25 Figure 2. Serum triglycerides according to type of treatment Finnish Registry for Kidney Diseases 22 Figure 2. Serum HDL cholesterol according to type of treatment Finnish Registry for Kidney Diseases 22 Serum triglycerides (mmol/l) Serum HDL cholesterol (mmol/l) N = Peritoneal dialysis Transplantation N = Peritoneal dialysis Hemodialysis Hemodialysis 6 Transplantation The concentration of serum triglycerides was higher among peritoneal dialysis patients than among other patients in and 22 (p<.) (Figure 2). In all treatment groups, the concentration of serum triglycerides had remained virtually unchanged since. The concentration of HDL cholesterol had also remained fairly constant since (Figure 2). Transplantation patients had a considerably higher concentration of HDL cholesterol than other patients (p<.). Finnish Registry for Kidney Diseases Report 22 2

26 Figure 26. Serum CRP according to type of treatment Finnish Registry for Kidney Diseases 22 Serum CRP (mg/l) ,,2, N = Peritoneal dialysis Hemodialysis Transplantation Figure 26 shows RRT patients concentration of serum C- reactive protein (CRP) at the end of and 22. Determination methods have become increasingly sensitive since. As a result, concentrations lower than mg/l are seen in 22. In, hemodialysis patients had higher concentrations of CRP than peritoneal dialysis (p<.) and transplantation (p<.) patients. In 22, no significant difference was present in CRP concentrations between hemodialysis and peritoneal dialysis patients.xxxxxxxxxxxx 22 Finnish Registry for Kidney Diseases Report 22

27 Finnish Registry for Kidney Diseases Report 22 23

28 Index of Reports 22 Age at end of year :, 2:, 2:, 22: effect on survival 22: 6 of new patients with glomerulonephritis : of new RRT patients :, 2:,2, 2: Body-mass index :2, 22: Causes of death type of treatment 2: Changes in type of treatment :, :6, 2:6, 2:, 22: Cockroft Gault formula : Comorbidity according to kidney diagnosis : amputation 2:2 angina pectoris 2: arterial disease other than coronary disease 2:2 cerebrovascular hemorrhage or infarction 2:2 coronary disease 2: heart failure 2: high blood pressure :, :, 2:, 2:2, 22:, hyperlipidemia 2:2 left ventricular hypertrophy 2: myocardial infarction 2: Cox regression :, 22: 6 Erythropoietin treatment :6 Finnish population age groups :, :2, 2:2, 2:2, 22:2 gender 2:2, 22:2 in healthcare districts :, :, 2:, 2:, 22: in regions :, :, 2:, 2: 2, 22: 2 Glomerulus filtration : High blood pressure, see comorbidity High blood pressure, treatment :, 2:, 2:2 Immunosuppressive treatment :, 2:2 3 Incidence of RRT children :, :, 2:, 2:3, 22:3 diagnosis :, 2:, 2:, 22: in health care districts :, :, 2:, 2:3, 22:3 in regions :, :, 2:, 2:2 3, 22:3 international 2:, 22: standardized 2:3, 22:3 type of treatment :, :6, 2:6, 2:, 22: Kidney transplantation donor 2:6 probability : proportion receiving 2:6 time from start of dialysis 2: Kt/V :, 22: Laboratory tests albumin :, : 2, 22:,6, cholesterol, total :3, 22:2 creatinine :, 22: CRP :, 22:,22 glycosylated hemoglobin-a c 22: HDL cholesterol :3, 22:,2 hematocrit :6, 22: hemoglobin 22: ionized calcium :, :, 22:, LDL cholesterol 22:,2 phosphate :, 22:,6, triglycerides :3, 22:,2 urea :, 22: Length 22: Mortality days after start of RRT 22:2 diagnosis 2: earlier than days after start of RRT 2:2 in regions 2:2, 22:2 standardized 2:3, 22:2 transplantation patients 2: type of treatment :, :6, 2:6,6, 2: Patient-years diagnosis :6, :, 2:, 2:, 22:3 age groups :6, :, 2:, 2: definition :6, :, 22:3 type of treatment :6, :, 2:,, 2: Peritonitis : Prevalence of RRT age groups :2, :3, 2:3, 2:, 22: diagnosis :, 2:, 2:, 22: gender 2:, 22: in healthcare districts :2 3, :2,, 2:2,, 2:6,, 22:6, in regions :2, :2 3, 2:2 3, 2:6, 22:6 international 2:, 22: standardized 2:, 22: type of treatment :, :6,, 2:6, 2:,, 22:, Pulse pressure 22:, Regions :, :, 2:, 2:, 22: Survival by age group :, 22: by diagnosis :2 by start period of RRT 22: by type of treatment : effect of various variables :, 22: 6 multivariate model 22:6 Tobacco smoking 2:2 Vitamin D treatment : Weight 22: 2 Finnish Registry for Kidney Diseases Report 22

29 Finnish Registry for Kidney Diseases Report 22 Rovaniemi Mariehamn University hospital Central hospital Other hospital Other dialysis unit Pietarsaari Kokkola Kemi Raahe Oulainen Oulu Pudasjärvi Puolanka Iisalmi Kajaani Nurmes Vaasa Karstula Kuopio Seinäjoki Joensuu Kristiinankaupunki Keu- Virrat ruu Jyväskylä Varkaus Kihniö Mänttä Hämeenkyrö Jämsä Savonlinna Pori Mikkeli Vammala Tampere Valkeakoski Rauma UrjalaHämeenlinna Imatra Loimaa Forssa Lahti Kotka Lappeenranta Turku Hyvinkää Salo Porvoo Helsinki Tammisaari Finnish Registry for Kidney Diseases Pohjoinen Hesperiankatu A FIN-26 Helsinki Finland Phone Fax Rauni.Jukkara@musili.fi Patrik.Finne@hus.fi Suomen munuaistautirekisteri Pohjoinen Hesperiankatu A FIN-26 Helsinki Suomi Puh Faksi +3-- Sähköposti Rauni.Jukkara@musili.fi Patrik.Finne@hus.fi Yliopistopaino Helsinki 23 ISSN 23 6