Finnish Registry for Kidney Diseases Report 2001

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2 Finnish Registry for Kidney Diseases Report 2001 Contents Finnish Registry for Kidney Diseases ii Board of the Finnish Registry for Kidney Diseases...iii The Finnish population and its distribution in healthcare districts in Healthcare districts and regions in Finland...1 The Finnish population according to region, age group, and gender in Incidence of RRT in regions in Number of new RRT patients in healthcare districts and regions in Standardized incidence of RRT in regions in Incidence of RRT according to diagnosis in Mean age of new dialysis patients older than 15 years in International comparison of incidence of RRT in Patients in RRT at end of year in healthcare districts and regions in Prevalence of RRT in regions in Patients in RRT at end of 2001 according to age group and region...7 Standardized prevalence of RRT in regions in Prevalence of RRT in healthcare districts on 31 December Prevalence of RRT at end of year according to type of treatment in Prevalence of RRT at end of year according to diagnosis in International comparison of prevalence of RRT on 31 December Net changes in type of treatment in Number of deaths among RRT patients according to region in Mortality of RRT patients according to region in Mortality of RRT patients in regions in Standardized mortality of RRT patients in Number of patient-years according to age group in Number of patient-years according to type of treatment in Number of patient-years according to age group and type of treatment in Number of patient-years according to diagnosis Number and donor status of kidney transplantations performed on patients aged >20 in Number and donor status of kidney transplantations performed on patients aged <20 in Proportion receiving a kidney transplant within two years from start of RRT in Time from start of dialysis to first kidney transplantation in Frequency of angina pectoris at start of RRT in Coronary bypass or angioplasty in anamnesis at start of RRT Myocardial infarction in anamnesis at start of RRT in Anamnestic myocardial infarction at start of RRT according to age group in Left ventricular hypertrophy at start of RRT in Chronic heart failure at start of RRT in Symptomatic arterial disease other than coronary disease at start of RRT in Surgical bypass of arteries (not coronary artery) in anamnesis at start of RRT in Amputation performed due to arterial disease before start of RRT in Cerebrovascular hemorrhage or infarction in anamnesis at start of RRT in Treatment of high blood pressure at start of RRT in Treatment of hyperlipidemia at start of RRT in Tobacco smoking at start of RRT in Index covering Reports

3 Finnish Registry for Kidney Diseases Report 2001 The Finnish Registry for Kidney Diseases contains data on dialysis and kidney transplantation patients in Finland since On 31 December 2001, data were available on patients, 3 4 of whom were alive. The prevalence of renal replacement therapy (RRT) continues to increase as rapidly as in previous years (see front page), however, the incidence has not increased in four years. The mortality of RRT patients has remained virtually unchanged during the past ten years, although the patients have gotten older. Prevalence will continue to increase as long as incidence exceeds mortality. In , the annual number of new RRT patients was on average 0 larger than the annual number of deceased RRT patients. In addition to unadjusted incidence and prevalence rates, this report provides age- and gender-standardized regional comparisons of incidence and prevalence of RRT, and mortality of RRT patients. An international comparison shows that Finnish incidence and prevalence rates are lower than those in several other European countries. In the healthcare districts and regions, incidence of RRT correlates with early mortality (before 90 days after start of RRT). This may be due to varying reporting practices in the hospitals. Very short periods of treatment may not be reported by some centers. Thus, the criteria for reporting new RRT patients must be made more precise. Patients who have regained independent kidney function within 90 days from start of RRT are excluded from the statistics of this report, whereas patients who die within 90 days are included. Since 2000, the Finnish Registry for Kidney Diseases has collected data on comorbidity of new RRT patients using a "Tick the correct box" system, and not ICD-codes as previously. Data have been collected only on the most important comorbidic conditions and tobacco smoking. The results for are presented on pages A new age grouping is used in this year's report to be consistent with the report of the ERA-EDTA registry. Another novelty in this report is the index, which covers the annual reports from 1998 to All statistics and analyses are not presented each year, and the index helps to locate information in previous reports. 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 reporting hospitals for excellent cooperation. Helsinki, 14 October 2002 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, MD Agneta Ekstrand, Docent Patrik Finne, MD Carola Grönhagen-Riska, Professor Rauni Jukkara Erkki Lampainen, MD Marjatta Linnanvuo-Laitinen, MD Maija Piitulainen Kai Rönnholm, MD Kaija Salmela, Docent Risto Tertti, MD

5 On 31 December 2001, there were million inhabitants in Finland (Table 1). During the past ten years the population has increased most in the southern region. In the eastern region, the population has decreased. Since 1991, the populations have decreased in 14 healthcare districts and increased in 7, the largest increase occurring in the healthcare district of Helsinki-Uusimaa. The numbers in Figure 1 refer to the healthcare districts listed in Table 1. In this report, "region" refers to university hospital region.

6 Region South South-West West East North Entire country Total Total Total Total Total Total (27) (27) (27) (29) (27) (28) (28) (27) (27) (29) (27) (28) (27) (26) (27) (28) (27) (27) (38) (35) (36) (34) (31) (32) (34) (30) (32) (32) (29) (31) (33) (30) (32) (35) (32) (33) (25) (23) (24) (24) (22) (23) (25) (23) (24) (25) (23) (24) (28) (27) (27) (25) (23) (24) (6) (8) (7) (8) () (9) (8) () (9) (9) (11) () (8) (9) (8) (8) (9) (9) (4) (7) (6) (5) () (8) (5) () (8) (5) () (7) (4) (8) (6) (4) (9) (7) 0 19 (%) (%) (%) (%)

7 Table 3. Number of new RRT patients in healthcare districts and regions Finnish Registry for Kidney Diseases Healthcare district New 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 < 15 y Figure 3. Standardized incidence of RRT in regions Finnish Registry for Kidney Diseases 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 19% during the past five years. In the southern region, the incidence has decreased 13%; in the other regions, it has increased on average 36%. In , the average incidence was largest in the eastern region and smallest in the southern region. Among the healthcare districts, the average five-year incidence was largest in Itä-Savo and smallest in Vaasa. In Figure 3, the incidence rates are age- and gender-

8 Incidence/million inhabitants 30 IDDM and NIDDM together Other defined diagnoses NIDDM Glomerulonephritis IDDM Year

9 Figure 6. International comparison of incidence of RRT in 2000 Finnish Registry for Kidney Diseases 2000 Incidence/million inhabitants Norway The Netherlands Finland Denmark Austria Sweden Belgium (Dutch-speaking) Spain (Catalonia) Greece Figure 6 shows the incidence of RRT in selected European countries (ERA-EDTA Registry, Annual Report 2000; Dansk Nefrologisk Selskab, Landsregister for patienter i aktiv behandling för kronisk nyresvigt, Rapport for Danmark 2000; Svenskt register för aktiv uremivård, Aktiv uremivård i Sverige ). In Denmark and Sweden, the incidence of RRT was 36% higher than in Finland. The incidence in Finland was the third lowest of the countries compared, the incidence rates being lowest in Norway and the Netherlands. Finnish Registry for Kidney Diseases Report

10 Table 4. Patients in RRT at end of year in healthcare districts and regions Finnish Registry for Kidney Diseases 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 31 December are shown in Table 4. In 2001, the prevalence was higher than in 1997 in all healthcare districts but one. In the entire country, the prevalence has increased 26% since On 31 December 2001, 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 (37%) and the least in the western region (17%). Figure 7 shows the prevalence of RRT in as smoothed averages according to region. Figure 7. Prevalence of RRT in regions Finnish Registry for Kidney Diseases South-West East South Entire country North West

11 Region South Total South-West Total West Total East Total North Total Entire country Total Figure 8. Standardized prevalence of RRT in regions Finnish Registry for Kidney Diseases Year

12 Figure 9. Prevalence of RRT in healthcare districts on 31 December 2001 Finnish Registry for Kidney Diseases 2001 Entire country 609 patients/million inhabitants Group 1 <565 patients/million inhabitants Group patients/million inhabitants Group 3 >640 patients/million inhabitants The healthcare districts shown on the map are grouped according to the prevalence of RRT at the end of 2001 (Figure 9). The prevalence was <565 in seven districts, in seven districts, and >640 patients/million inhabitants in seven districts. The borders of the regions are indicated with thick lines. 8 Finnish Registry for Kidney Diseases Report 2001

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14 Figure 12. International comparison of prevalence of RRT on 31 December Finnish Registry for Kidney Diseases 2000 Prevalence/million inhabitants Norway Finland The Netherlands Denmark Sweden Austria Greece Belgium (Dutch-speaking) Spain (Catalonia) Figure 12 displays the prevalence of RRT on 31 December 2000 in selected European countries (ERA-EDTA Registry, Annual Report 2000; Dansk Nefrologisk Selskab, Landsregister for patienter i aktiv behandling för kronisk nyresvigt, Rapport for Danmark 2000; Svenskt register för aktiv uremivård, Aktiv uremivård i Sverige ). The Finnish prevalence rate was the second lowest. In Sweden and Denmark, the respective prevalences were 26% and 15% higher than in Finland. Finnish Registry for Kidney Diseases Report 2001

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16 Table 6. Number of deaths among RRT patients according to region, and the proportion of deceased patients who died within 90 days from start of RRT Finnish Registry for Kidney Diseases Region 1997 Number of deaths Proportion of deaths in occurring within 90 days from start of RRT South South-West West East North % 8.5 % 6.3 % 11.0 % 5.3 % Entire country % Table 7. Mortality of RRT patients according to region Finnish Registry for Kidney Diseases Region Deaths/1 000 patient-years South South-West West East North Entire country The number of deaths among RRT patients according to region is presented in Table 6. The proportion of deaths occurring within 90 days from start of RRT was 7% for the entire country, varying between 5% and 11% for different regions. The variation is apparently caused by different reporting practice in the hospitals. The proportion of deaths occurring within 90 days from start of RRT did not correlate with RRT patients' total mortality in the regions during (r=0.17, p=0.471, n=5). However, it did correlate with incidence of RRT (average incidence in ) both in regions (r=0.90, p=0.037, n=5) and healthcare districts (r=0.51, p=0.020, n=21). No correlation was found between incidence of RRT and RRT patients' total mortality in the regions (r=0.469, p=0.425, n=5) or healthcare districts (r=0.382, p=0.087, n=21). Average mortality in was largest in the western region (133 deaths/1 000 patient-years) and smallest in the southern and south-western regions (91 deaths/1 000 patient-years) (Table 7). In the entire country, mortality was 12% lower in 2001 than in Finnish Registry for Kidney Diseases Report 2001

17 Figure 15. Standardized mortality of RRT patients Finnish Registry for Kidney Diseases Mortality/1 000 patient-years Year West East North Entire country South South-West -01

18 Table 8. Number of patient-years according to age group Finnish Registry for Kidney Diseases Age group (years) Patient-years (%) (3.7) (28.1) (45.8) (17.9) (4.5) (3.6) (27.4) (46.2) (17.4) (5.4) (3.8) (25.9) (46.3) (17.6) (6.4) (3.7) (24.2) (45.4) (19.7) (7.7) (3.6) (22.7) (46.0) (20.0) (7.7) All Type of treatment Patient-years (%) Peritoneal dialysis Hemodialysis Transplantation (9.5) (29.8) (60.6) All Increase from previous years (%) 6.6 Patient-years (%)

19 Table 11. Number of patient-years according to diagnosis Finnish Registry for Kidney Diseases Patient-years (%) Diagnosis Glomerulonephritis IDDM Polycystic degeneration Pyelonephritis NIDDM Undefined kidney disease Amyloidosis Nephrosclerosis Other systemic disease Urinary tract obstruction Congenital diseases Other kidney diseases Tubulointerstitial nephritis Congenital nephrosis, Finnish type Malignancies Metabolic diseases (28.5) (18.3) (11.5) (.1) (4.8) (3.4) (4.3) (3.9) (3.4) (3.1) (3.2) (0.6) (2.1) (1.8) (0.5) (0.3) (27.4) (18.4) (12.1) (9.7) (5.5) (3.9) (4.1) (3.8) (3.4) (3.2) (3.1) (0.7) (2.0) (1.8) (0.5) (0.3) (26.4) (18.2) (12.2) (9.3) (5.7) (4.3) (4.2) (4.3) (3.4) (3.1) (3.1) (1.2) (1.8) (1.8) (0.7) (0.4) (25.7) (17.3) (12.3) (8.8) (6.8) (4.7) (4.3) (4.2) (3.4) (3.3) (3.2) (1.5) (1.8) (1.8) (0.7) (0.4) (24.8) (17.0) (12.6) (8.7) (7.2) (5.3) (4.3) (4.1) (3.3) (3.3) (3.1) (1.7) (1.7) (1.7) (0.7) (0.4) All The number of patient-years in according to diagnosis of kidney disease is shown in Table 11. Glomerulonephritis is the most common diagnosis, but its proportion of patient-years has decreased continuously since IDDM is the second most common diagnosis, with its proportion since 1997 decreasing 1.3 percentage units. Polycystic degeneration is the third most common diagnosis; its proportion has increased 1.1 percentage units during the past five years. In 2001, NIDDM was the fifth most common diagnosis; the number of patients-years contributed by NIDDM patients has doubled since The absolute number of patient-years increased the most (8 patientyears) among patients with polycystic degeneration. Finnish Registry for Kidney Diseases Report

20 Figure. Number and donor status of kidney transplantations performed on patients older than 20 years Finnish Registry for Kidney Diseases Dead donor 97 Living donor 3 n= n= n= n= n=548 Figure 17. Number and donor status of kidney transplantations performed on patients younger than 20 years Finnish Registry for Kidney Diseases Dead donor 79 Living donor 21 n= n= n= n= n=33 Figure 18. Proportion of RRT patients receiving a kidney transplant within two years from start of RRT Finnish Registry for Kidney Diseases RRT started: Kidney transplant within 2 years from start of RRT No kidney transplant within 2 years n= n= n= n= n=865 In , the proportion of kidney transplants coming from living donors was larger among patients younger than 20 years than among other patients (Figures and 17). In , the proportion of living donors was somewhat larger than in other periods. Figures and 17 include all kidney transplantations, not only the patient's first transplantation as in Figure 19. The proportion of all RRT patients receiving a kidney transplant within two years from start of RRT has decreased continuously (Figure 18). The proportion was 61% in and 27% in Finnish Registry for Kidney Diseases Report 2001

21 Figure 19. Time from start of dialysis to first kidney transplantation Finnish Registry for Kidney Diseases Number of patients receiving their first kidney transplant Median=1.02 y n=729 Time period of first kidney transplantation: Median=0.77 y n= Median=0.37 y n= Years from start of dialysis to first kidney transplantation Figure 19 shows the waiting time in dialysis of patients who have received their first kidney transplantation. The waiting time has gotten longer since In , the median waiting time was 1.02 years, and in , it was 1.31 years. In , kidney transplantation was the first type of treatment for 19% of patients. In , the proportion was 0.3% and in correspondingly 0.5%. At the time of the first transplantation, patients' average age was 41 years in , 42 years in , 45 years in , and 46 years in The median queuing time for transplantation (time from joining transplantation queue to transplantation) was 0.48 years in and 0.56 years in (data obtained from the Registry for follow-up of kidney transplantation patients, Helsinki University Central Hospital). Finnish Registry for Kidney Diseases Report

22 Figure 20. Frequency of angina pectoris at start of RRT Finnish Registry for Kidney Diseases Angina pectoris No symptoms of angina pectoris n=458 (561) n=315 (389) Figure 21. Coronary bypass or angioplasty in anamnesis at start of RRT Finnish Registry for Kidney Diseases Bypass or angioplasty performed No coronary bypass or angioplasty performed n=461 (561) 5 95 n=313 (389) Figure 22. Myocardial infarction in anamnesis at start of RRT Finnish Registry for Kidney Diseases Myocardial infarction No myocardial infarction n=465 (561) n=318 (389) Since 2000, the Finnish Registry for Kidney Diseases has collected data on new RRT patients' comorbidity and smoking habits. The number of patients with data on comorbidity is shown in the right margins of Figures The total number of patients is indicated in parentheses. The proportion of patients with data available was 68% in 2000 and 85% in Figures show the frequency of signs of coronary disease among new RRT patients. Twenty-one percent of the new RRT patients had symptoms of angina pectoris (Figure 20). A coronary bypass or angioplasty had been performed on 11% of male patients and 5% of female patients (p=0.007, Figure 21). Eighteen percent of the male patients and 11% of the female patients had previously had a myocardial infarction (p=0.007, Figure 22). 18 Finnish Registry for Kidney Diseases Report 2001

23 Figure 23. Anamnestic myocardial infarction at start of RRT according to age group Finnish Registry for Kidney Diseases Myocardial infarction No myocardial infarction 0 19 y 0 n=27 (28) y 2 98 n=126 (159) y n=320 (384) y n=212 (265) 75 y n=98 (114) Figure 24. Left ventricular hypertrophy at start of RRT Finnish Registry for Kidney Diseases Left ventricular hypertrophy No left ventricular hypertrophy n=420 (561) n=286 (389) Figure 25. Chronic heart failure at start of RRT Finnish Registry for Kidney Diseases Heart failure No heart failure n=451 (561) n=303 (389) The frequency of myocardial infarction in the anamnesis correlated with age at start of RRT (p<0.001, Figure 23). Left ventricular hypertrophy was reported for 29% of new male patients and 26% of new female patients (p=0.304, Figure 24). Heart failure was reported for one-tenth of the new patients, and the proportion did not differ between men and women (p=0.782, Figure 25). Finnish Registry for Kidney Diseases Report

24 Figure 26. Symptomatic arterial disease other than coronary or cerebrovascular disease at start of RRT Finnish Registry for Kidney Diseases Symptomatic arterial disease No symptomatic arterial disease n=460 (561) n=307 (389) Figure 27. Surgical bypass of arteries (not coronary artery) in anamnesis at start of RRT Finnish Registry for Kidney Diseases Bypass surgery performed Bypass surgery not performed 90 n=458 (561) 5 95 n=304 (389) Figure 28. Amputation performed due to arterial disease before start of RRT Finnish Registry for Kidney Diseases Amputation No amputation n=456 (561) n=305 (389) The frequency of symptomatic arterial diseases, other than coronary and cerebrovascular disease, is shown in Figures In , 15% of new male patients and 12% of new female patients had symptomatic arterial disease (p=0.281, Figure 26). A surgical arterial bypass (not coronary artery) had been performed on % of the male patients and 5% of the female patients (p=0.029, Figure 27). Arterial disease had lead to amputation in 5% of the men and 3% of the women (p=0.125, Figure 28). 20 Finnish Registry for Kidney Diseases Report 2001

25 Figure 29. Cerebrovascular hemorrhage or infarction in anamnesis at start of RRT Finnish Registry for Kidney Diseases Cerebrovascular hemorrhage or infarction No cerebrovascular hemorrhage or infarction 90 n=465 (561) 90 n=3 (389) Figure 30. Treatment of high blood pressure at start of RRT Finnish Registry for Kidney Diseases High blood pressure No high blood pressure n=477 (561) n=315 (389) Figure 31. Treatment of hyperlipidemia at start of RRT Finnish Registry for Kidney Diseases Treatment with drug Only dietary treatment No hyperlipidemia n=442 (561) 48 n=298 (389) 15 Figure 32. Tobacco smoking at start of RRT Finnish Registry for Kidney Diseases Current smoker Previous smoker Nonsmoker n=422 (561) n=287 (389) Of both male and female new RRT patients, % had previously had a cerebrovascular hemorrhage or infarction (p=0.770, Figure 29). The treatment f=609 2igureh[(smok)209 TJ0 4 8r The treatment f=609 2igureh[(smok)209 TJ0 4 8r.ously had 6N22 v8

26 Age of new patients 1998:8, 2000:9,12, 2001:4 of new patients with glomerulonephritis 1998:8 on 31 December 1999:, 2000:11 Body-mass index 1999:12 Causes of death type of treatment 2000:18 Changes in type of treatment 1998:5, 1999:6, 2000:6, 2001:11 Cockroft Gault formula 1998: Comorbidity according to kidney diagnosis 1998:7 amputation 2001:20 angina pectoris 2001:18 arterial disease other than coronary disease 2001:20 cerebrovascular hemorrhage or infarction 2001:21 coronary disease 2001:18 heart failure 2001:19 high blood pressure 1998:, 1999:17, 2000:14 15, 2001:21

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