Abstract
Incidence of kidney replacement therapy (KRT) stabilizes or declines both in Europe and in the US; however, it is predictable that global prevalence of KRT will double by 2030. In this paper, we focus on the patterns of incidence, mortality, and prevalence of KRT in Italy, and we compare, when possible, the findings with other countries. The Italian Dialysis and Transplantation Registry (IDTR) currently collects aggregate data from regional registries. In Italy, KRT yearly incidence is around 160 patients per million population (pmp). This incidence showed an increasing trend up until 2011 with an average annual percentage change (AAPC) of 1.8%, after which it stabilized. Older age is an important determinant for KRT incidence, and it is strongly associated with the variability between Italian regions. Incidence is very stable within patients less than 50 years old; however, it greatly differs between regions for patients over 75 years old, ranging from 400 to 900 pmp. Moreover, the incidence for patients over 50 years old declined from 366 pmp in 2011 to 285 in 2017. An age-period-cohort (APC) model showed a very strong cohort effect, which shows the decline in incidence seems mainly due to the better health conditions of people born after 1940. Mortality rate in KRT patients was 109 per 1000 patient-year (py) between 2011 and 2017 with great differences among treatment modalities: 162 per 1000 py in haemodialysis, 117 per 1000 py in peritoneal dialysis, and 16 per 1000 py in kidney transplantation. Premature death is better detected by the standard expected years of life lost (YLL). The distribution of YLL rate per age shows a sharp increase between 40 and 70 years old both in haemodialysis and peritoneal dialysis patients with an AAPC of 5.2% and 4.1% respectively. Transplanted patients experience a very low YLL rate at any age. KRT prevalence was 1118 pmp in 2017 and it should be close to 1175 pmp by 2025 with a projected increase of transplanted patients’ prevalence to 500 pmp, and a decrease of dialysis patients from 714 to 680 pmp. The proportion of patients treated with one of the three modalities strictly depends on age, with a sharp increase of haemodialysis after the age of 50. All data suggests the necessity to improve the care of middle and older age patients who experience the higher incidence of disease and mortality.
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References
Liyanage T, Ninomiya T, Jha V, Neal B, Patrice HM, Okpechi I, Zhao Mh, Lv J, Garg AX, Knight J, Rodgers A, Gallagher M, Kotwal S, Cass A, Perkovic V (2015) Worldwide access to treatment for end-stage kidney disease: a systematic review. Lancet 385:1975–1982
Heaf J (2017) Current trends in European renal epidemiology. Clin Kidney J 10:149–153
Vigneau C, Kolko A, Stengel B, Jacquelinet C, Landais P, Rieu P, Bayat S, Couchoud C, on behalf of the REIN registry (2017) Ten-years trends in renal replacement therapy for end-stage renal disease in mainland France: lessons from te French Renal Epidemiology and Information Network (REIN) registry. Néphrologie Thérapeutique 13:228–235
Pippias M, Jager KJ, Kremer A, Leivestad T, Sanchez MB et al (2016) The changing trends and outcomes in renal replacement therapy: data from ERA-EDTA Registry. Nephrol Dial Transplant 31:831–841
United States Renal Data System (2018) 2018 USRDS annual data report: Epidemiology of kidney disease in the United States. National Institutes of Health, Bethesda
Heaf J (2016) The Danish Nephrology Registry. Clin Epidemiol 2016(8):621–627
Schmid VJ, Held L (2007) Bayesian age-period-cohort modelling and prediction—BAMP. J Stat Softw 21:1–15
McCullough KP, Morgenstern H, Saran R, Herman WH, Robinson BM (2019) Projecting ESRD incidence and prevalence in the United States through 2030. J Am Soc Nephrol 30:127–135
Cavanaugh KL (2019) Public policy and equal access to home dialysis. CJASN 14:1128–1130
Briggs V, Davies S, Wilkie M (2019) International variations in peritoneal dialysis utilization and implications for practice. Am J Kidney Dis 74:101–110
Masakane I, Taniguchi M, Nakai S, Tsuchida K, Wada A, Ogata S, Hasegawa T, Hamano T, Hanafusa N, Hoshino J, Goto S, Yamamoto K, Minakuchi J, Nakamoto H (2018) Annual dialysis data report 2016, JSDT renal data registry. Ren Replace Ther 4:45
Johansen KL (2018) Life expectancy gains for patients with ESRD. Clin J Am Soc Nephrol 13:11–12
Murray CJL, Lopez AD (1996) World Health Organization, World Bank & Harvard School of Public Health. The Global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020: summary/ edited by Murray CJL, Lopez AD World Health Organization. https://apps.who.int/iris/handle/10665/41864
Aragòn TJ, Lichtensztajn DV, Katcher BS, Reiter R, Katz MH (2008) Calculating expected years of life lost for assessing local ethnic disparities in causes of premature death. BMC Public Health 8:116
Martinez R, Soliz P, Caixeta R, Ordunez P (2019) Reflection on modern methods: years of life lost due to premature mortality—a versatile and comprehensive measure for monitoring noncommunicable disease mortality. Int J Epidemiol 48:1367–1376
ERA-EDTA Registry: ERA-EDTA Registry Annual Report 2017 (2019) Amsterdam UMC, location AMC, Department of Medical Informatics, Amsterdam, The Netherlands
Lassalle M, Monnet E, Ayav C, Hogan J, Moranne O, Couchoud C, Registry REIN (2019) 2017 Annual report digest of renal epidemiology information network (REIN) registry. Transpl Int 32:892–902
Thomas B, Wulf S, Bikbov B, Perico N, Cortinovis M, Courville de Vaccaro K, Flaxman A, Peterson H, Delossantos A, Haring D, Mehrotra R, Himmelfarb J, Remuzzi G, Murray C, Naghavi M (2015) Maintenance dialysis throughout the world in years 1990 and 2010. J Am Soc Nephrol 26:2621–2633
Wetmore JB, Collins AJ (2016) Global challenges posed by the growth of end-stage renal disease. Renal Replace Ther 2:15. https://doi.org/10.1186/s41100-016-0021-7
Stenvinkel P (2010) Chronic kidney disease: a public health priority and harbinger of premature cardiovascular disease. J Intern Med 268:456–467
Tamura MK, Tan JC, O’Hare AM (2012) Optimizing renal replacement therapy in older adults: a framework for making individualized decisions. Kidney Int 82:261–269
Acknowledgments
We thank Dr. Valentina Postorino for assistance in Revising Manuscript. IDTR Scientific and Technical Committee: D. Bolignano, M. Cirillo, F. Conte, A. Di Napoli, F. Fabbian, PM. Ferraro, D. Gibertoni, PL. Lentini, G. Reboldi.
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Nordio, M., Limido, A., Postorino, M. et al. Present and future of kidney replacement therapy in Italy: the perspective from Italian Dialysis and Transplantation Registry (IDTR). J Nephrol 33, 1195–1200 (2020). https://doi.org/10.1007/s40620-020-00750-z
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DOI: https://doi.org/10.1007/s40620-020-00750-z