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A comparative study of the risk profile of hemodialysis patients in a for profit network and in two regional registries of the Italian Society of Nephrology

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Abstract

In 2013, the Italian Society of Nephrology joined forces with Nephrocare-Italy to create a clinical research cohort of patients on file in the data-rich clinical management system (EUCLID) of this organization for the performance of observational studies in the hemodialysis (HD) population. To see whether patients in EUCLID are representative of the HD population in Italy, we set out to compare the whole EUCLID population with patients included in the regional HD registries in Emilia-Romagna (Northern Italy) and in Calabria (Southern Italy), the sole regions in Italy which have systematically collected an enlarged clinical data set allowing comparison with the data-rich EUCLID system. An analysis of prevalent and incident patients in 2010 and 2011 showed that EUCLID patients had a lower prevalence of coronary heart disease, peripheral vascular disease, heart failure, valvular heart disease, liver disease, peptic ulcer and other comorbidities and risk factors and a higher fractional urea clearance (Kt/V) than those in the Emilia Romagna and Calabria registries. Accordingly, survival analysis showed a lower mortality risk in the EUCLID 2010 and 2011 cohorts than in the combined two regional registries in the corresponding years: for 2010, hazard ratio (HR) EUCLID vs. Regional registries: 0.80 [95% confidence interval: 0.71–0.90]; for 2011, HR: 0.76 [0.65–0.90]. However, this difference was nullified by statistical adjustment for the difference in comorbidities and risk factors, indicating that the longer survival in the EUCLID database was attributable to the lower risk profile of patients included in that database. This preliminary analysis sets the stage for future observational studies and indicates that appropriate adjustment for difference in comorbidities and risk factors is needed to generalize to the Italian HD population analyses based on the data-rich EUCLID database.

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References

  1. Laine C, Davidoff F (1996) Patient-centered medicine. A professional evolution. JAMA 275:152–156

    Article  CAS  PubMed  Google Scholar 

  2. Zoccali C (2001) The importance of large, high quality clinical databases in nephrology. J Nephrol 14:89–93

    Google Scholar 

  3. Shlipak M, Stehman-Breen C (2005) Observational research databases in renal disease. J Am Soc Nephrol 16:3477–3484

    Article  PubMed  Google Scholar 

  4. Winkelmayer WC, Liu J, Kestenbaum B (2011) Comparative effectiveness of calcium-containing phosphate binders in incident U.S. dialysis patients. Clin J Am Soc Nephrol 6:175–183

    Article  PubMed  PubMed Central  Google Scholar 

  5. Chang TI, Winkelmayer WC (2012) Comparative effectiveness research: what is it and why do we need it in nephrology? Nephrol Dial Transplant 27:2156–2161

    Article  PubMed  Google Scholar 

  6. Marcelli D, Kirchgessner J, Amato C et al (2001) EuCliD (European Clinical Database): a database comparing different realities. J Nephrol 14(Suppl 4):S94–S100

    PubMed  Google Scholar 

  7. Alloatti S, Strippoli GF, Buccianti G et al (2008) Current structure and organization for renal patient assistance in Italy. Nephrol Dial Transplant 23:1323–1329

    Article  PubMed  Google Scholar 

  8. http://www.nephrocare.com/dialysiscentres.html?tx_fkclinicfinder_pi1%5Bloc%5D = 5&cHash = d28b0432d290402e4408b7281bac1d83. Accessed 6 May 2016

  9. Relman AS, Rennie D (1980) Treatment of end-stage renal disease: free but not equal. N Engl J Med 303:996–998

    Article  CAS  PubMed  Google Scholar 

  10. Woolhandler S, Himmelstein DU (1999) When money is the mission–the high costs of investor-owned care. N Engl J Med 341:444–446

    Article  CAS  PubMed  Google Scholar 

  11. Nissenson AR, Owen WF (2000) Ownership of dialysis facilities and patients’ survival. N Engl J Med 342:1054-5-6

    Google Scholar 

  12. Devereaux PJ, Schünemann HJ, Ravindran N et al (2002) Comparison of mortality between private for-profit and private not-for-profit hemodialysis centers: a systematic review and meta-analysis. JAMA 288:2449–2457

    Article  CAS  PubMed  Google Scholar 

  13. Nordio M, Limido A, Maggiore U et al (2012) Survival in patients treated by long-term dialysis compared with the general population. Am J Kidney Dis 59:819–828

    Article  PubMed  Google Scholar 

  14. Floege J, Gillespie IA, Kronenberg F et al (2015) Development and validation of a predictive mortality risk score from a European hemodialysis cohort. Kidney Int 87:996–1008

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

Collaborators for the Calabrian and Emilian Dialysis and Transplantation Registries Workgroups

Andreoli D., Ascoli G., Barreca E., Bovino M., Bruzzese V., Candela V. (deceased), Caruso F., Chiarella S., Cianfrone P., D’Agostino F., D’Anello E., Ferrari L., Figoli D., Fornaciari C., Franco C., Galati D., Grandinetti F., Gullo M., Lo Gozzo D., Lucisano S., Mancuso F., Mannino M.L., Marsico M.L., Martire V., Mazza G., Mazza B., Mellace A., Messina A., Pisani A., Plutino D., Policastro M., Pugliese A., Reina A., Santangelo M., Sapio C., Scicchitano R., Sellaro A., Tramontana D., Vardè C., Zingone F.

Collaborators for the Emilian Dialysis and Transplantation Registries Workgroups

Dalmastri V., Rapanà R., Giovannone C., Giudicissi A., Russo G., Zambianchi L., Lucchi L., David S., Gerra D., Ballocchi S., Isola E., Stefani A., Flachi M., Mencarelli F.

Author contributions

The proposal of of a joint effort for creating a shared data base for clinical research in the Italian dialysis population was originally formulated by A Di B, SS, FC (by Nephrocare and Fresenius Medical Care) and GBC (President of the Italian Society of Nephrology in 2013–2014) who then involved AS and CZ into the project. All these investigators contributed to the planning of the present study. MP,CA, PC, CM and AV assembled and validated the study database. GD and GT made the statistical analysis and MP,CA, EA and PC callaborated into this analysis. MP, GT and CZ prepared the first draft of the paper which was then revised and integrated by AS and SS and the final version was read and approved by all investigators.

Author information

Authors and Affiliations

  1. Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Azienda Ospedaliera Bianchi Melacrino Morelli, CNR-IFC, Reggio Calabria, Italy

    Maurizio Postorino, Graziella D’Arrigo, Carmela Marino, Antonio Vilasi, Giovanni Tripepi & Carmine Zoccali

  2. Fresenius Medical Care, Bad Homburg, Germany

    Claudia Amato, Paola Carioni & Stefano Stuard

  3. Division of Nephrology, Dialysis and Hypertension, Policlinico S. Orsola-Malpighi, Bologna, Italy

    Elena Mancini

  4. NephroCare Italy, Naples, Italy

    Attilio Di Benedetto & Fabrizio Cerino

  5. Department of Nephrology, Second University of Naples, Naples, Italy

    Giovanbattista Capasso

  6. Italian Society of Neprology, Milan, Italy

    Antonio Santoro

Authors
  1. Maurizio Postorino
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  2. Claudia Amato
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  3. Elena Mancini
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  4. Paola Carioni
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  5. Graziella D’Arrigo
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  6. Attilio Di Benedetto
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  7. Fabrizio Cerino
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  8. Carmela Marino
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  9. Antonio Vilasi
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  10. Giovanni Tripepi
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  11. Stefano Stuard
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  12. Giovanbattista Capasso
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  13. Antonio Santoro
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  14. Carmine Zoccali
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Consortia

On Behalf of Calabrian and Emilian Dialysis and Transplantation Registries Workgroups

  • D. Andreoli
  • , G. Ascoli
  • , E. Barreca
  • , M. Bovino
  • , V. Bruzzese
  • , V. Candela
  • , F. Caruso
  • , S. Chiarella
  • , P. Cianfrone
  • , F. D’Agostino
  • , E. D’Anello
  • , L. Ferrari
  • , D. Figoli
  • , C. Fornaciari
  • , C. Franco
  • , D. Galati
  • , F. Grandinetti
  • , M. Gullo
  • , D. Lo Gozzo
  • , S. Lucisano
  • , F. Mancuso
  • , M.L. Mannino
  • , M.L. Marsico
  • , V. Martire
  • , G. Mazza
  • , B. Mazza
  • , A. Mellace
  • , A. Messina
  • , A. Pisani
  • , D. Plutino
  • , M. Policastro
  • , A. Pugliese
  • , A. Reina
  • , M. Santangelo
  • , C. Sapio
  • , R. Scicchitano
  • , A. Sellaro
  • , D. Tramontana
  • , C. Vardè
  • , F. Zingone
  • , V. Dalmastri
  • , R. Rapanà
  • , C. Giovannone
  • , A. Giudicissi
  • , G. Russo
  • , L. Zambianchi
  • , L. Lucchi
  • , S. David
  • , D. Gerra
  • , S. Ballocchi
  • , E. Isola
  • , A. Stefani
  • , M. Flachi
  •  & F. Mencarelli

Corresponding author

Correspondence to Carmine Zoccali.

Ethics declarations

Conflict of interest

CA, PC and SS are Fresenius Medical Care employees, AdiB and FC are Nephrocare Italy employees. The other authors have no conflict to declare.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

No written informed consent was required from participants, because standard aggregated registry data were used.

Additional information

Collaborators of the Calabrian and Emilian Dialysis and Transplantation Registries Workgroups are listed in “Acknowledgment”.

Appendices

Appendix A

See Table 4.

Table 4 Other comorbidities of prevalent patients
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Appendix B

See Table 5.

Table 5 Other comorbidities of incident patients
Full size table

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Postorino, M., Amato, C., Mancini, E. et al. A comparative study of the risk profile of hemodialysis patients in a for profit network and in two regional registries of the Italian Society of Nephrology. J Nephrol 31, 119–127 (2018). https://doi.org/10.1007/s40620-016-0372-8

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  • DOI: https://doi.org/10.1007/s40620-016-0372-8

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