Incidence, prevalence and crude survival of patients starting dialysis in Portugal (2010-16): analysis of the National Health System individual registry.

BACKGROUND: The Portuguese Society of Nephrology (PSN) reported that Portugal has one of the highest incidences of dialysis in Europe. However, this claim was based on aggregated data supplied by dialysis providers, hampering comparisons between countries. In 2009, an individual registry of patients starting dialysis was set up by the Portuguese Ministry of Health. We analysed individual data of patients starting dialysis from January 2010 until December 2016. METHODS: Demography, starting treatment day, modality, regional distribution and outcomes, such as death, recovery of renal function, transfer to renal transplantation, peritoneal dialysis or conservative management, were extracted. Incidence, prevalence and survival analysis were calculated and compared with the PSN registry. RESULTS: Out of 19 190 registrations, 16 775 were incident patients (61.8% men). Yearly incidence of renal replacement therapy was 250, 248, 229, 239, 230, 231 and 244 per million population (p.m.p.) for 2010 to 2016, compared with 235, 224, 218, 230, 234, 225 and 239 p.m.p. reported by the PSN registry. On the other hand, prevalence increased from 998 p.m.p. in 2010 to 1286 p.m.p. in 2016, compared with 1010 p.m.p. in 2010 increasing to 1203 p.m.p. in 2016 from the PSN registry. The regions of Alentejo (122.9 p.m.p.) and the the Centre (160.8 p.m.p.) had the lowest regional incidence, while Lisbon had the highest (386 p.m.p. in 2016). Unadjusted survival analysis revealed that 93.5% of the patients were alive on the 91st day, whereas 85.2 and 78.3% were alive at 1 and 2 years, respectively. Crude survival at 7 years was 40%. CONCLUSIONS: For the first time, an individual registry of patients starting dialysis in Portugal was subject to analysis and added new information about long-term survival and regional differences in the incidence and prevalence of renal replacement therapy. We were able to confirm that Portugal has one of the world's highest incidences and prevalences of dialysis. We also demonstrate, for the first time, a striking regional difference in the incidence of dialysis and an excellent early and long-term survival of patients on dialysis. These results compare well with other European countries in terms of the dialysis efficiency.

Evaluation of an instrument for screening patients at risk for chronic kidney disease: testing SCORED (Screening for Occult Renal Disease) in a Portuguese population.

Prevalence of chronic kidney disease (CKD) is increasing and CKD has a long asymptomatic phase suitable for screening. SCORED (Screening for Occult Renal Disease) is a prescreening test which has compared favorably with KEEP. We report the results of SCORED testing in subjects attending a World Kidney Day event. After SCORED, subjects were tested for creatinine, urinary albumin and creatinine, and renal ultrasound. Eighty-eight subjects participated (32 men; mean age 59.7 ± 14.8 years; 58% hypertensive and 15.9% diabetics) of which 60 had a high score for kidney disease. Thirty-eight of 47 (80.8%) subjects that were further evaluated had a high-risk score. All subjects with CKD had a high score (100% sensitivity). SCORED showed low specificity (24.3%), but a high negative predictive value (100%). Including albuminuria in the definition of CKD increased the positive predictive value to 43.6%. In conclusion, SCORED is good for prescreening subjects for CKD in a European population as it captures all patients with CKD. Moreover, in subjects with low risk, the probability of CKD is low. SCORED is useful in alerting the general population and the medical community about the risk factors of CKD.

Ascites complicating unilateral nephrectomy and peritoneal dialysis catheter implantation in a patient with massive polycystic kidney and liver disease.

Peritoneal dialysis (PD) is a well-established therapeutic option for patients with polycystic kidney disease. However, in patients with massive polycystic kidney and liver disease, subclinical hepatic venous outflow obstruction may elicit the appearance of ascites after implantation of a peritoneal catheter. The case of a patient who developed ascites after implantation of a PD catheter and further lowering of abdominal pressure after unilateral nephrectomy is discussed.

Ambulatory blood pressure measurement in young normotensive patients with autosomal dominant polycystic kidney disease.

INTRODUCTION: Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic disorder causing chronic kidney disease in adults. Hypertension occurs early and frequently precedes the development of renal failure. It has been shown that clinically normotensive young adults with ADPKD exhibit increased left ventricular mass and left ventricular mass index (LVMI), which contributes to the increased cardiovascular risk in these patients. We set out to investigate whether normotensive patients have a prehypertensive state that could account for their increased LVMI. METHODS: Patients with ADPKD followed as outpatients were selected if they were aged between 21-30 years, were normotensive (office and sporadic blood pressure < 140/90 without medication), and had normal renal function (GFR > 90 ml/min). Normotensive controls aged between 21-30 years were selected, all with normal renal ultrasound, serum creatinine, dipstick analysis and microalbuminuria /creatinine ratio. Patients and controls underwent 24-hour ambulatory blood pressure measurement (ABPM) according to the local protocol. RESULTS: Systolic (124.7 +/- 7.6 vs. 115.2 +/- 6.9; p < 0.0001), diastolic (77.3 +/- 6.3 vs. 70.5 +/- 3.9; p < 0.0001) and mean (92.7 +/- 8.5 vs. 85.7 +/- < 0.001) 24-hour blood pressure was significantly higher in patients with ADPKD compared to controls. Statistically significant differences were also found when daytime and night-time periods were analyzed separately. Hypertension on ABPM was diagnosed in 6 patients but differences in the ABPM profile persisted even when these patients were excluded from the analysis. CONCLUSION: In young adults with ADPKD there is a prehypertensive state that can be detected using ABPM.

Diastolic function in several stages of chronic kidney disease in patients with autosomal dominant polycystic kidney disease: a tissue Doppler imaging study.

BACKGROUND: This study evaluates the prevalence of diastolic dysfunction (DD) in several stages of chronic kidney disease (CKD) in patients with autosomal dominant polycystic kidney disease (ADPKD). METHODS: 107 ADPKD patients performed echocardiographic and Doppler studies and a tissue Doppler imaging (TDI) study. Patients were divided in three groups: group 1, 57 patients with CKD stage I, group 2, 37 patients in stages II and III, and group 3, 13 patients with CKD stages IV and V (not on dialysis). RESULTS: In transmitral Doppler, 1 patient in group 1 compared to 5 in group 2, and 4 in group 3 exhibited DD (p < 0.005); moreover, E/A ratio decreases progressively from group 1 to 3 (p < 0.0001). In TDI, DD was observed in 8 patients in group 1, 17 in group 2, and 8 in group 3 had DD (p < 0.001). Em velocity, the best TDI parameter for DD, correlated with age, renal function and blood pressure. When adjusted for age, increased left ventricular mass index and decreased renal function were independent risk factors of DD. CONCLUSIONS: DD occurred progressively as renal function deteriorates in patients with ADPKD and this effect is independently related to age and blood pressure.

Hypertension in autosomal dominant polycystic kidney disease: observational study in 207 patients with a mean follow-up of 107 months.

INTRODUCTION AND OBJECTIVES: Autosomal dominant polycystic kidney disease (ADPKD) is one of the most common hereditary diseases in adults. ADPKD is a frequent cause of 4 secondary hypertension and, conversely, hypertension is a common manifestation of ADPKD and, more importantly, one of the few that are treatable. Given the autosomal dominant nature of the disease and the fact that it is easy to diagnose with a renal scan, ADPKD patients can be diagnosed early at a pre-symptomatic stage, and hypertension can be detected and treated. The main purpose of this article is to report our experience in the long-term follow-up of patients with ADPKD, with particular emphasis on hypertension. METHODS: A retrospective analysis was made of 532 patients observed in our outpatient clinic due to renal cysts over the last 17 years, of whom 383 were diagnosed with ADPKD according to Ravine's criteria. Patients were followed-up as outpatients on a yearly basis, or more frequently if necessary. Data on demography and clinical findings were analyzed with particular emphasis on blood pressure control, number and type of antihypertensive drugs, and left ventricular mass index (LVMI). RESULTS: At the beginning of follow-up 56% of the patients, including 30.7% of the young adults aged 20 to 34 years, were hypertensive. Focusing on 207 patients observed in 2006, with a mean follow-up of 107 +/- 66 months, a significant decrease in systolic and diastolic blood pressure was observed between the first and last observations. Of a subgroup of 115 patients who were normotensive at the initial observation, 50% became hypertensive by the age of 40. During follow-up, only eleven had a cardiovascular event such as angina, myocardial infarction, stroke or peripheral artery disease (rate 0.006 events/patient-year). LVMI correlated with age, renal function and systolic and diastolic blood pressure, but only age was an independent risk factor for increased left ventricular mass. CONCLUSION: Hypertension is a common complication in ADPKD patients. Early diagnosis and follow-up at a pre-symptomatic stage of the disease are important since this enables early initiation of antihypertensive therapy, which could reduce the rate of cardiovascular events in this population.