Gabinete do Registo da Doença Renal Crónica da Sociedade ... · Sociedade Portuguesa de...
Transcript of Gabinete do Registo da Doença Renal Crónica da Sociedade ... · Sociedade Portuguesa de...
Gabinete do Registo da Doença Renal Crónica
da
Sociedade Portuguesa de Nefrologia
Gabinete de Registo da SPN, 2016 – Fernando Macário Portuguese Society of Nephrology, 2017 – Fernando Macário
Abbreviations
• CKD – Chronic Kidney Disease
• HD - Haemodialysis
• PD - Peritoneal Dialysis
• KTr - Kidney Transplant
• PMP - Per Million Population
• RRT - Renal Replacement Therapy
• Pts – patients
• Nº - number
• VA – Vascular Access
• AVFistula – Arteriovenous fistula
• Cat. – Catheter
• CVC – Central Vein Catheter
• EDTA – European Dialysis and Transplantation Association
Brief appointment of the Portuguese Registry of Dialysis and Transplantation
• 1984: national registry for Chronic Renal Insufficiency was created by Prof. Dr. Jacinto Simões, President of the Portuguese Society of
Nephrology
• From 1984 till end of eighties the registry follows casuistic EDTA model
• From the end of eighties till 1996 permanent registry with data on incidence, prevalence, mortality and other clinical data
• 1997 to 2007, aggregated data on incidences, prevalence and mortality with 100% of clinics and hospitals reporting
• Since 2007, analysis of new clinical data on several aspects of CKD 5 treatment: incidence, prevalence, analysis by sexes and country
regions, median age and age groups, etiology of CKD, gross mortality rates, vascular access, virology status, etc. Hundred percent
response rate
• 2010, online registry
• Head of Registry:
– 1984 – 1990: Dr. João Ribeiro Santos
– 1991 – 1992: Dr. Pedro Ponce
– 1993: Dr. João Ribeiro Santos
– 1994 – 1996: Dr. Francisco Remédio
– 1997 – 2007: Dr. João Pinto dos Santos
– 2007 - ... Fernando Macário
Portuguese Society of Nephrology, 2017 – Fernando Macário
Portuguese Society of Nephrology, 2017 – Fernando Macário
Questionnaires for Hemodialysis (HD),
Peritoneal Dialysis (PD) and Kidney Transplantation
123 Hemodialysis Centers
25 Peritoneal Dialysis Units
8 adult and 1 pediatric kidney transplantation centers
100% response rate
Portuguese Registry of Dialysis and Transplantation 2017
Gabinete de Registo da SPN, 2016 – Fernando Macário Portuguese Society of Nephrology, 2017 – Fernando Macário
New patients starting dialysis or submitted to renal transplantation during 2017 (n=2372)
0
500
1000
1500
2000
2500
HD PD TX
2113
228
31
716
157
895
50
499
14 3 7
Nº
of
patients
All 18 to 65 years (37,3%) 65 to 80 years (40,4%)
> 80 years (21,9%) < 15 years (0,4%)
Portuguese Society of Nephrology, 2017 – Fernando Macário
0
2.000
4.000
6.000
8.000
10.000
12.000
HD PD TX
11.985
756
7.518
4.499
552
4866
175
2620
29
Nº
pa
tien
ts
Total < 65 years (39,6%) 65 to 80 years (39,6%) > 80 years (20,8%)
Total number of pts – 20259
Prevalence - 1965,1 pmp
Nº of KTx pt / NºD pt = 0,59 (0,58 in 2016)
?
Portuguese Society of Nephrology, 2017 – Fernando Macário Mean age HD + PD = 67,1 years
Patients treated by dialysis or with functioning kidney transplant
31st December 2017
Incident patients accepted for RRT per million population during 2017
230,08 227,07
204,96
22,12
3,01
pm
p
All HD + PD HD PD KTx
Portuguese Society of Nephrology, 2017 – Fernando Macário
166
176
195
190
198 200
204
215
204
230 227
231 232 235,2
224,4
218,14
230,56 234,86
225,08
233,73
227,07
97 98 99 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
pm
p
Portuguese Society of Nephrology, 2017 – Fernando Macário
Incident patients accepted for dialysis HD and PD per million population 2007 - 2017
0,00
100,00
200,00
300,00
400,00
500,00
600,00
700,00
800,00
900,00
Global < 65 years 65 to 80years
> 80 years
227,07
108,57
612,16
810,53
204,96
88,41
579,77
788,41
22,17 20,16 32,39 22,12
HD + PD HD PD
Portuguese Society of Nephrology, 2017 – Fernando Macário
Incident patients accepted for dialysis HD and PD per million population by age group during 2017
Prevalent patients on RRT by modality per million population 31st December 2017
1965,07
1235,84 1162,51
73,33
729,23
pm
p
All HD + PD HD PD KTx
Portuguese Society of Nephrology, 2017 – Fernando Macário
0,0
500,0
1000,0
1500,0
2000,0
2500,0
3000,0
3500,0
4000,0
4500,0
Global < 65 years 65 to 80years
> 80 years
1235,8
621,2
3265,5
4185,4
1162,5
553,2
3152,1
4139,5
73,3 68,0 113,4 45,8
pm
p
HD + DP HD DP
Portuguese Society of Nephrology, 2017 – Fernando Macário
Prevalence of CKD patients treated by dialysis per million population by age group in 2017
Incident and prevalent pediatric patients on dialysis HD and PD per million population 2017
0,00
5,00
10,00
15,00
Incidence Prevalence
5,00
10,50
1,50
3,50 3,50
7,00
pm
p
HD + PD HD PD
Portuguese Society of Nephrology, 2017 – Fernando Macário
Portuguese Society of Nephrology, 2017 – Fernando Macário
1000
3000
5000
7000
9000
11000
13000
97 98 99 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Nº
of
pts
4%
4,1%
4,3%
6,4%
2,7%
4,4%
5,8%
3,9%
8%
4,7%
2.7%
3,9%
5,6%
1,5%
3,9%
3,2%
5970
2,7%
1,5%
12556
1,6%
12741
1,47%
Patients on dialysis and annual growth per million population end of each year 1997 - 2017
595 626
675 701 716
744 760
804 834
870 902
924 961
1016 1052
1068
1116
1159 1182
1212 1236
500
600
700
800
900
1000
1100
1200
1300
97 98 99 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
pm
p
Portuguese Society of Nephrology, 2017 – Fernando Macário
Prevalent patients on dialysis per million population end of each year 1997 - 2017
1374 1410
1507
1578
1662 1670
1749
1794 1824
1911
1965
1200
1300
1400
1500
1600
1700
1800
1900
2000
7 8 9 10 11 12 13 14 15 16 17
pm
p
Portuguese Society of Nephrology, 2017 – Fernando Macário
Prevalent patients on RRT per million population end of each year 1997 - 2017
Gabinete de Registo da SPN, 2016 – Fernando Macário Portuguese Society of Nephrology, 2017 – Fernando Macário
Incident patients starting PD vs HD 1997 - 2017
97 98 99 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
HD 1531 1655 1833 1800 1939 1956 2016 2129 2038 2273 2286 2285 2300 2312 2143 2084 2210 2233 2106 2166 2113
PD 91 103 108 93 101 118 102 135 116 149 147 170 229 190 227 220 208 216 229 215 228
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
PD HD
Portuguese Society of Nephrology, 2017 – Fernando Macário
97 98 99 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
HD 5710 5989 6455 6701 7071 7370 7559 8077 8392 8708 9037 9303 9646 10152 10409 10540 10977 11350 11514 11738 11985
PD 206 261 293 311 346 376 398 390 437 481 517 511 571 660 704 742 732 735 751 720 758
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
PD HD
Portuguese Society of Nephrology, 2017 – Fernando Macário
Prevalent patients on PD vs HD 1997 - 2017
Portuguese Society of Nephrology, 2017 – Fernando Macário
Percentage of dialysis patients treated by PD Incident and prevalent pts 1997 - 2017
5,6 5,9
5,6
4,9 5,0
5,7
4,8
6,0
5,4
6,2 6,0
6,9
9,1
7,6
9,6 9,5
8,6 8,8
9,8
9,0
9,7
3,5
4,2 4,3 4,4 4,7 4,9
5,0
4,6 4,9
5,2 5,4 5,2
5,6
6,1 6,3
6,6 6,3 6,1 6,1
5,8 5,9
0,0
2,0
4,0
6,0
8,0
10,0
12,0
97 98 99 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
% P
D v
s al
l dia
lysi
s
Incident PD Prevalent PD
7122 408 4672
4822 308 2774
0%
20%
40%
60%
80%
100%
HD PD Kidney tx
Man Women
* 153 missing data
Gabinete de Registo da SPN, 2016 – Fernando Macário
Gender distribution in each modality 31st December 2017
Portuguese Society of Nephrology, 2017 – Fernando Macário
2499,5
1456,4
pm
p
Man Women
Gabinete de Registo da SPN, 2016 – Fernando Macário
Prevalence by gender, all RRT per million population 31st December 2017
Portuguese Society of Nephrology, 2017 – Fernando Macário
Not available = 6
Diabetes 32,2%
Hypertension 15,0%
Chronic Gln 10,8%
Policystic Disease 5,4% Hipoplasia/Displasia
0,6%
Other Known 19,4%
Unknown 16,5%
Portuguese Society of Nephrology, 2017 – Fernando Macário
Primary renal disease of patients accepted for dialysis HD and PD during 2017
N = 12548 Not available = 193
Diabetes 28,0%
Hypertension 13,3%
Chronic Gln 12,8%
Policystic Disease 6,2%
Hipoplasia/Displasia 0,7%
Other Known 19,9%
Unknown 19,1%
Portuguese Society of Nephrology, 2017 – Fernando Macário
Primary renal disease of prevalent patients HD and PD, 31st December 2017
Gabinete de Registo da SPN, 2016 – Fernando Macário Portuguese Society of Nephrology, 2017 – Fernando Macário
1531
1655
1833 1800
1939 1956 2016
2129 2038
2273 2286 2285 2300 2312
2143 2084
2210 2233
2106 2206
2113
0
500
1000
1500
2000
2500
97 98 99 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Portuguese Society of Nephrology, 2017 – Fernando Macário
New patients accepted for hemodialysis 1997 - 2017
Incident patients accepted for hemodialysis per million population 2007 - 2017
Portuguese Society of Nephrology, 2017 – Fernando Macário
213,20
215,21 216,42
217,34
202,90
197,31
210,73
214,15
202,99
212,97
204,96
185,00
190,00
195,00
200,00
205,00
210,00
215,00
220,00
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
pm
p
97 98 99 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
PD or Ktx to HD 211 178 172 213 268 208 251 274 224
Incident 1531 1655 1833 1800 1939 1956 2016 2129 2038 2273 2286 2285 2300 2312 2143 2084 2210 2233 2106 2206 2113
1400
1600
1800
2000
2200
2400
2600
Portuguese Society of Nephrology, 2017 – Fernando Macário
All patients accepted for hemodialysis Incident and returning from other modalities 1997 - 2017
214,15
202,99
212,97
204,96
234,10
225,06
239,43
226,68
2014 2015 2016 2017
pm
p
HD as first treatment Incidence of HD
Portuguese Society of Nephrology, 2017 – Fernando Macário
Patients accepted for hemodialysis “Incident” and “Incident plus returning from other modalities”, pmp, 2014-2017
202
197
210,7
214,15
202,99
212,97
204,96
186,52 185,3
199,8
202,26
190,75
199,17
193,51
180
190
200
210
220
2011 2012 2013 2014 2015 2016 2017
pm
p H
D
Inc d0 Inc d91
5,6%
7,7%
6,5% 5,2%
Incident patients accepted for hemodialysis Day 0 and day 91, 2011-2017
5,9%
6,0% 5,6%
Portuguese Society of Nephrology, 2017 – Fernando Macário
0
200
400
600
800
1000
HD
3
716
895
499
Pat
ien
ts c
ou
nt
< 18 years old (0,1%) 18 to 65 years old (33,9%) 65 to 80 years old (42,4%) >80 years old (23,6%)
Portuguese Society of Nephrology, 2017 – Fernando Macário
Patients accepted for hemodialysis by age group, during 2017
N = 2113
0
1000
2000
3000
4000
5000
HD
7
4492 4866
2620
Pat
ien
ts c
ou
nt
< 18 years old (0,06%) 18 to 65 years old (37,48%) 65 to 80 years old (40,6%) >80 years old (21,86%)
Portuguese Society of Nephrology, 2017 – Fernando Macário
Patients treated by hemodialysis by age group , 31st December 2017
N = 11985
Incident and prevalent patients treated by hemodialysis
per million population by age group, 2017
0,00
1000,00
2000,00
3000,00
4000,00
5000,00
Global < 65 years 65 to 80years
> 80 years
204,96 88,41
579,77 788,41
1162,51
553,18
3152,13
4139,60 p
mp
Incidence Prevalence
Portuguese Society of Nephrology, 2017 – Fernando Macário
5710 5989
6455 6701
7071 7370
7559
8077 8392
8708 9037
9303 9646
10152 10409 10540
10977
11350 11514
11836 11985
4000
5000
6000
7000
8000
9000
10000
11000
12000
13000
97 98 99 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Pat
ien
ts c
ou
nt
Gabinete de Registo da SPN, 2016 – Fernando Macário
Patients treated by hemodialysis 31st of December each year, 1997 – 2017
Portuguese Society of Nephrology, 2017 – Fernando Macário
Distribution of hemodialysis patients by type of dialysis facility
31st of December 2017
1126; 9,4%
10859; 90,6%
In Hospital In center
Portuguese Society of Nephrology, 2017 – Fernando Macário
13,8
14,5
16,7
19,4
17,7
19,2
16,5
15,7 15,8
10,6 10,3 10,2
10,7 10,7
10,4
8,5 9,01
9,4
5
10
15
20
2009 2010 2011 2012 2013 2014 2015 2016 2017
Pat
ien
ts %
Incident pts (%) Prevalent pts (%)
Portuguese Society of Nephrology, 2017 – Fernando Macário
Hemodialysis patients treated in Hospital (%) 31st of December each year (2009 – 2017)
Portuguese Society of Nephrology, 2017 – Fernando Macário
Hemodialysis growth 2017 vs 2016 (%) 31st of December each year
-4,22
-2,05
-4,61
1,26
6,43
0,75
-6,00
-4,00
-2,00
0,00
2,00
4,00
6,00
8,00
ALL IN HOSPITAL IN CENTER
Var
iati
on
20
17
/ 2
01
6 (
%)
Hemodialysis Growth Portugal
Incident pts % Prevalent pts %
-4,10
8,88
-5,90
1,08
6,49
0,66
-8,00
-6,00
-4,00
-2,00
0,00
2,00
4,00
6,00
8,00
10,00
ALL IN HOSPITAL IN CENTER
Var
iati
on
20
17
/ 2
01
6 (%
)
Hemodialysis Growth Continental Portugal
Incident pts % Prevalent pts %
Patients treated by hemodialysis distribution by techniques in each age group, 31st of December 2017
0
1000
2000
3000
4000
5000
6000
7000
Low flux HD High flux HD Hemodiafiltration
323
5166
6496
172
1893
2434
68
2100 2697
83
1173 1365
Nº
pat
ien
ts
Total < 65 years 65 to 80 years >80 years
Portuguese Society of Nephrology, 2017 – Fernando Macário
N = 11985 ; low flux 2,4% (2,6% in 2016); 62,5% older than > 65 years ; 21,9% older > 80 years (21,3% in 2016)
1259 946 761 874 629 405 346 314 313 304 323
3542 5269
5307 4843
4726 5000 5080
4076 4013 4117 5166
2436 3088 3574 4435
5054 5132 5551
6960 7188 7317 6496
0%
20%
40%
60%
80%
100%
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Nº
pat
ien
ts
Low flux High flux Hemodialfiltration
Portuguese Society of Nephrology, 2017 – Fernando Macário
* Due to water shortage in Portugal many patients
were switched from HDF to high flux HD by the end of 2017 and later returned to HDF
*
Patients treated by hemodialysis distribution by techniques, 31st Dec.1997 - 2017
50 0 11 92
170
323
267
56
1465 923 716
2016
46
5166
445
4721
1961 1369 1299
1670
197
6496
414
6082
0%
20%
40%
60%
80%
100%
North Centre South Lisbon Azores Madeira Global In Hospital In Center
Pat
ien
ts c
ou
nt
Low Flux High Flux Hemodiafiltration
Portuguese Society of Nephrology, 2017 – Fernando Macário N = 11985 by end of December 2017
Patients treated by hemodialysis distribution by techniques by region and facility type, 31st Dec. 2017
Mean Age of patients treated by hemodialysis 31st of December 2007 – 2017
Portuguese Society of Nephrology, 2017 – Fernando Macário
63,8
64,3
65,02
65,99
66,49 66,8 66,9
67,17 67,47
67,68 67,89
61
62
63
64
65
66
67
68
69
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Mea
n a
ge
55
60
65
70
20
07
20
08
20
09
20
10
20
11
20
12
20
13
20
14
20
15
20
16
20
17
Mea
n a
ge
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Islands 59,3 60,8 61,9 61,9 62,4 60,3 62,4 62,6 62,4 63,6 65,0
Lisbon 62,3 62,7 62,4 64,5 65,2 65,2 65,1 65,8 66,2 66,7 66,5
North 63,3 63,7 64,8 65,8 66,3 66,7 66,8 66,8 67,2 67,4 67,7
South 65 66,2 67 67,3 66,7 68 67,9 68 69,1 68,5 69,0
Centre 65,5 66 68 68,2 68 68,7 69,1 69,5 69,5 69,7 69,9
Portuguese Society of Nephrology, 2017 – Fernando Macário
Mean Age of patients treated by hemodialysis by country region, 31st of December 2007 – 2017
Portuguese Society of Nephrology, 2017 – Fernando Macário
Mean Age of patients treated by hemodialysis Hemodialysis “in Center”, 31st of December 2017
62,31
68,15
79,00
60,00
62,00
64,00
66,00
68,00
70,00
72,00
74,00
76,00
78,00
80,00
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55 57 59 61 63 65 67 69 71 73 75 77 79 81 83 85 87 89 91 93
Me
an a
ge (
year
s)
National mean age = 68,15y Average of units = 68,4y Standard deviation = 2,75y Median = 68,4y
N = 2113
Diabetes 33,4%
Hypertension 15,8%
Chronic Gln 9,8%
Policystic Disease 4,9% Hipoplasia/Displasia
0,4%
Other Known 19,6%
Unknown 16,1%
Portuguese Society of Nephrology, 2017 – Fernando Macário
Primary renal disease of Incident patients accepted for hemodialysis
during 2017
N = 11949 36 not available
Diabetes 28,7%
Hypertension 13,7%
Chronic Gln 12,1%
Policystic Disease 5,9% Hipoplasia/Displasia
0,6%
Other Known 19,9%
Unknown 19,2%
Portuguese Society of Nephrology, 2017 – Fernando Macário
Primary renal disease of prevalent hemodialysis patients
31st December 2017
Diabetes as primary renal disease in HD patients Incident and prevalent (%) 2007 - 2017
29
31 32
33,6 32,6
32 32,2 33
34,6
33 33,4
23,8
25 25
26,9 27,7 28 28,2 28,2
28,7 29,1 28,7
20
25
30
35
40
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
% D
iab
ete
s
Incident Pt Prevalent Pt
Portuguese Society of Nephrology, 2017 – Fernando Macário
Viral status in HD prevalent patients 31st December 2017
94,17%
1,18%
3,15%
1,50%
Neg Hbs Ag + HCV Ab + HIV Ab +
N = 11985
Portuguese Society of Nephrology, 2017 – Fernando Macário
Hepatitis C viral status in HD prevalent pts 31st December 2016 - 2017
Portuguese Society of Nephrology, 2017 – Fernando Macário
0
20
40
60
80
100
120
140
160
180
200
220
HCVAb+ / RNA + HCV Ab+ / RNA neg Seroconv to RNA neg Incident HCV +
2016 197 205 120 15
2017 149 128 119 15
2016 2017
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
NO 617 816 702 737 694 737 716 655 509 537 473
YES 1447 1464 1483 1522 1410 1342 1477 1541 1597 1629 1640
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Portuguese Society of Nephrology, 2017 – Fernando Macário
Previous follow-up by nephrology (> 3 months) HD patients, 31st of December 2007 – 2017
Norte Centro Lisboa Sul Açores Madeira Global Hosp Perif
NO 114 81 172 91 2 13 484 135 349
YES 521 304 473 281 28 33 1629 199 1430
521 304 473 281
28
33 1629
199
1430
114 81 172 91
2
13 484
135
349
0%
20%
40%
60%
80%
100%
Portuguese Society of Nephrology, 2017 – Fernando Macário
Previous follow-up by nephrology (> 3 months) HD patients, by country region and facility type - 31st of December 2017
Vascular access of HD incident patients during 2017
AVFistula 40,5%
Graft 2,7% Tunneled catheter
51,4%
Non-tunneled cat. 5,5%
N = 2130 17 duplicated
Portuguese Society of Nephrology, 2017 – Fernando Macário
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Non-tunneled cat. 296 282 219 188 163 143 163 81 103 117
Tunneled cat. 864 940 1034 1033 1007 1101 1088 1068 1093 1094
Graft 109 111 117 71 61 61 60 74 59 57
AVFistula 990 895 931 844 844 870 912 872 940 862
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Portuguese Society of Nephrology, 2017 – Fernando Macário
Vascular access of HD incident patients 2008 – 2017
Portuguese Society of Nephrology, 2017 – Fernando Macário
Catheter rate (%) in the first HD session of incident patients
2008 – 2017
51,4
54,8 54,5
57,2
56,4
57,2
56,3
54,8 54,5
56,9
48
49
50
51
52
53
54
55
56
57
58
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
North Centre Lisbon South Azores Madeira GlobalIn
HospitalIn
Center
Non-tunneled Cat. 34 19 43 16 5 0 117 74 43
Tunneled Catheter 262 240 370 178 9 35 1094 171 923
Graft 5 3 19 29 1 0 57 6 51
AVFistula 335 131 222 148 15 11 862 83 779
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
AVFistula Graft Tunneled Catheter Non-tunneled Cat.
Portuguese Society of Nephrology, 2017 – Fernando Macário
N = 2130 17 duplicated
Vascular access of HD incident patients by country region and facility type - 31st of December 2017
Vascular access of HD prevalent patients 31st December 2017
AVFistula 73,3%
Graft 10,2%
Tunneled catheter 16,5%
Non-tunneled cat. 0,1%
N = 11979 6 not available
Portuguese Society of Nephrology, 2017 – Fernando Macário
North Centre Lisbon South Azores Madeira GlobalIn
HospitalIn
Center
Non-tunneled Cat. 1 2 1 2 4 0 10 6 4
Tunneled Catheter 467 427 662 289 20 106 1971 345 1626
Graft 95 185 514 398 12 12 1216 91 1125
AVFistula 2920 1677 2589 1337 134 125 8782 686 8096
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Portuguese Society of Nephrology, 2017 – Fernando Macário
Vascular access of HD prevalent patients by country region and facility type, 31st of December 2017
N = 11979 6 not available
83,8 73,2
68,7 66,0
78,8
51,4
73,3
60,8
74,6
2,7
8,1 13,6 19,6
7,1
4,9
10,2
8,1
10,4
13,4 18,7 17,6 14,4 14,1
43,6
16,5
31,1
15,0
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
North Centre Lisbon South Azores Madeira Global In Hospital In Center
AVFistula Graft Catheter
Portuguese Society of Nephrology, 2017 – Fernando Macário
Vascular access of HD prevalent patients Percentage by country region and facility type, 31st of December 2017
N = 11979 6 not available
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Non-Tunneled Cat 91 76 39 42 25 16 23 15 24 2 10
Tunneled Catheter 1386 1572 1769 1953 1905 1889 1834 1770 1804 1895 1971
Graft 1185 1191 1256 1365 1402 1349 1358 1317 1273 1239 1216
AVFistula 6937 6464 6538 6788 7077 7257 7750 8202 8434 8598 8782
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Portuguese Society of Nephrology, 2017 – Fernando Macário
Vascular access of HD prevalent patients 31st December, 2007 - 2017
Portuguese Society of Nephrology, 2017 – Fernando Macário
Vascular access of prevalent patients (%) 31st December, 2007 - 2017
72,3 69,5
68,1 66,9 68 69 70,7
72,6 73,1 73,3 73,3
12,3 12,8 13,1 13,5 13,5 12,8 12,4 11,7 11 10,6 10,2
15,4 17,7 18,8 19,7 18,5 18,1 16,9 15,8 15,8 16,2 16,5
0
10
20
30
40
50
60
70
80
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
% o
f p
atie
nts
AVFistula Graft Catheter
Portuguese Society of Nephrology, 2017 – Fernando Macário
AV Fistula rate of prevalent patients (%) 31st December, 2007 - 2017
72,3
69,5
68,1
66,9
68
69
70,7
72,6 73,1 73,3 73,3
60
62
64
66
68
70
72
74
76
78
80
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
% o
f p
atie
nts
Portuguese Society of Nephrology, 2017 – Fernando Macário
Graft rate of prevalent patients (%) 31st December, 2007 - 2017
12,3
12,8 13,1
13,5 13,5
12,8
12,4
11,7
11
10,6
10,2
8
9
10
11
12
13
14
15
16
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
% o
f p
atie
nts
Portuguese Society of Nephrology, 2017 – Fernando Macário
Catheter rate of prevalent patients (%) 31st December, 2007 - 2017
15,4
17,7
18,8
19,7
18,5 18,1
16,9
15,8 15,8 16,2
16,5
10
12
14
16
18
20
22
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
% o
f p
atie
nts
Portuguese Society of Nephrology, 2017 – Fernando Macário
Catheter rate of prevalent patients (%) 31st December 2017
70,0
16,5
2,8
0,0
10,0
20,0
30,0
40,0
50,0
60,0
70,0
80,0
36 centers above 20% cat rate 24 centers below 10% cat rate National rate = 16,5% Average of units = 18,9% Standard deviation = 13,1% Median = 16,5%
Portuguese Society of Nephrology, 2017 – Fernando Macário
Catheter rate of prevalent patients (%) In Hospital HD patients, 31st December 2017
70,0
31,1
2,9
0,0
10,0
20,0
30,0
40,0
50,0
60,0
70,0
80,0
20 centers above 20% cat rate 4 centers below 10% cat rate National rate = 31,1% Average of units = 31,6% Standard deviation = 19,6% Median = 33,3%
Portuguese Society of Nephrology, 2017 – Fernando Macário
Catheter rate of prevalent patients (%) In Center HD patients - 2017
35,6
15,0
2,8
0,0
10,0
20,0
30,0
40,0
50,0
60,0
70,0
80,0
16 centers above 20% cat rate 20 centers below 10% cat rate National rate = 15,0% Average of units = 15,0% Standard deviation = 6,6% Median = 14,3%
Mortality - hemodialysis
Portuguese Society of Nephrology, 2017 – Fernando Macário
< 65 years 65 - 80 years >80 years
Prevalent 4499 4866 2620
Died 263 620 667
263 620
667
4499 4866 2620
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
* 83,03% of 1550 patients that died in 2017 were more than 65 years old and 43,03% more than 80 years
* 7,8% of deaths occurred during the first 90 days after starting dialysis
* Mortality in the first 90 days was 5,05%
Portuguese Society of Nephrology, 2017 – Fernando Macário
Deaths in hemodialysis by age group in 2017
Death causes in HD patients during 2017
Cardiovascular 24,5%
Sudden death 9,5%
Infection (related with VA) 2,3%
Infection (not related with VA)
23,0%
Malignancy 11,1%
Cachexia 8,2%
Others known 13,8%
Unknown 7,6%
Portuguese Society of Nephrology, 2017 – Fernando Macário
N=1550
Deaths in hemodialysis 2007 - 2017
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Cardiovascular Sudden death Infection (related to VA)Infection (not related to VA) Malignancy CachexiaOthers Known Not available
Ga Portuguese Society of Nephrology, 2017 – Fernando Macário
* Sudden death and cachexia were not reported until 2010
*
Deaths in hemodialysis 2007 - 2017
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Not available 42 16 43 90 96 103 119 136 118
Others Known 472 430 454 487 205 132 219 194 212 224 214
Cachexia 109 114 117 115 129 115 127
Malignancy 144 145 134 154 159 158 150 140 167 162 172
Infection (not related to VA) 229 235 237 220 312 278 292 332 354 335 357
Infection (related to VA) 64 70 62 69 44 45 36 44 36 32 35
Sudden death 109 138 121 123 125 134 147
Cardiovascular 386 418 394 370 393 347 380 335 369 374 380
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Ga Portuguese Society of Nephrology, 2017 – Fernando Macário
* Sudden death and cachexia were not reported until 2010
*
Portuguese Society of Nephrology, 2017 – Fernando Macário
28,9
31,8
29,8
28,5 27,7
28,6
26,9
24,2 24,4 24,7 24,5
17,1 17,9 17,9
16,9
22,0 22,9
20,7
24,0 23,4
22,2 23,0
10,0
15,0
20,0
25,0
30,0
35,0
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
CV Inf (not rel VA)
Cardiovascular and Infection deaths in hemodialysis (%)
2007 - 2017
Portuguese Society of Nephrology, 2017 – Fernando Macário
28,9
31,8
29,8 28,5
27,7 28,6
26,9
24,2
24,4 24,7
24,5
21,9 23,2
22,6 22,2
25,1
26,7
23,2
27,1
25,8 24,3
25,3
10,0
15,0
20,0
25,0
30,0
35,0
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
CV Inf (all)
Cardiovascular and Infection deaths in hemodialysis (%)
2007 - 2017
Portuguese Society of Nephrology, 2017 – Fernando Macário
28,9
31,8
29,8 28,5
35,3
40,0
35,5
33,0 32,7 33,6 34,0
17,1 17,9 17,9
16,9
22,0 22,9
20,7
24,0 23,4 22,2
23,0
21,9 23,2 22,6 22,2
25,1 26,7
23,2
27,1 25,8
24,3 25,3
10,0
15,0
20,0
25,0
30,0
35,0
40,0
45,0
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
CV Inf (not rel VA) Inf (all)
*
* Sudden death was not reported until 2010
Cardiovascular (+sudden death) and Infection deaths in hemodialysis (%)
2007 - 2017
Death causes during the first 90 days of HD 2017
Cardiovascular 5,9%
Sudden death 4,2%
Infection (related with VA) 17,8%
Infection (not related with VA)
15,3% Malignancy 12,7%
Cachexia 6,8%
Others known 6,8%
Unknown 30,5%
Portuguese Society of Nephrology, 2017 – Fernando Macário
N=118
Patients movement in 2017
0
100
200
300
400
500
408
55 48
96 106 118
Nu
mb
er o
f p
ts
Out = 607 ; In = 224
Portuguese Society of Nephrology, 2017 – Fernando Macário
IN OUT
First treatment 2113 Deaths 1550
Transplant failure 118 Transplanted 408
PD into HD 106 HD into PD 65
Stop treat. or recovery
144
National Crude Mortality Rate in HD = 13,03%
Portuguese Society of Nephrology, 2017 – Fernando Macário
HD patients movement in 2017
National crude mortality rate = 13,03% (90 day mortality = 5,05%)
Hemodialysis in hospital 19,13% (90 day mortality = 9,41%)
Hemodialysis in center 12,42% (90 day mortality = 4,17%)
Portuguese Society of Nephrology, 2017 – Fernando Macário
Mortality rates – hemodialysis 2017
22,48
24,51
21,31 20,95
29,44
21,39
20,03
21,41 22,14
20,79
19,13
14,46 13,28 13,24
12,35 11,82
12,76 12,39 11,49
12,49 12,36 12,42
15,26 14,45 14,01
13,24 13,79 13,65 13,18
12,49 13,28 13,09 13,03
8
10
12
14
16
18
20
22
24
26
28
30
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Gro
ss m
ort
alit
y ra
te (
%)
HD in Hospital HD in Center All pts
Portuguese Society of Nephrology, 2017 – Fernando Macário
Crude mortality rate in hemodialysis 2007 - 2017
Crude mortality rate in hemodialysis 2007 - 2017
15,26
14,45
14,01
13,24
13,79 13,65
13,18
12,49
13,28 13,09 13,03
10
11
12
13
14
15
16
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Gro
ss m
ort
alit
y ra
te (
%)
All patients
Portuguese Society of Nephrology, 2017 – Fernando Macário
22,48
24,51
21,31 20,95
29,44
21,39
20,03
21,41 22,14
20,79
19,13
8
10
12
14
16
18
20
22
24
26
28
30
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Gro
ss m
ort
alit
y ra
te (
%)
HD in Hospital
Portuguese Society of Nephrology, 2017 – Fernando Macário
Crude mortality rate in hemodialysis in hospital treated patients, 2007 - 2017
14,46
13,28 13,24
12,35
11,82
12,76
12,39
11,49
12,49 12,36 12,42
10
11
12
13
14
15
16
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Gro
ss m
ort
alit
y ra
te (
%)
HD in Center
Portuguese Society of Nephrology, 2017 – Fernando Macário
Crude mortality rate in hemodialysis in center treated patients, 2007 - 2017
Crude mortality rate Impact of deaths until day 90, 2017
13,04 12,42
19,13
12,04 11,67
15,72
7
9
11
13
15
17
19
All In Center In Hospital
Gro
ss m
ort
alit
y ra
te (
%)
Mortality since d1 Mortality since d91
4,17% died until d90
9,41% died until d90
Portuguese Society of Nephrology, 2017 – Fernando Macário
5,05% died until d90
Mean Age Mortality
since d1
Mortality
since d91
Deaths until d90 (% of incident)
Global 67,9 13,03% 12,04% 5,05%
North 67,7 13,22% 12,21%
4,91%
Center 69,9 15,60%
14,55% 5,41%
South 69,0 10,96% 10,11% 4,24%
Lisbon 66,5 12,54% 11,50% 5,64%
Azores 63,6 11,90%
11,31% 2,70%
Madeira 65,9 11,37% 10,44% 4,00%
Portuguese Society of Nephrology, 2017 – Fernando Macário
Crude mortality rates – hemodialysis since d1 and d91 by country region, 2017
21,0%
79,0%
YES NO
Portuguese Society of Nephrology, 2017 – Fernando Macário
Waiting list for renal transplantation Hemodialysis patients, 2017
13,9%
7,2%
79,0%
Normal and Urgent Temporary out No
Portuguese Society of Nephrology, 2017 – Fernando Macário
Waiting list for renal transplantation HD patients, Active and temporary contraindication - 2017
Gabinete de Registo da SPN, 2016 – Fernando Macário
91
103 108
93 101
118
102
135
116
149 147
170
229
190
227 220
208 216
229
215
228
60
80
100
120
140
160
180
200
220
240
97 98 99 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Gabinete de Registo da SPN, 2016 – Fernando Macário Portuguese Society of Nephrology, 2017 – Fernando Macário
New patients starting peritoneal dialysis 1997 - 2017
Gabinete de Registo da SPN, 2016 – Fernando Macário
13,9
16,01
21,55
17,86
21,5 20,8
19,8
20,7
22,1
20,76
22,12
5
10
15
20
25
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
pm
p
Portuguese Society of Nephrology, 2017 – Fernando Macário
Incident patients accepted for peritoneal dialysis per million population 2007 - 2017
206
261
293 311
346 376
398 390
437
481
517 511
571
660
704
742 732 735 751
720
756
150
250
350
450
550
650
750
97 98 99 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Gabinete de Registo da SPN, 2016 – Fernando Macário Portuguese Society of Nephrology, 2017 – Fernando Macário
Patients treated by peritoneal dialysis Count at 31st of December each year, 1997 – 2017
N = 228 No answer:3
Diabetes 21,3%
Hypertension 7,6%
Chronic GN 20,4%
Policystic Disease 10,7% Hipoplasi/Displasia
2,7%
Other Known 17,3%
Unknown 20,0%
Gabinete de Registo da SPN, 2016 – Fernando Macário Portuguese Society of Nephrology, 2017 – Fernando Macário
Primary renal disease of patients accepted for peritoneal dialysis
during 2017
Diabetes 16,4% Hypertension
7,0%
Chronic GN 24,9%
Policystic Disease 9,8%
Hipoplasia/Displasia 2,6%
Other Known 20,5%
Unknown 18,7%
N = 755 n.avail. 1pt
Gabinete de Registo da SPN, 2016 – Fernando Macário Portuguese Society of Nephrology, 2017 – Fernando Macário
Primary renal disease of prevalent peritoneal dialysis patients
31st December 2017
0
50
100
150
200
250
300
350
400
450
CAPD APD
440
316
128
76
22 7
0 14
Pat
ien
ts c
ou
nt
Total > 65 years > 80 years < 18 years
N = 756 ; APD:41,8%; Age>65 years:26,9%; Age>80years:3,8%
Gabinete de Registo da SPN, 2016 – Fernando Macário Portuguese Society of Nephrology, 2017 – Fernando Macário
Patients treated by peritoneal dialysis Manual vs automated, 31st of December 2017
756
440
316
0
100
200
300
400
500
600
700
800
Total CAPD APD
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
N2017 = 756 ; CAPD:440 ; APD/Others:316
Gabinete de Registo da SPN, 2016 – Fernando Macário Portuguese Society of Nephrology, 2017 – Fernando Macário
Patients treated by peritoneal dialysis Manual vs automated, 31st December 2007 - 2017
Automated Peritoneal Dialysis usage (%) 31st December 2007 - 2017
Gabinete de Registo da SPN, 2016 – Fernando Macário
18,9
36,8
44,4
53,1
58,1 60,6
63,1 63,1
56,8
71,1
64 61,1
53,2 52,1 49,7
41,3 41,5
47,5
43,9 43,8 41,7
0
10
20
30
40
50
60
70
80
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2106 2017
% o
f p
atie
nts
Portuguese Society of Nephrology, 2017 – Fernando Macário
0
50
100
150
200
250
300
North Center South Lisbon Islands
226
118
106
200
70 Nu
mb
er o
f Pa
tien
ts
2010 2011 2012 2013 2014 2015 2016 2017
Patients treated by peritoneal dialysis by region, 31st of December 1997 to 2017
N = 756 (2017)
Gabinete de Registo da SPN, 2016 – Fernando Macário Portuguese Society of Nephrology, 2017 – Fernando Macário
89,9%
10,1%
Yes No
N = 228
Gabinete de Registo da SPN, 2016 – Fernando Macário Portuguese Society of Nephrology, 2017 – Fernando Macário
Previous follow-up by nephrology (> 3 months) PD patients, 31st of December 2007 – 2017
Gabinete de Registo da SPN, 2016 – Fernando Macário
49,5
50,3
50,9
51,5
50,1
52,2
53,7 53,9
54,5 54,5 54,8
46
47
48
49
50
51
52
53
54
55
56
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Mea
n a
ge (
year
s)
Portuguese Society of Nephrology, 2017 – Fernando Macário
Mean Age of patients treated by peritoneal dialysis 31st of December 2007 – 2017
95,90%
1,32%
1,59%
1,19%
Neg HbsAg + AntiVHC + AntiHIV +
N = 756
Gabinete de Registo da SPN, 2016 – Fernando Macário Portuguese Society of Nephrology, 2017 – Fernando Macário
Viral status in PD prevalent patients 31st December 2017
IN OUT
New patients 228 Death 44
KTr failure 14 Transplant 71
HD to PD 37 PD to HD 126
Suspension 1
Renal Recovery 3
National Crude Mortality Rate in PD = 5,16 % (90 d mortality = 2,5%)
Gabinete de Registo da SPN, 2016 – Fernando Macário Portuguese Society of Nephrology, 2017 – Fernando Macário
PD patients movement in 2017
7,65
8,93
7,09
5,62
6,79 6,73
5,54 5,42 5,33
7
5,16
4
5
6
7
8
9
10
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Gro
ss m
ort
alit
y ra
te (
%)
Gabinete de Registo da SPN, 2016 – Fernando Macário Portuguese Society of Nephrology, 2017 – Fernando Macário
Crude mortality rate in peritoneal dialysis 2007 - 2017
Reasons for PD withdraw 2017
N = 119
Infection 35,3%
UF failure/Inadequacy 30,3%
Mechanical problems 10,1%
Non compliance 9,2%
Others 15,1%
Gabinete de Registo da SPN, 2016 – Fernando Macário Portuguese Society of Nephrology, 2017 – Fernando Macário
Peritonitis episodes 2017
N = 246
0,29 episodes / patients-2017
Gabinete de Registo da SPN, 2016 – Fernando Macário
0,5 0,48
0,45 0,46 0,43
0,45
0,41
0,37 0,35
0,29
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Per
ito
nit
is r
ate
Portuguese Society of Nephrology, 2017 – Fernando Macário
Death causes in PD patients 31st December 2014 - 2017
N = 44
7 patients died until day 90; 3,0% of incident patients and 15,9% of all deaths
CardioVasc 43,2%
Sudden death 11,4%
Infection (PD related) 6,8%
Infection ( Not PD related) 22,7%
Neoplasia 2,3%
Cachexia 11,4%
Others Known 2,3%
Gabinete de Registo da SPN, 2016 – Fernando Macário Portuguese Society of Nephrology, 2017 – Fernando Macário
Gabinete de Registo da SPN, 2016 – Fernando Macário
PD patients in waiting list for renal transplantation Active and excluded for transplantation,
31st December 2014 - 2017
386 416 388 401
349 335 322 355
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2014 2015 2016 2017
Yes No
Portuguese Society of Nephrology, 2017 – Fernando Macário
PD patients in waiting list for renal transplantation Active, temporary contraindication and excluded for transplantation
31st December 2014 - 2017
326 358 332 355
60 58 105 92
349 335 283 309
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2014 2015 2016 2017
Active List Temporary CI No
Portuguese Society of Nephrology, 2017 – Fernando Macário
Gabinete de Registo da SPN, 2016 – Fernando Macário
8 26 30
69 63
99 106
182 199
260 256
304
367
286
346 370
400 382
309
367 358 359
398
355
436
380 393
480
525
593 573
530
429 448 448
485
513 527
0
100
200
300
400
500
600
80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Ren
al T
ran
spla
nt
cou
nts
per
yea
r
Years
Renal Transplants performed 1980-2017
Total = 12659
Gabinete de Registo da SPN, 2016 – Fernando Macário Portuguese Society of Nephrology, 2017 – Fernando Macário
Renal transplantation activity characterization 2017
31 pre-emptive (3 receptors <18A)
0
100
200
300
400
500
Dec
ease
d d
on
or
Dec
ease
d d
on
or
/R
ecep
tor
<18
y
Dec
ease
d d
on
or
/R
ecep
tor>
65
y
Livi
ng
do
no
r
Livi
ng
do
no
r /
Rec
epto
r <1
8Y
Livi
ng
do
no
r /
Rec
epto
r >6
5y
450
10
61 77
3 6
Nº
of
Pa
tie
nts
Gabinete de Registo da SPN, 2016 – Fernando Macário Portuguese Society of Nephrology, 2017 – Fernando Macário
0
20
40
60
80
100
120
140
HGSA HSMaria HG Orta CHLO StC HS João HC Cabral HSM-Ped CHUC CVP
92
55
16
37
68
56
3
121
2
30
5
0
18 13
0 0 0 0
13
0 0 0 1 0 1
Pat
ien
t n
um
ber
s
Deceased donor Living donor Kidney and Pancreas Kidney and Liver Kidney and Heart Pacreas after Kidney
Portuguese Transplant Centers Activity 2017
N = 450 tx deceased donor and 77 (14,6%) live donor; 34 multi-organ transplants (total = 527)
Gabinete de Registo da SPN, 2016 – Fernando Macário Portuguese Society of Nephrology, 2017 – Fernando Macário
Renal transplantation: living vs deceased donor pts with functioning Ktx, 31st December 2017
9,3%
90,7%
Living donor Deceased donor
Gabinete de Registo da SPN, 2016 – Fernando Macário
N = 7518
Portuguese Society of Nephrology, 2017 – Fernando Macário
Prevalent Renal Transplanted Patients Previous renal replacement therapy, 2015-2017
Gabinete de Registo da SPN, 2016 – Fernando Macário
N = 527 (2017)
375
65
17
377
101
25
414
82
31
0
50
100
150
200
250
300
350
400
450
Hemodialysis Peritoneal Dialysis Pre-emptive
2015
2016
2017
Portuguese Society of Nephrology, 2017 – Fernando Macário
Gabinete de Registo da SPN, 2016 – Fernando Macário
38
31
37 35
34
38
34
41
36 38
45,3
49,45
55,8 53,9
50,2
40,6 42,7 43
46,75
49,53 51,12
0
10
20
30
40
50
60
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
20
10
20
11
20
12
20
13
20
14
20
15
20
16
20
17
pm
p
Portuguese Society of Nephrology, 2017 – Fernando Macário
Renal Transplants Performed per million population, 2007 - 2017
N = 519 8 not available
Diabetes 14,9% Hypertension
10,0%
Chronic GN 29,4%
Policystic Disease 21,6%
Hipoplasia/Displasia 1,4%
Other Known 22,7%
Gabinete de Registo da SPN, 2016 – Fernando Macário Portuguese Society of Nephrology, 2017 – Fernando Macário
Primary renal disease of renal transplanted patients
during 2017
267
2843 2989
3256 3472
3673 3861
4140 4408
4538
5013 5151
5794 5976
6440 6359 6636 6618 6681
7242 7518
0
1000
2000
3000
4000
5000
6000
7000
8000
97 98 99 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
CUMUL
%
10,5%
2,9%
6,5% 7,2%
5,1%
5,8%
6,6%
8,9%
5,1% 6,6%
2,8%
12,4%
3,1%
Gabinete de Registo da SPN, 2016 – Fernando Macário
7,8%
-1,2% 4,3% 0,9%
8,4%
3,8%
Portuguese Society of Nephrology, 2017 – Fernando Macário
Patients with functioning graft and annual growth 31st December 1997 - 2017
N = 7242
Gabinete de Registo da SPN, 2016 – Fernando Macário
268 285
299
326 335 353
369 393
417 430
473 485
545 562
610 602
633 635 642
699
729
200
300
400
500
600
700
800
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
20
10
20
11
20
12
20
13
20
14
20
15
20
16
20
17
pm
p
Portuguese Society of Nephrology, 2017 – Fernando Macário
Prevalence of CKD patients with functioning graft cumulative per million population end of each year 1997 - 2017
-400 -300 -200 -100 0 100 200 300 400 500 600
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1011121314151617
Number
Yea
rs
Lost grafts Transplantations
Renal transplantation activity 1980 - 2017
2017: 104 patients died with functioning graft; 120 transferred to HD / 8 transferred to PD
Gabinete de Registo da SPN, 2016 – Fernando Macário Portuguese Society of Nephrology, 2017 – Fernando Macário