gabinete do registo da doença renal crónica sociedade ...1984: nationalregistry forchronic renal...
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Gabinete do Registo da Doença Renal Crónica
da
Sociedade Portuguesa de Nefrologia
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
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 – 2018: Fernando Macário
2019 - …: Ana Galvão
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Abbreviators
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
Questionnaires for Hemodialysis (HD),
Peritoneal Dialysis (PD) and Kidney
Transplantation
129 Hemodialysis Centers
25 Peritoneal Dialysis Units
8 adult and 1 pediatric kidney transplantation
centers
100% response rate
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Portuguese Registry of Dialysis and Transplantation 2019
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
New patients starting dialysis or submitted to renal transplantation during 2019 (n=2673)
0
500
1000
1500
2000
2500
HD PD TX
2356
285
32
832
180
986
89
531
10 7 6
Nº
of
pa
tien
ts
All 18 to 65 years 65 to 80 years > 80 years < 15 years
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
0
2 000
4 000
6 000
8 000
10 000
12 000
14 000
HD PD TX
12 523
852
7 265
4 722
604
5035
214
2766
34
Nº
pa
tien
ts
Total < 65 years 65 a 80 years > 80 years
Total number of pts – 20640
Prevalence – 2008,44 pmp
Nº of KTx pt / NºD pt = 0,59
Mean age HD + PD = 67,5 years
Patients treated by dialysis or with functioning kidney transplant 31st December 2019
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Incident patients accepted for RRT during 2019
260,11 256,99
229,26
27,73
3,11
pm
p
All HD + PD HD PD KTx
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
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
253,33
99 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
pm
p
256,99
Incident patients accepted for dialysis HD and PD per million population 1999 - 2019
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
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
256,99
126,85
679,19
817,89
229,26
104,45
622,96
802,77
27,73 22,40 56,23
15,20
HD + PD HD PD
Incident patients accepted for dialysis HD and PD per million population by age group during 2019
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Incidence How do we compare?
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
vol 2 Figure 11.1 Geographic variation in the incidence rate of treated ESRD (per million population), by country, 2016
2018 Annual Data Report Volume 2 ESRD, Chapter 11
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Prevalent patients on RRT by modality 31st December 2019
2008,44
1301,5 1218,59
82,91
706,94
pm
p
All HD + PD HD PD KTx
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
0,0
500,0
1000,0
1500,0
2000,0
2500,0
3000,0
3500,0
4000,0
4500,0
Global < 65 years 65 a 80years
> 80 years
1301,5
658,9
3316,3
4233,1
1218,6
587,9
3181,1
4181,7
82,9 71,0 135,2 51,4
pm
p
HD + DP HD DP
Prevalence of CKD patients treated by dialysis per million population by age group in 2019
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Incident and prevalent pediatric patients on dialysis HD and PD per million population 2019
0,00
5,00
10,00
15,00
Incidence Prevalence
6,63
13,77
3,57 3,06 3,06
10,71
pm
p
HD + PD HD PD
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
1000
3000
5000
7000
9000
11000
13000
15000
99 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
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%
2,7%
1,5%
3,7%
3,2%
1,4%
1,5%
1,4%
2,14%
Patients on dialysis and annual growth end of each year 1999 - 2019
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
675 701 716
744 760 804
834 870
902 924
961
1016 1052 1068
1116 1159
1182 1212
1236 1264
1301
500
600
700
800
900
1000
1100
1200
1300
1400
99 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
pm
p
Prevalent patients on dialysis per million population end of each year 1999 - 2019
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
675 701 716
744 760 804
834 870
902 924
961
1016 1052 1068
1116 1159
1182 1212
1236 1264
1301
500
600
700
800
900
1000
1100
1200
1300
1400
99 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
pm
p
Prevalent patients on dialysis per million population end of each year 1999 - 2019
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
1507
1578
1662 1670
1749 1794
1824
1911
1965
2014 2008
1200
1300
1400
1500
1600
1700
1800
1900
2000
2100
9 10 11 12 13 14 15 16 17 18 19
pm
p
Prevalent patients on RRT per million population end of each year 2009 - 2019
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Prevalence How do we compare?
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
vol 2 Figure 11.9 Prevalence of treated ESRD (per million
population), by country, 2016
2018 Annual Data Report Volume 2 ESRD, Chapter 11
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Incident patients starting PD vs HD 1999 - 2019
99 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
HD 1833 1800 1939 1956 2016 2129 2038 2273 2286 2285 2300 2312 2143 2084 2210 2233 2106 2166 2113 2378 2356
PD 108 93 101 118 102 135 116 149 147 170 229 190 227 220 208 216 229 215 228 229 285
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
PD HD
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
99 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
HD 6455 6701 7071 7370 7559 8077 8392 8708 9037 9303 9646 10152 10409 10540 10977 11350 11514 11738 11985 12227 12523
PD 293 311 346 376 398 390 437 481 517 511 571 660 704 742 732 735 751 720 758 787 852
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
PD HD
Prevalent patients starting PD vs HD 1999 - 2019
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
type of renal replacement therapy modality used by ESRD patients
How do we compare?
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
vol 2 Figure 11.12 Percentage distribution of type of renal
replacement therapy modality used by ESRD patients, by country, in
2016
2018 Annual Data Report Volume 2 ESRD, Chapter 11
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Gender distribution in each modality 31st December 2019
7493 496 4606
5030 356 2659
0%
20%
40%
60%
80%
100%
HD PD Kidney tx
Man Women
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
2595,64
1482,7
pm
p
Man Women
Prevalence by gender, all RRT per million population 31st December 2019
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Diabetes 33,2%
Hypertension 13,0%
Chronic Gln 11,8%
Policystic Disease 5,2% Hipoplasia/Displasia
0,7%
Other Known 20,0%
Unknown 16,1%
Primary renal disease of patients accepted for dialysis HD and PD during 2019
Not available = 14
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Diabetes in incident patients How do we compare?
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
vol 2 Figure 11.4 Incidence of treated ESRD due to diabetes as the assigned primary cause of ESRD cause, by country, 2016
(a) Percentage of incident ESRD patients
2018 Annual Data Report Volume 2 ESRD, Chapter 11
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Diabetes 28,0%
Hypertension 13,4%
Chronic Gln 13,3%
Policystic Disease 6,3%
Hipoplasia/Displasia 0,9%
Other Known 19,3%
Unknown 18,9%
Primary renal disease of prevalent patients HD and PD, 31st December 2019
N = 13375 Not available = 162
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
1833 1800
1939 1956 2016
2129 2038
2273 2286 2285 2300 2312
2143 2084
2210 2233
2106 2206
2113
2378 2356
0
500
1000
1500
2000
2500
99 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
New patients accepted for hemodialysis 1999 - 2019
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
99 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
PD or Ktx to HD 211 178 172 213 268 208 251 274 224 258 258
Incident 1833 1800 1939 1956 2016 2129 2038 2273 2286 2285 2300 2312 2143 2084 2210 2233 2106 2206 2113 2378 2356
1400
1600
1800
2000
2200
2400
2600
2800
All patients accepted for hemodialysis Incident and returning from other modalities 1999 - 2019
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Incident patients accepted for hemodialysis per million population 2009 - 2019
216,42 217,34
202,90
197,31
210,73
214,15
202,99
212,97
204,96
231,08 229,26
180,00
190,00
200,00
210,00
220,00
230,00
240,00
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
pm
p
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
NO 702 737 694 737 716 655 509 537 473 500 506
YES 1483 1522 1410 1342 1477 1541 1597 1629 1640 1878 1850
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Previous follow-up by nephrology (> 3 months) HD patients 2009 – 2019
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão 3
Norte Centro Lisboa Sul Açores Madeira Global Hosp Perif
NO 121 97 199 73 5 11 506 124 382
YES 614 398 535 251 22 30 1850 207 1643
614 398 535 251 22
30 1850
207
1643
121 97 199 73 5
11 506
124
382
0%
20%
40%
60%
80%
100%
Previous follow-up by nephrology (> 3 months) HD patients, by country region and facility type - 2019
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
202
197
210,7
214,15
202,99
212,97
204,96
231,08 229,26
186,52 185,3
199,8 202,26
190,75
199,17
193,51
218,83 220,5
180
190
200
210
220
230
240
2011 2012 2013 2014 2015 2016 2017 2018 2019
pm
p H
D
Inc d0 Inc d91
6%
3,8% 5,3%
5,6%
6,4% 5,5% 5,2%
Incident patients accepted for hemodialysis
Day 0 and day 91, 2011-2019
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
0
200
400
600
800
1000
HD
7
832
986
531
Pat
ien
ts c
ou
nt
< 18 years old (0,2%) 18 a 65 years old (35,4%) 65 a 80 years old (42%) >80 years old (22,5%)
Patients accepted for hemodialysis by age group, during 2019
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
0
1000
2000
3000
4000
5000
HD
6
4716 5035
2766
Pat
ien
ts c
ou
nt
< 18 years old (0,1%) 18 a 65 years old (37,1%) 65 a 80 years old (40,2%) >80 years old (22%)
Patients treated by hemodialysis by age group , 31st December 2019
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Incident and prevalent patients treated by hemodialysis by country region, 2019
0
500
1000
1500
2000
2500
3000
3500
4000
North Center South Lisbon Azores Madeira
735
495 324
734
27 41
3698
2465
1958
3974
188 240
Inc Patients Prev patients
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Incident and prevalent patients treated by hemodialysis per million population by age group, 2019
0,00
1000,00
2000,00
3000,00
4000,00
5000,00
Global < 65 years 65 to 80years
> 80 years
229,26 104,45
622,96 802,77
1218,59
587,86
3181,13
4181,68
Incidence Prevalence
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
6455 6701
7071 7370 7559
8077 8392
8708 9037
9303 9646
10152 10409 10540
10977 11350 11514
11836 11985 12227 12523
0
2000
4000
6000
8000
10000
12000
14000
99 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Pat
ien
ts c
ou
nt
Patients treated by hemodialysis 31st of December each year, 1999 – 2019
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
6455 6701
7071 7370 7559
8077 8392
8708 9037
9303 9646
10152 10409 10540
10977 11350 11514
11836 11985 12227 12523
0
2000
4000
6000
8000
10000
12000
14000
99 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Pat
ien
ts c
ou
nt
Patients treated by hemodialysis 31st of December each year, 1999 – 2019
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Hemodialysis growth 2019 vs 2018 (%) 31st of December each year
-15
-10
-5
0
5
ALL HOSPITAL CENTER -0,92
-13,12
1,4 2,4
-2,6
2,9 V
aria
tio
n 2
019/
108
%
Hemodialysis Growth Portugal
incident Pts % Prevalent Pts %
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Distribution of hemodialysis patients by type of dialysis facility 31st of December 2019
9%
91%
In Hospital In center
N = 12523 In Hospital:1116 In Center:11407
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Patients treated by hemodialysis distribution by techniques in each age group, 31st of December 2019
0
1000
2000
3000
4000
5000
6000
7000
Low flux HD High flux HD Hemodiafiltration
266
5217
7026
105
1914
2750
118
2109 2764
43
1194 1512
Nº
pat
ien
ts
Total < 65 years 65 a 80 years >80 years
N = 12509 14 not available low flux 2,1% (2,2% in 2018)
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
761 874 629 405 346 314 313 304 323 270 266
5307 4843
4726 5000 5080
4076 4013 4117 5166 4944 5217
3574 4435
5054 5132 5551
6960 7188 7317 6496 7013 7026
0%
20%
40%
60%
80%
100%
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Nº
pat
ien
ts
Low flux High flux Hemodialfiltration
Patients treated by hemodialysis distribution by techniques, 31st Dec. 2009 - 2019
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
47 1 10 114
94
266
214
52
1665 993
523
1924
94
18
5217
442
4775
1976 1471
1425
1932
222
7026
450
6576
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 HemodiafiltrationN = 12509 by end of December 2019 14 not available
Patients treated by hemodialysis distribution by techniques by region and facility type, 31st Dec. 2019
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Mean Age of patients treated by hemodialysis 31st of December 2009 – 2019
65,02
65,99
66,49
66,8 66,9 67,17
67,47 67,68
67,89 68,02
68,3
63
64
65
66
67
68
69
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Mea
n a
ge
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
55
60
65
70
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Islands 61,9 61,9 62,4 60,3 62,4 62,6 62,4 63,6 65,0 64,2 64,5
Lisbon 62,4 64,5 65,2 65,2 65,1 65,8 66,2 66,7 66,5 65 67,1
North 64,8 65,8 66,3 66,7 66,8 66,8 67,2 67,4 67,7 68,1 68,6
South 67 67,3 66,7 68 67,9 68 69,1 68,5 69,0 68,9 69,1
Centre 68 68,2 68 68,7 69,1 69,5 69,5 69,7 69,9 69,8 69,9
Mea
n a
ge
Mean Age of patients treated by hemodialysis by country region, 31st of December 2009 – 2019
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Diabetes 34,6%
Hypertension 13,6%
Chronic Gln 10,2%
Policystic Disease 4,6%
Hipoplasia/Displasia 0,6%
Other Known 20,3%
Unknown 16,2%
Primary renal disease of patients accepted for hemodialysis during 2019
N = 2343 13 not available
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Etiology of All patients accepted for hemodialysis during 2019
Diabetes 31,1%
Hypertension 12,2%
Chronic Gln 9,2%
Policystic Disease 4,2%
Hipoplasia/Displasia 0,5% Other Known
18,3%
Unknown 14,6%
Tx/DP Failure 9,9%
N = 2601
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
DM 28,6%
HTA 13,8%
GNC 12,3%
DRPQA 5,9%
hip/displasia 0,7%
other Known 19,2%
unknwon 19,1%
Not available 0,5%
Primary renal disease of prevalent hemodialysis patients 31st December 2019
N = 12417 106 not available
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Diabetes as primary renal disease in HD patients Incident and prevalent (%) 2009 - 2019
32
33,6 32,6
32 32,2 33
34,6
33 33,4 32,5
34,6
25
26,9 27,7 28 28,2 28,2
28,7 29,1 28,7 28,1
28,6
20
25
30
35
40
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
% D
iab
ete
s
Incident Pt Prevalent Pt
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Viral status in HD prevalent patients 31st December 2019
94,21%
1,37%
2,80%
1,62%
Neg Hbs Ag + HCV Ab + HIV Ab +
N = 12523
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Hepatitis C viral status in HD prevalent pts 31st December 2016 – 2017 – 2018 - 2019
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
2018 99 266 82 16
2019 68 283 49 10
2016
2017
2018
2019
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Vascular access
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Vascular access of HD incident patients during 2019
AVFistula 41,1%
Graft 1,7% Tunneled catheter
50,9%
Non-tunneled cat. 6,3%
N = 2349 7 unavailable
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Non-tunneled cat. 282 219 188 163 143 163 81 103 117 173 148
Tunneled cat. 940 1034 1033 1007 1101 1088 1068 1093 1094 1222 1196
Graft 111 117 71 61 61 60 74 59 57 45 40
AVFistula 895 931 844 844 870 912 872 940 862 926 965
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Vascular access of HD incident patients 2009 – 2019
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Catheter rate (%) in the first HD session of incident patients 2009 – 2019
54,8 54,5
57,2
56,4
57,2
56,3
54,8 54,5
56,9
58,6
50,9
46
48
50
52
54
56
58
60
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
53,7%
30,5% 34,8% 36,4% 43,4%
4,3%
39,1% 27%
41,4%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
North Centre Lisbon South Azores Madeira Global In Hospital In Center
AVFistula Graft Tunneled Catheter Non-tunneled Cat.
Vascular access of HD incident patients by country region and facility type
N = 2349 7 not available
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Vascular access of HD prevalent patients 31st December 2019
AVFistula 74,2%
Graft 8,4%
Tunneled catheter 17,3%
[NOME DA CATEGORIA] 0,1%
N = 12508 15 not available
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Non-Tunneled Cat 39 42 25 16 23 15 24 2 10 35 6
Tunneled Catheter 1769 1953 1905 1889 1834 1770 1804 1895 1971 2109 2170
Graft 1256 1365 1402 1349 1358 1317 1273 1239 1216 1101 1049
AVFistula 6538 6788 7077 7257 7750 8202 8434 8598 8782 8978 9283
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Vascular access of HD prevalent patients 31st December, 2009 - 2019
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Vascular access of prevalent patients (%) 31st December, 2009 - 2019
68,1 66,9 68 69
70,7 72,6 73,1 73,3 73,3 73,5 74,2
13,1 13,5 13,5 12,8 12,4 11,7 11 10,6 10,2 9 8,4
18,8 19,7 18,5 18,1 16,9 15,8 15,8 16,2 16,5 17,5 17,3
0
10
20
30
40
50
60
70
80
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
% o
f p
atie
nts
AVFistula Graft Catheter
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
AV Fistula rate of prevalent patients (%) 31st December, 2009 - 2019
68,1
66,9
68 69
70,7
72,6 73,1 73,3 73,3 73,5
74,2
60
62
64
66
68
70
72
74
76
78
80
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
% o
f p
atie
nts
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Graft rate of prevalent patients (%) 31st December, 2008 - 2018
13,1
13,5 13,5
12,8
12,4
11,7
11
10,6
10,2
9
8,4 8
9
10
11
12
13
14
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
% o
f p
atie
nts
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Catheter rate of prevalent patients (%) 31st December, 2009 - 2019
18,8
19,7
18,5 18,1
16,9
15,8 15,8 16,2
16,5
17,5 17,3
10
12
14
16
18
20
22
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
% o
f p
atie
nts
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
North Centre Lisbon South Azores Madeira Global In Hospital In Center
AVFistula Graft Tunneled Catheter Non-tunneled Cat.
83,8% 74,9%
68,1% 70,3% 73,4%
53,3%
74,2%
59%
75,7%
Vascular access of HD prevalent patients by country region and facility type, 31st of December 2019
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Catheter rate of prevalent patients (%) 31st December 2019
68,5
1,4
0
10
20
30
40
50
60
70
80
42 centers above 20% cat rate 13 centers below 10% cat rate National rate = 17,3% Standard deviation = 3,7
17,3%
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Catheter rate of prevalent patients (%) In Hospital HD patients - 2019
68,5
34,3
10,6
0
10
20
30
40
50
60
70
80
23 centers above 20% cat rate 0 centers below 10% cat rate National rate = 34,3 % Standard deviation = 20,1
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Catheter rate of prevalent patients (%) In Center HD patients - 2019
50
15,7
1,4
0
10
20
30
40
50
60
19 centers above 20% cat rate 13 centers below 10% cat rate National rate = 15,7% Standard deviation = 3,9
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Mortality - hemodialysis
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
< 65 years 65 - 80 years >80 years
Prevalent 4722 5035 2766
Died 289 589 655
289
589
655
Deaths in hemodialysis by age group in 2019
* 81,1% of 1533 patients that died in
2019 were more than 65 years old and
42,7% more than 80 years
* 5,8% of deaths occurred during the
first 90 days after starting dialysis
* Mortality in the first 90 days was
3,4% (5,7% em 2018)
N: 1533
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Death causes in HD patients during 2019
Cardiovascular 26,7%
Sudden death 11,4%
Infection (related with VA)
1,5% Infection (not related with VA)
22,5%
Malignancy 10,1%
Cachexia 7,0%
Others known 14,5%
Unknown 6,3%
N=1533
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
29,8
28,5 27,7
28,6
26,9
24,2 24,4 24,7 24,5 24,8
26,7
17,9 16,9
22,0 22,9
20,7
24,0 23,4
22,2 23,0
21,6 22,5
10,0
15,0
20,0
25,0
30,0
35,0
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
CV
Inf (not rel VA)
Cardiovascular and Infection deaths in hemodialysis (%) 2009 - 2019
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Cardiovascular and Infection deaths in hemodialysis (%) 2009 - 2019
29,8
28,5 27,7
28,6
26,9
24,2 24,4 24,7 24,5 24,8
26,7
22,6 22,2
25,1
26,7
23,2
27,1
25,8
24,3 25,3
23,3 24
10,0
15,0
20,0
25,0
30,0
35,0
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
CV
Inf (all)
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Death causes during the first 90 days of HD 2019
Cardiovascular 22,1%
Sudden death 11,6%
Infection (related with VA) 3,5% Infection (not related with VA)
24,4%
Malignancy 16,3%
Cachexia 7,0%
Others known 4,7%
Unknown 10,5%
N=86 4 not available
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Patients movement in 2019
0
100
200
300
400388
78
36
123 109
149
Nu
mb
er o
f p
ts
Out = 625 ; In = 258
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
IN OUT
First treatment 2356 Deaths 1533
Transplant failure 149 Transplanted 388
PD into HD 109 HD into PD 78
Stop treat. or recovery 159
GROSS MORTALITY RATE = 12,47%
HD patients movement in 2019
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
National gross mortality rate = 12,47% (90 day mortality = 3,44%)
Hemodialysis in hospital 17,81% (90 day mortality = 5,5%)
Hemodialysis in center 11,95% (90 day mortality = 3,07%)
Mortality rates – hemodialysis
2019
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
21,31 20,95
29,44
21,39
20,03
21,41 22,14
20,79
19,13
20,66
17,81
13,24 12,35
11,82 12,76 12,39
11,49 12,49 12,36 12,42
13,1 11,95
14,01 13,24
13,79 13,65 13,18 12,49
13,28 13,09 13,03 13,78
12,47
8
10
12
14
16
18
20
22
24
26
28
30
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Gro
ss m
ort
alit
y ra
te (
%)
HD in Hospital HD in Center All pts
Gross mortality rate in hemodialysis
2009 - 2019
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
14,01
13,24
13,79 13,65
13,18
12,49
13,28 13,09 13,03
13,78
12,47
10
11
12
13
14
15
16
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Gro
ss m
ort
alit
y ra
te (
%)
All patients
Gross mortality rate in hemodialysis
2009 - 2019
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
13,24
12,35
11,82
12,76 12,39
11,49
12,49 12,36 12,42
13,1
11,95
10
11
12
13
14
15
16
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Gro
ss m
ort
alit
y ra
te (
%)
HD in Center
Gross mortality rate in hemodialysis
in center treated patients, 2009 - 2019
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Gross mortality rate
Impact of deaths until day 90, 2019
12,47 11,95
17,81
11,74 11,35
15,78
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
3,07% died until d90
5,5% died until d90
3,44% died until d90
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Mean Age Mortality
since d1
Mortality
since d91
Deaths until d90 (% of incident)
Global 68,3 12,47% 11,74% 3,44%
North 68,6 11,69% 11,16%
2,37%
Center 69,9 13,01%
12,22% 3,36%
South 69,1 13,16% 12,39% 4,1%
Lisbon 67,1 12,44% 11,52% 4,48%
Azores 65,09 14,62%
14,1% 2,94%
Madeira 64,15 11,79% 11,79% 0,00%
Gross mortality rates – hemodialysis
since d1 and d91 by country region, 2019
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
[PERCENTAGEM] (2614)
79,0%
YES NO
Waiting list for renal transplantation Hemodialysis patients, 2019
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
12,8%
8,1%
79,1%
Normal and Urgent Temporary out No
Waiting list for renal transplantation HD patients, Active and temporary contraindication - 2019
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
108
93 101
118
102
135
116
149 147
170
229
190
227 220
208 216
229
215
228 229
285
60
80
100
120
140
160
180
200
220
240
260
280
300
99 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
New patients starting peritoneal dialysis 1999 - 2019
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
21,55
17,86
21,5 20,8
19,8 20,7
22,1
20,76
22,12 22,25
27,73
5
10
15
20
25
30
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
pm
p
Incident patients accepted for peritoneal dialysis per million population 2009 - 2019
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
80,7%
19,3%
Yes No N = 285
Previous follow-up by nephrology (> 3 months) PD patients, 31st of December 2019
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
293 311
346 376
398 390
437
481
517 511
571
660
704
742 732 735 751
720
756 787
852
150
250
350
450
550
650
750
850
950
99 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Patients treated by peritoneal dialysis Count at 31st of December each year, 1999 – 2019
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Diabetes 21,8%
Hypertension 8,5%
Chronic GN 24,6%
Policystic Disease 10,2%
Hipoplasia/Displasia 1,8%
Other Known 18,0%
Unknown 15,1%
Primary renal disease of patients accepted for peritoneal dialysis during 2019
N = 284
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Diabetes 16,9%
Hypertension 8,0%
Chronic GN 26,3%
Policystic Disease 11,0%
Hipoplasia/Displasia 3,5%
Other Known 19,4%
Unknown 14,9%
Primary renal disease of prevalent peritoneal dialysis patients 31st December 2019
N = 852
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
0
50
100
150
200
250
300
350
400
450
500
CAPD APD
459
393
158
90
24 10 2
19
Pat
ien
ts c
ou
nt
Total > 65 years > 80 years < 18 years
N = 852 APD:46,1%
Age>65 years:29,1%; Age>80years:3,9%
Patients treated by peritoneal dialysis Manual vs automated, 31st of December 2019
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
852
459
393
0
100
200
300
400
500
600
700
800
900
Total CAPD APD
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Patients treated by peritoneal dialysis Manual vs automated, 31st December 1999 - 2019
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
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
47,2 46,1
0
10
20
30
40
50
60
70
80
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2106 2017 2018 2019
% o
f p
atie
nts
Automated Peritoneal Dialysis usage (%) 31st December 1999 - 2019
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
0
50
100
150
200
250
300
North Center South Lisbon Islands
280
159
91
244
78 Nu
mb
er o
f P
atie
nts
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Patients treated by peritoneal dialysis by region, 31st of December 2010 to 2019
N = 852 (2019)
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
50,9
51,5
50,1
52,2
53,7 53,9
54,5 54,5 54,8
55,1 55,4
47
48
49
50
51
52
53
54
55
56
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Mea
n a
ge (
year
s)
Mean Age of patients treated by peritoneal dialysis 31st of December 2009 – 2019
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
96,36%
1,06%
1,29%
1,29%
Neg HbsAg + AntiVHC + AntiHIV +
Viral status in PD prevalent patients 31st December 2019
N = 852
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
IN OUT
New patients 285 Death 41
KTr failure 31 Transplant 90
HD to PD 44 PD to HD 135
Suspension 2
Renal Recovery 4
Mortality rate = 4,33 % (90 d mortality = 2,4%)
PD patients movement in 2019
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
7,09
5,62
6,79 6,73
5,54 5,42 5,33
7
5,16 5,22
4,33
4
5
6
7
8
9
10
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Gro
ss m
ort
alit
y ra
te (
%)
Gross mortality rate in peritoneal dialysis
2009 - 2019
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Death causes in PD patients 2019
CardioVasc 41,5%
Sudden death 4,9% Infection (PD related)
2,4%
Infection ( Not PD related) 29,3%
Neoplasia 19,5%
Cachexia 0,0%
Others Known 2,4%
N = 41
7 patients died until day 90;
2,4% of incidente patients and
17% of all deaths
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Reasons for PD withdraw 2019
N = 114
Infection 27,3%
UF failure/Inadequacy 35,6%
Mechanical problems 15,2%
Non compliance 4,5%
Others 17,4%
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Peritonitis episodes 2019
N = 247
0,26 episodes / patients-2019
0,48
0,45 0,46
0,43 0,45
0,41
0,37 0,35
0,29 0,31
0,26
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Pe
rito
nit
is r
ate
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
49,5%
50,5%
YES NO
PD patients in waiting list for renal transplantation 2019
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
37,3%
12,2%
50,5%
Normal and Urgent Temporary out No
PD patients in waiting list for renal transplantation Active ant temporary contraindication for transplantation
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
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
505 514
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 18 19
Ren
al T
ran
spla
nt
cou
nts
per
yea
r
Years
Renal Transplants performed 1980-2019
Total = 13674
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Renal transplantation activity characterization 2019
0
100
200
300
400
500
Dec
ease
d do
nor
Dec
ease
d do
nor
/R
ecep
tor
<18y
Dec
ease
d do
nor
/R
ecep
tor>
65y
Livi
ng d
on
or
Livi
ng d
ono
r /
Rec
epto
r<1
8Y
Livi
ng d
ono
r /
Rec
epto
r>6
5y
439
7
65 75
3 4
Nº
of
Patients
32 pre-emptive
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Portuguese Transplant Centers Activity 2019
0
20
40
60
80
100
120
HGSA HSMaria HG Orta CHLO StC HS João HC Cabral HSM-Ped CHUC CVP
77
69
16
42
67
55
3
110
0
30
10
0
6 11
4 3
11
0
9
0 0 0 0
13
0 0 0 1 0 0 0 0 2 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 3
0 0 0
Pat
ient
num
ber
s
Deceased donor Living donor Kidney and Pancreas Kidney and Liver Kidney and Heart Pacreas after Kidney
439 tx deceased donor 75 (17%) live donor 29 multi-organ transplants total = 514
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
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
49,07 50,02
0
10
20
30
40
50
60
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
pm
p
Renal Transplants Performed per million population, 2009 - 2019
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Renal Transplanted Patients
Previous renal replacement therapy, 2015-2019
N = 514 (2019)
[VALOR]
65
17
377
101
25
414
82
31
398
80
27
383
99
32
0
50
100
150
200
250
300
350
400
450
Hemodialysis Peritoneal Dialysis Pre-emptive
2015
2016
2017
2018
2019
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
N =514
Diabetes 17,0%
Hypertension 8,0%
Chronic GN 31,6%
Policystic Disease 17,3%
Hipoplasia/Displasia 1,5%
Other Known 24,6%
Primary renal disease of renal transplanted patients during 2019
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Incidence of transplantation How do we compare?
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Patients with functioning graft and annual growth 31st December 1999 - 2019
2989 3256
3472 3673
3861 4140
4408 4538
5013 5151
5794 5976
6440 6359 6636 6618 6681
7242 7518
7716
7265
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
99 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Nº
of
pat
ien
ts
CUMUL
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
N = 7265
299
326 335 353
369 393
417 430
473 485
545 562
610 602
633 635 642
699
729 749
707
200
300
400
500
600
700
800
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
20
18
20
19
pm
p
Prevalence of CKD patients with functioning graft cumulative per million population end of each year 1999 - 2019
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Renal transplantation: living vs deceased donor
2019
10,6%
89,4%
Living donor Deceased donor N = 7265
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
-400 -300 -200 -100 0 100 200 300 400 500 600
8081828384858687888990919293949596979899
0123456789
10111213141516171819
Number
Yea
rs
Lost grafts Transplantations
Renal transplantation activity 1980 - 2019
2019: 112 patients died with functioning graft;
138 transferred to HD / 18 transferred to PD
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
A incidência pmp de doentes a iniciar TSFR continua muito elevada – 260 pmp Continuamos no topo da Europa e do mundo Pelo 2º ano consecutivo a prevalência de doentes sob TSFR pmp ultrapassou 2000 pmp
Portuguese Registry of Dialysis and Transplantation 2019
Portuguese Registry of Dialysis and
Transplantation 2019
Ana Galvão
Hemodiálise A incidência em HD é inferior em relação a 2018 mas > 200 pmp A prevalência continua a aumentar (2,4%) A idade média continua a aumentar (68,3 anos) A taxa de mortalidade global diminuiu (12,47%) A mortalidade nos 1º 90 dias teve impacto inferior (3,4%)
Diálise Peritoneal Aumento da inicidencia em 2019 (27 pmp) Crescimento na prevalência de 8,2% A idade média continua a aumentar (55,4 anos) A taxa de mortalidade e o nº de episódios de peritonite/doente.ano diminuiram
Transplantação Renal Aumento da inicidência em 2019 (50 pmp) Pool de doentes transplantados continua a crescer Crescimento do tx dador vivo
Portuguese Registry of Dialysis and Transplantation 2019
Gabinete do Registo da Doença Renal Crónica
da
Sociedade Portuguesa de Nefrologia