Sensing Savvy

(Gleaned from the 2018 USRDS Annual Data Report: Volume II: Chapter 3)

• In 2016, 80% of patients were using a catheter at hemodialysis (HD) initiation.
• At 90 days after the initiation of HD, 69% of patients were still using catheters.
• Arteriovenous (AV) fistula use at HD initiation rose from 12% to 17% between 2005 and 2016.
• The percentage of patients using an AV fistula or with a maturing AV fistula at HD initiation increased from 28.9% to 33% over the same period.
  

(From 2018 USRDA Data Volume 2: ESRD in the United States)

Diabetes mellitus remains the predominant likely underlying cause of treated ESRD worldwide. Nearly 71 percent of the countries that participated in the U.S. Renal Data system report assigned DM as the primary cause for the incidence of treated ESRD and a key contributor to the global burden of kidney disease and ESRD.

Some stats gleaned from the USRDA report:

Study: Influence on For-Profit Dialysis Centers on Kidney Transplantation

While most nephrologists agree that kidney transplants are the optimal choice for patients with kidney disease, a recent study from JAMA reports that the likelihood of a patient receiving a transplant depends on who owns the dialysis facility. The study, which analyzed data from the U.S. Renal Data System, found that dialysis clinics owned by for-profit companies had a lower rate of referrals for transplant.

Source: Nephrology News & Issues

(Gleaned from 2018 USRDA Data Volume 2: ESRD in the United States)

Incidence is the ratio of total new cases in a population divided by total population. Incidence refers to new cases of the disease in the population in a year.

Incidence rates of treated ESRD have remained relatively stable since 2002-2003 in most high-income countries, but have actually declined by 2 percent to 10 percent in Austria, Finland, Sweden, Scotland, Denmark and Iceland.

Prevalence is the ratio of the total number of patients diagnosed and getting treatment of a disease to the total population. It tells how widespread disease is in a population.

(Gleaned from the 2018 USRDS Annual Data Report: Volume 1, Chapter 4: www.usrds.org)

Cardiovascular disease (CVD) remains the leading cause of death in the United States and most other developed countries. It accounts for approximately 39 percent of deaths among those on dialysis. Among patients with chronic kidney disease (CKD), death from CVD is far more common than progression to end-stage renal disease (ESRD). CKD has been identified as an independent risk factor for CVD, and arguably should be recognized as a coronary disease risk equivalent, similar to diabetes mellitus (DM). The complex relationship between CVD and kidney disease is thought to be due to shared traditional risk factors, such as DM, hypertension (HTN), physical inactivity, left ventricular hypertrophy, smoking, family history and abnormal lipid levels in the blood.

No individual data source exists that captures the disease experiences of all Americans who live with kidney disease. A large proportion of the USRDS information is drawn from Medicare beneficiaries. However, they are not a nationally representative population. Since 2017, two new data sources have been utilized that have expanded the USRDS’s coverage of the U.S. population.

(Gleaned from the 2018 USRDS Annual Data Report: Volume II: Chapter 3)

Clinical practice guidelines from the National Kidney Foundation in 2006 recommend an autogenous arteriovenous (AV) fistula as the preferred vascular access for hemodialysis. Central venous catheters are associated with higher risks of death, infection and cardiovascular events than other types of vascular access. Patients with a usable AV fistula exhibit the lowest risks for these events.

(Gleaned from the 2018 USRDS Annual Data Report: Volume 1, Chapter 7: www.usrds.org)

Persons with chronic kidney disease (CKD), but not end-stage renal disease (ESRD) often have extensive healthcare needs and frequently face coexisting illnesses. Medicare beneficiaries enrolled in managed care grew from 13 percent in 2004 to 33 percent in 2017. In March 2017, 19 million individuals were enrolled in a Medicare Advantage plan.

(Gleaned from the 2018 USRDS Annual Data Report: Volume II: Chapter 8)

Patients with end-stage renal disease (ESRD) are among the highest risk populations for cardiovascular diseases (CVDs)—a major cause of death in ESRD patients. The relationship between kidney disease and acute myocardial infarction (AMI), coronary artery disease (CAD), heart failure (HF), and sudden death/cardiac arrhythmias is complex and bi-directional. ESRD often complicates disease management of CVD, influencing both medical and procedural options, thereby adversely affecting a patient’s prognosis.

(Gleaned from the 2018 USRDS Annual Data Report: Volume II: Chapter 7)

In children, adolescents and young adults, end-stage renal disease (ESRD) is caused by both congenital and acquired disorders. A majority of children with ESRD will depend on the spectrum of the available renal replacement therapies throughout their lifetime, including hemodialysis, peritoneal dialysis and transplantation. Throughout their ESRD experience, children are at risk for failure to grow, frequent hospitalizations, and significantly higher mortality than the general pediatric population. Hospitalizations due to medical or surgical indications are a particular burden to the ESRD population.