NIV Congres
A PHP Error was encountered
Severity: Notice
Message: Trying to get property of non-object
Filename: views/programma_sessie_prod.php
Line Number: 181
The influence of region on expected patient survivalof patients starting with renal replacement therapy
Hemke, A.C., Dorpel, R.M.A. van den, Heemskerk, M.B.A., Hoitsma, A.J.
Categorie(ën):
Renal transplantation is the optimal treatment modality for most patients with end stage renal disease (ESRD). However, the transplant policy (donor and patient selection) among the Dutch transplant centres is different. We know already that there are regional differences in registration on the waiting list and in transplantation rate, according to the patient’s residence. We wondered whether these differences in transplantation policy affect expected patient survival for all patients starting renal replacement therapy (RRT), instead of focussing on graft survival of transplanted patients only. We also wondered whether there are regional differences with respect to expected patient survival from the start of RRT.
We obtained data from the Dutch Renal Replacement Registry (RENINE), on patients between 18 and 70 years old, who started RRT in the period 2004-2008 (N=5026). The 5 year survival was analysed with Kaplan Meier, and (uni- and multivariate) Cox regression analysis. Included variables in the analysis were: age, primary renal disease, sex, therapy at 90 days, transplant region and municipal health service (GGD) region. The transplant region was derived from the centre where the patient started RRT treatment and the GGD-region was derived from the address of the patient.
In Kaplan Meier analysis RRT-patient survival was different for the different transplant regions (P=0.032) as well as for the different GGD regions (p=0.001). Multivariate Cox regression analysis, with age, primary renal disease and transplant region, showed that transplant region is no longer related to 5 year patient survival independently (p=0.18). A similar analysis with GGD region instead of transplant region, showed that this GGD region is also an independent predictor for survival when we correct for age and primary renal disease (p= 0.003).
Based on the analysed data we conclude that there are remarkable regional differences in the patient survival after the start of RRT. However, this cannot be related to differences in transplant policy in the different transplant centres. Reasons for regional differences should be subject of further research.