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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 - ... Fernando MacárioPortuguese Registry of Dialysis and Transplantation 2018
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
Portuguese Registry of Dialysis and Transplantation 2018
Questionnaires for Hemodialysis (HD),
Peritoneal Dialysis (PD) and Kidney Transplantation
124 Hemodialysis Centers
25 Peritoneal Dialysis Units
8 adult and 1 pediatric kidney transplantation
centers
100% response rate
Portuguese Registry of Dialysis and Transplantation 2018
Portuguese Registry of Dialysis and Transplantation 2018
New patients starting dialysis or submitted to renal transplantation during 2018 (n=2634)
0
500
1000
1500
2000
2500
HD PD TX
2378
229
27
843
164
952
46
578
105 9
Nº
of
patients
All 18 to 65 years 65 to 80 years > 80 years < 15 years
Portuguese Registry of Dialysis and Transplantation 2018
Portuguese Registry of Dialysis and Transplantation 2018
0
2 000
4 000
6 000
8 000
10 000
12 000
14 000
HD PD TX
12 227
787
7 716
4 581
567
4901
191
2745
29
Nº
pa
tien
ts
Total < 65 years 65 a 80 years > 80 years
Total number of pts – 20730
Prevalence – 2014,38 pmp
Nº of KTx pt / NºD pt = 0,59
Mean age HD + PD = 67,2 years
Patients treated by dialysis or with functioning kidney transplant 31st December 2018
Portuguese Registry of Dialysis and Transplantation 2018
Incident patients accepted for RRTduring 2018
255,95 253,33231,08
22,252,62
pm
p
All HD + PD HD PD KTx
Portuguese Registry of Dialysis and Transplantation 2018
176
195190
198 200204
215
204
230227
231 232235,2
224,4
218,14
230,56234,86
225,08
233,73
227,07
253,33
98 99 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
pm
pIncident patients accepted for dialysis
HD and PD per million population 1998 - 2018
Portuguese Registry of Dialysis and Transplantation 2018
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
253,33
126,40
637,14
908,97
231,08
104,98
607,77
893,51
22,25 21,42 29,37 15,46
HD + PD HD PD
Incident patients accepted for dialysisHD and PD per million population by age group during 2018
Portuguese Registry of Dialysis and Transplantation 2018
IncidenceHow do we compare?
Portuguese Registry of Dialysis and Transplantation 2018
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 2018
Portuguese Registry of Dialysis and Transplantation 2018
Portuguese Registry of Dialysis and Transplantation 2018
Prevalent patients on RRT by modality31st December 2018
2014,38
1264,6 1188,12
76,47
749,78
pm
p
All HD + PD HD PD KTx
Portuguese Registry of Dialysis and Transplantation 2018
0,0
500,0
1000,0
1500,0
2000,0
2500,0
3000,0
3500,0
4000,0
4500,0
Global < 65years
65 a 80years
> 80years
1264,3
633,2
3270,6
4286,7
1187,8
563,0
3148,7
4241,9
76,5 70,2 121,9 44,8
pm
p
HD + DP HD DP
Prevalence of CKD patients treated by dialysisper million population by age group in 2018
Portuguese Registry of Dialysis and Transplantation 2018
Incident and prevalent pediatric patients on dialysisHD and PD per million population 2018
0,00
5,00
10,00
15,00
Incidence Prevalence
7,07
16,67
2,53
7,07
4,55
9,60
pm
p
HD + PD HD PD
Portuguese Registry of Dialysis and Transplantation 2018
1000
3000
5000
7000
9000
11000
13000
98 99 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
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 growthend of each year 1998 - 2018
Portuguese Registry of Dialysis and Transplantation 2018
626675
701 716744 760
804834
870902
924961
10161052 1068
11161159
11821212
12361264
500
600
700
800
900
1000
1100
1200
1300
98 99 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
pm
pPrevalent patients on dialysis
per million population end of each year 1998 - 2018
Portuguese Registry of Dialysis and Transplantation 2018
626675
701 716744 760
804834
870902
924961
10161052 1068
11161159
11821212
12361264
500
600
700
800
900
1000
1100
1200
1300
98 99 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
pm
pPrevalent patients on dialysis
per million population end of each year 1998 - 2018
Portuguese Registry of Dialysis and Transplantation 2018
1410
1507
1578
1662 1670
17491794
1824
1911
1965
1200
1300
1400
1500
1600
1700
1800
1900
2000
8 9 10 11 12 13 14 15 16 17 18
pm
pPrevalent patients on RRT
per million population end of each year 1998 - 2018
2014
Portuguese Registry of Dialysis and Transplantation 2018
PrevalenceHow do we compare?
Portuguese Registry of Dialysis and Transplantation 2018
Portuguese Registry of Dialysis and Transplantation 2018
Portuguese Registry of Dialysis and Transplantation 2018
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 2018
Incident patients starting PD vs HD1998 - 2018
98 99 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
HD 1655 1833 1800 1939 1956 2016 2129 2038 2273 2286 2285 2300 2312 2143 2084 2210 2233 2106 2166 2113 2378
PD 103 108 93 101 118 102 135 116 149 147 170 229 190 227 220 208 216 229 215 228 229
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
PD HD
Portuguese Registry of Dialysis and Transplantation 2018
98 99 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
HD 5989 6455 6701 7071 7370 7559 8077 8392 8708 9037 9303 9646 10152 10409 10540 10977 11350 11514 11738 11985 12227
PD 261 293 311 346 376 398 390 437 481 517 511 571 660 704 742 732 735 751 720 758 787
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
PD HD
Prevalent patients starting PD vs HD1998 - 2018
Portuguese Registry of Dialysis and Transplantation 2018
type of renal replacement therapy modality used by ESRD patientsHow do we compare?
Portuguese Registry of Dialysis and Transplantation 2018
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 2018
7276 4484863
4951 3392853
0%
20%
40%
60%
80%
100%
HD PD Kidney tx
Man Women
Gender distribution in each modality31st December 2018
Portuguese Registry of Dialysis and Transplantation 2018
2585,8
1501,4
pm
p
Man Women
Prevalence by gender, all RRTper million population 31st December 2018
Portuguese Registry of Dialysis and Transplantation 2018
Diabetes31,5%
Hypertension13,9%
Chronic Gln11,9%
Policystic Disease5,1%Hipoplasia/Displasia
0,6%
Other Known19,3%
Unknown17,8%
Primary renal disease of patients accepted for dialysisHD and PD during 2018
Not available = 9
Portuguese Registry of Dialysis and Transplantation 2018
Diabetes in incident patientsHow do we compare?
Portuguese Registry of Dialysis and Transplantation 2018
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 2018
Diabetes27,8%
Hypertension13,8%
Chronic Gln13,8%
Policystic Disease6,2%
Hipoplasia/Displasia0,7%
Other Known18,5%
Unknown19,2%
Primary renal disease of prevalent patientsHD and PD, 31st December 2018
N = 12762Not available = 220
Portuguese Registry of Dialysis and Transplantation 2018
Portuguese Registry of Dialysis and Transplantation 2018
1655
1833 1800
1939 19562016
21292038
2273 2286 2285 2300 2312
21432084
2210 22332106
22062113
2378
0
500
1000
1500
2000
2500
98 99 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
New patients accepted for hemodialysis1998 - 2018
Portuguese Registry of Dialysis and Transplantation 2018
98 99 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
PD or Ktx to HD 211 178 172 213 268 208 251 274 224 258
Incident 1655 1833 1800 1939 1956 2016 2129 2038 2273 2286 2285 2300 2312 2143 2084 2210 2233 2106 2206 2113 2378
1400
1600
1800
2000
2200
2400
2600
All patients accepted for hemodialysisIncident and returning from other modalities 1998 - 2018
2636
Portuguese Registry of Dialysis and Transplantation 2018
Incident patients accepted for hemodialysisper million population 2008 - 2018
215,21 216,42 217,34
202,90
197,31
210,73
214,15
202,99
212,97
204,96
231,08
180,00
190,00
200,00
210,00
220,00
230,00
240,00
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
pm
p
Portuguese Registry of Dialysis and Transplantation 2018
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
NO 816 702 737 694 737 716 655 509 537 473 500
YES 1464 1483 1522 1410 1342 1477 1541 1597 1629 1640 1878
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Previous follow-up by nephrology (> 3 months)HD patients 2008 – 2018
Portuguese Registry of Dialysis and Transplantation 2018
Norte Centro Lisboa Sul Açores Madeira Global Hosp Perif
NO 104 109 190 87 6 4 500 147 353
YES 576 392 568 259 40 43 1878 234 1644
576392 568 259
40 431878
234
1644
104109 190 87
6 4500
147
353
0%
20%
40%
60%
80%
100%
Previous follow-up by nephrology (> 3 months)HD patients, by country region and facility type - 2018
Portuguese Registry of Dialysis and Transplantation 2018
202
197
210,7214,15
202,99
212,97
204,96
231,08
186,52 185,3
199,8202,26
190,75
199,17
193,51
218,83
180
190
200
210
220
230
240
2011 2012 2013 2014 2015 2016 2017 2018
pm
p H
D
Inc d0 Inc d91
5,6%
Incident patients accepted for hemodialysis
Day 0 and day 91, 2011-2018
7,7%
5,2%
5,9%
6,5%
6,0%5,6%
5,3%
Portuguese Registry of Dialysis and Transplantation 2018
0
200
400
600
800
1000
HD
5
843
952
578P
ati
en
ts c
ou
nt
< 18 years old (0,2%) 18 a 65 years old (35,4%) 65 a 80 years old (40%) >80 years old (24,4%)
Patients accepted for hemodialysis by age group, during 2018
Portuguese Registry of Dialysis and Transplantation 2018
0
1000
2000
3000
4000
5000
HD
14
45344934
2745
Pat
ien
ts c
ou
nt
< 18 years old (0,1%) 18 a 65 years old (37,1%) 65 a 80 years old (40,4%) >80 years old (22,4%)
Patients treated by hemodialysisby age group , 31st December 2018
Portuguese Registry of Dialysis and Transplantation 2018
Incident and prevalent patients treated by hemodialysisby country region, 2018
0
500
1000
1500
2000
2500
3000
3500
4000
Nort Center South Lisbon Azores Madeira
680501
346
758
46 47
3555
2370
2021
3845
187 249
Incident Patients Prevalent Patients
Portuguese Registry of Dialysis and Transplantation 2018
Incident and prevalent patients treated by hemodialysisper million population by age group, 2018
0,00
1000,00
2000,00
3000,00
4000,00
5000,00
Global < 65years
65 to 80years
> 80years
231,08104,98
607,77893,51
1188,12
563,40
3148,65
4241,85
Incidence Prevalence
Portuguese Registry of Dialysis and Transplantation 2018
5989 6455 67017071
7370 75598077
83928708
90379303
964610152
10409 1054010977
11350 1151411836 11985
12227
0
2000
4000
6000
8000
10000
12000
14000
98 99 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Pat
ien
ts c
ou
nt
Patients treated by hemodialysis31st of December each year, 1998 – 2018
Portuguese Registry of Dialysis and Transplantation 2018
5989 6455 67017071
7370 75598077
83928708
90379303
964610152
10409 1054010977
11350 1151411836 11985
12227
0
2000
4000
6000
8000
10000
12000
14000
98 99 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Pat
ien
ts c
ou
nt
Patients treated by hemodialysis31st of December each year, 1998 – 2018
Portuguese Registry of Dialysis and Transplantation 2018
Hemodialysis growth 2018 vs 2017 (%)31st of December each year
0
2
4
6
8
10
12
14
All Hospital Center
12,5
14
12,2
2 1,7 2
Var
iati
on
201
7/2
01
8 (
%)
Hemodialysis Growth Portugal
Incident pts % Prevalent pts %
Portuguese Registry of Dialysis and Transplantation 2018
Distribution of hemodialysis patients by type of dialysis facility 31st of December 2018
9%
91%
In Hospital In center
N = 12227In Hospital:1146In Center:11081
Portuguese Registry of Dialysis and Transplantation 2018
Patients treated by hemodialysisdistribution by techniques in each age group, 31st of December 2018
0
1000
2000
3000
4000
5000
6000
7000
Low flux HD High flux HD Hemodiafiltration
270
4944
7013
132
1746
2672
87
1985
2861
51
12131480
Nº
pat
ien
ts
Total < 65 years 65 a 80 years >80 years
N = 12227low flux 2,2% (2,4% in 2017)
Portuguese Registry of Dialysis and Transplantation 2018
946 761 874 629 405 346 314 313 304 323 270
52695307
48434726 5000 5080
4076 4013 41175166 4944
3088 35744435
5054 5132 55516960 7188 7317
6496 7013
0%
20%
40%
60%
80%
100%
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
Nº
pat
ien
ts
Low flux High flux Hemodialfiltration
Patients treated by hemodialysisdistribution by techniques, 31st Dec. 2008 - 2018
Portuguese Registry of Dialysis and Transplantation 2018
48 0 11 115
96
270
195
75
1618938
416
1848
91
33
4944
510
4434
18891429
1594
1885
216
7013
441
6572
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
N = 12227 by end of December 2018
Patients treated by hemodialysisdistribution by techniques by region and facility type, 31st Dec. 2018
Portuguese Registry of Dialysis and Transplantation 2018
Mean Age of patients treated by hemodialysis31st of December 2008 – 2018
64,3
65,02
65,99
66,4966,8 66,9
67,1767,47
67,6867,89 68,02
62
63
64
65
66
67
68
69
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
Mea
n a
ge
Portuguese Registry of Dialysis and Transplantation 2018
55
60
65
70
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
Islands 60,8 61,9 61,9 62,4 60,3 62,4 62,6 62,4 63,6 65,0 64,2
Lisbon 62,7 62,4 64,5 65,2 65,2 65,1 65,8 66,2 66,7 66,5 65
North 63,7 64,8 65,8 66,3 66,7 66,8 66,8 67,2 67,4 67,7 68,1
South 66,2 67 67,3 66,7 68 67,9 68 69,1 68,5 69,0 68,9
Centre 66 68 68,2 68 68,7 69,1 69,5 69,5 69,7 69,9 69,8
Mea
n a
geMean Age of patients treated by hemodialysis
by country region, 31st of December 2008 – 2018
Portuguese Registry of Dialysis and Transplantation 2018
Diabetes32,5%
Hypertension14,2%
Chronic Gln10,3%
Policystic Disease5,2%Hipoplasia/Displasia
0,3%
Other Known19,3%
Unknown18,2%
Primary renal disease of patients accepted for hemodialysisduring 2018
N = 2378
Portuguese Registry of Dialysis and Transplantation 2018
Etiology of All patients accepted for hemodialysisduring 2018
Diabetes29,3%
Hypertension12,8%
Chronic Gln9,3%
Policystic Disease4,7%
Hipoplasia/Displasia0,3%Other Known
17,4%
Unknown16,4%
Tx/DP Failure9,8%
N = 2636
Portuguese Registry of Dialysis and Transplantation 2018
DM28,1%
HTA13,9%
GNC12,8%
DRPQA5,8%hip/displasia
0,7%
other Known19,2%
unknwon18,7%
Not available0,8%
Primary renal disease of prevalent hemodialysis patients31st December 2018
N = 1219433 not available
Portuguese Registry of Dialysis and Transplantation 2018
Diabetes as primary renal disease in HD patientsIncident and prevalent (%) 2008 - 2018
3132
33,632,6
32 32,233
34,6
33 33,432,5
25 25
26,927,7 28 28,2 28,2 28,7 29,1 28,7
28,1
20
25
30
35
40
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
% D
iab
etes
Incident Pt Prevalent Pt
Portuguese Registry of Dialysis and Transplantation 2018
Viral status in HD prevalent patients31st December 2018
94,27%
1,18%
2,99%
1,56%
Neg Hbs Ag + HCV Ab + HIV Ab +N = 12227
Portuguese Registry of Dialysis and Transplantation 2018
Hepatitis C viral status in HD prevalent pts31st December 2016 – 2017 - 2018
0
50
100
150
200
250
300
HCV Ab+/RNA+ HCV Ab+/RNA- Seroconv to RNA - Incid HCV +
2016 197 205 120 15
2017 149 128 119 15
2018 99 266 82 16
2016 2017 2018
Portuguese Registry of Dialysis and Transplantation 2018
Vascular access
Portuguese Registry of Dialysis and Transplantation 2018
Vascular access of HD incident patientsduring 2018
AVFistula39,1%
Graft1,9%
Tunneled catheter51,6%
Non-tunneled cat.7,3%
N = 236612 unavailable
Portuguese Registry of Dialysis and Transplantation 2018
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
Non-tunneled cat. 296 282 219 188 163 143 163 81 103 117 173
Tunneled cat. 864 940 1034 1033 1007 1101 1088 1068 1093 1094 1222
Graft 109 111 117 71 61 61 60 74 59 57 45
AVFistula 990 895 931 844 844 870 912 872 940 862 926
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Vascular access of HD incident patients2008 – 2018
Portuguese Registry of Dialysis and Transplantation 2018
Catheter rate (%) in the first HD session of incident patients 2008 – 2018
51,4
54,854,5
57,2
56,4
57,2
56,3
54,854,5
56,9
58,6
46
48
50
52
54
56
58
60
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
Portuguese Registry of Dialysis and Transplantation 2018
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 InHospital
In Center
AVFistula Graft Tunneled Catheter Non-tunneled Cat.
Vascular access of HD incident patientsby country region and facility type
N = 236612 not
available
Portuguese Registry of Dialysis and Transplantation 2018
Vascular access of HD prevalent patients31st December 2018
AVFistula73,5%
Graft9,0%
Tunneled catheter17,3%
Non-tunneled cat.0,2%
N = 122234 not available
Portuguese Registry of Dialysis and Transplantation 2018
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
Non-Tunneled Cat 76 39 42 25 16 23 15 24 2 10 35
Tunneled Catheter 1572 1769 1953 1905 1889 1834 1770 1804 1895 1971 2109
Graft 1191 1256 1365 1402 1349 1358 1317 1273 1239 1216 1101
AVFistula 6464 6538 6788 7077 7257 7750 8202 8434 8598 8782 8978
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Vascular access of HD prevalent patients31st December, 2008 - 2018
Portuguese Registry of Dialysis and Transplantation 2018
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.
83,9%73,8%
68,4%67,9% 71,1%
51%
73,5%
60%
74,8%
Vascular access of HD prevalent patientsby country region and facility type, 31st of December 2018
N = 122234 not available
Portuguese Registry of Dialysis and Transplantation 2018
Vascular access of prevalent patients (%)31st December, 2008 - 2018
69,5 68,1 66,9 68 69 70,772,6 73,1 73,3 73,3 73,5
12,8 13,1 13,5 13,5 12,8 12,4 11,7 11 10,6 10,2 9
17,7 18,8 19,7 18,5 18,1 16,9 15,8 15,8 16,2 16,5 17,5
0
10
20
30
40
50
60
70
80
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
% o
f p
ati
en
ts
AVFistula Graft Catheter
Portuguese Registry of Dialysis and Transplantation 2018
AV Fistula rate of prevalent patients (%)31st December, 2008 - 2018
69,5
68,1
66,9
6869
70,7
72,673,1 73,3 73,3 73,5
60
62
64
66
68
70
72
74
76
78
80
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
% o
f p
atie
nts
Portuguese Registry of Dialysis and Transplantation 2018
12,813,1
13,5 13,5
12,812,4
11,7
1110,6
10,2
9
8
9
10
11
12
13
14
15
16
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
% o
f p
atie
nts
Graft rate of prevalent patients (%)31st December, 2008 - 2018
Portuguese Registry of Dialysis and Transplantation 2018
17,7
18,8
19,7
18,518,1
16,9
15,8 15,816,2 16,5
17,5
10
12
14
16
18
20
22
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
% o
f p
atie
nts
Catheter rate of prevalent patients (%)31st December, 2008 - 2018
Portuguese Registry of Dialysis and Transplantation 2018
Catheter rate of prevalent patients (%)31st December 2018
72,0
4,1
0,0
10,0
20,0
30,0
40,0
50,0
60,0
70,0
80,0
17,5%
42 centers above 20% cat rate19 centers below 10% cat rateNational rate = 17,5%Standard deviation = 3,6
Portuguese Registry of Dialysis and Transplantation 2018
72,0
5,4
0,0
10,0
20,0
30,0
40,0
50,0
60,0
70,0
80,0
19 centers above 20% cat rate2 centers below 10% cat rateNational rate = 33,6%Standard deviation = 20,1
Catheter rate of prevalent patients (%)In Hospital HD patients - 2018
33,6%
Portuguese Registry of Dialysis and Transplantation 2018
Catheter rate of prevalent patients (%)In Center HD patients - 2018
40,8
15,8
4,1
0,0
5,0
10,0
15,0
20,0
25,0
30,0
35,0
40,0
45,0
23 centers above 20% cat rate17 centers below 10% cat rateNational rate = 15,8%Standard deviation = 3,6
Portuguese Registry of Dialysis and Transplantation 2018
Mortality - hemodialysis
Portuguese Registry of Dialysis and Transplantation 2018
< 65 years 65 - 80 years >80 years
Prevalent 4548 4932 2744
Died 297 629 734
297
629
734
Deaths in hemodialysisby age group in 2018
* 82,1% of 1660 patients that died in
2018 were more than 65 years old and
44,2% more than 80 years
* 7,6% of deaths occurred during the
first 90 days after starting dialysis
* Mortality in the first 90 days was
4,78% (5,05% em 2017)
Portuguese Registry of Dialysis and Transplantation 2018
Death causes in HD patientsduring 2018
Cardiovascular24,8%
Sudden death8,5%
Infection (related with VA)1,7%
Infection (not related with VA)
21,6%Malignancy
11,5%
Cachexia8,0%
Others known13,4%
Unknown10,4%
N=1660
Portuguese Registry of Dialysis and Transplantation 2018
Deaths in hemodialysis2011 - 2018
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
Cardiovascular Sudden death Infection (related to VA)Infection (not related to VA) Malignancy CachexiaOthers Known Not available
Portuguese Registry of Dialysis and Transplantation 2018
Cardiovascular and Infection deaths in hemodialysis (%)2008 - 2018
31,8
29,828,5
27,728,6
26,9
24,2 24,4 24,7 24,5 24,8
17,9 17,916,9
22,022,9
20,7
24,0 23,422,2
23,021,6
10,0
15,0
20,0
25,0
30,0
35,0
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
CV
Inf (not rel VA)
Portuguese Registry of Dialysis and Transplantation 2018
31,8
29,828,5
27,728,6
26,9
24,2 24,4 24,7 24,5 24,8
23,222,6 22,2
25,1
26,7
23,2
25,8
24,325,3
23,3
10,0
15,0
20,0
25,0
30,0
35,0
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
CV
Inf (all)
Cardiovascular and Infection deaths in hemodialysis (%)2008 - 2018
Portuguese Registry of Dialysis and Transplantation 2018
Death causes during the first 90 days of HD2018
Cardiovascular23,8%
Sudden death11,1%
Infection (related with VA)
2,4%
Infection (not related with VA)
17,5%
Malignancy17,5%
Cachexia7,9%
Others known5,6%Unknown
14,3%
N=126
Portuguese Registry of Dialysis and Transplantation 2018
Patients movement in 2018
0
100
200
300
400394
5469
94 99
159
Nu
mb
er o
f p
ts
Out = 611 ; In = 258
Portuguese Registry of Dialysis and Transplantation 2018
IN OUT
First treatment 2378 Deaths 1660
Transplant failure 159 Transplanted 394
PD into HD 99 HD into PD 54
Stop treat. or recovery
163
GROSS MORTALITY RATE = 13,78%
HD patients movement in 2018
Portuguese Registry of Dialysis and Transplantation 2018
National gross mortality rate = 13,78%(90 day mortality = 4,78%)
Hemodialysis in hospital 20,66%(90 day mortality = 6,5%)
Hemodialysis in center 13,10% (90 day mortality = 4,4%)
Mortality rates – hemodialysis
2018
Portuguese Registry of Dialysis and Transplantation 2018
24,51
21,31 20,95
29,44
21,3920,03
21,4122,14
20,79
19,13
20,66
13,28 13,2412,35 11,82
12,76 12,3911,49
12,49 12,36 12,4213,1
14,45 14,0113,24 13,79 13,65 13,18
12,4913,28 13,09 13,03
13,78
8
10
12
14
16
18
20
22
24
26
28
30
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
Gro
ss m
ort
alit
y ra
te (
%)
HD in Hospital HD in Center All pts
Gross mortality rate in hemodialysis
2008 - 2018
Portuguese Registry of Dialysis and Transplantation 2018
14,4514,01
13,24
13,79 13,6513,18
12,49
13,28 13,09 13,03
13,78
10
11
12
13
14
15
16
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
Gro
ss m
ort
alit
y ra
te (
%)
All patients
Gross mortality rate in hemodialysis
2008 - 2018
Portuguese Registry of Dialysis and Transplantation 2018
13,28 13,24
12,35
11,82
12,7612,39
11,49
12,49 12,36 12,42
13,1
10
11
12
13
14
15
16
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
Gro
ss m
ort
alit
y ra
te (
%)
HD in Center
Gross mortality rate in hemodialysis
in center treated patients, 2008 - 2018
Portuguese Registry of Dialysis and Transplantation 2018
Gross mortality rate
Impact of deaths until day 90, 2018
13,7813,1
20,66
12,74 12,22
18
7
9
11
13
15
17
19
21
23
All In Center In Hospital
Gro
ss m
ort
alit
y ra
te (
%)
Mortality since d1 Mortality since d91
4,39% died until d90
6,56% died until d90
4,7% died until d90
Portuguese Registry of Dialysis and Transplantation 2018
Mean Age Mortality
since d1
Mortality
since d91
Deaths until d90 (% of incident)
Global 68,02 13,78% 12,74% 4,75%
North 68,1 12,99% 11,51% 6,93%
Center 69,8 15,78% 15.01% 2,98%
South 68,9 13,34% 12,6% 3,93%
Lisbon 65 13,69% 12,97% 3,18%
Azores 63,8 13,45% 5,6% 26,92%
Madeira 64,4 12,20% 11,79% 2,00%
Gross mortality rates – hemodialysis
since d1 and d91 by country region, 2018
Portuguese Registry of Dialysis and Transplantation 2018
20,8%(2542)
79,2%
YES NO
Waiting list for renal transplantationHemodialysis patients, 2018
Portuguese Registry of Dialysis and Transplantation 2018
13,5%
7,3%
79,2%
Normal and Urgent Temporary out No
Waiting list for renal transplantationHD patients, Active and temporary contraindication - 2018
Portuguese Registry of Dialysis and Transplantation 2018
Portuguese Registry of Dialysis and Transplantation 2018
103108
93101
118
102
135
116
149 147
170
229
190
227220
208216
229
215
228 229
60
80
100
120
140
160
180
200
220
240
98 99 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
New patients starting peritoneal dialysis1998 - 2018
Portuguese Registry of Dialysis and Transplantation 2018
16,01
21,55
17,86
21,520,8
19,820,7
22,1
20,76
22,12 22,25
5
10
15
20
25
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
pm
p
Incident patients accepted for peritoneal dialysisper million population 2008 - 2018
Portuguese Registry of Dialysis and Transplantation 2018
88,2%
11,8%
Yes NoN = 229
Previous follow-up by nephrology (> 3 months)PD patients, 31st of December 2018
Portuguese Registry of Dialysis and Transplantation 2018
261293
311346
376398 390
437
481517 511
571
660
704742 732 735
751720
756787
150
250
350
450
550
650
750
98 99 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Patients treated by peritoneal dialysisCount at 31st of December each year, 1998 – 2018
Portuguese Registry of Dialysis and Transplantation 2018
N = 229
Diabetes19,2%
Hypertension9,6%
Chronic GN27,1%
Policystic Disease10,0%
Hipoplasia/Displasia3,9%
Other Known17,9%
Unknown12,2%
Primary renal disease of patients accepted for peritoneal dialysisduring 2018
Portuguese Registry of Dialysis and Transplantation 2018
Diabetes15,5% Hypertension
7,8%
Chronic GN26,7%
Policystic Disease11,4%Hipoplasia/Displasia
2,3%
Other Known20,3%
Unknown16,0%
Primary renal disease of prevalent peritoneal dialysis patients31st December 2018
N = 787
Portuguese Registry of Dialysis and Transplantation 2018
0
50
100
150
200
250
300
350
400
450
CAPD APD
415
372
135
85
22 73
16
Pat
ien
ts c
ou
nt
Total > 65 years > 80 years < 18 years
N = 787APD:47,2%
Age>65 years:27,9%; Age>80years:3,6%
Patients treated by peritoneal dialysisManual vs automated, 31st of December 2018
Portuguese Registry of Dialysis and Transplantation 2018
787
415372
0
100
200
300
400
500
600
700
800
900
Total CAPD APD
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
Patients treated by peritoneal dialysisManual vs automated, 31st December 1998 - 2018
Portuguese Registry of Dialysis and Transplantation 2018
36,8
44,4
53,1
58,160,6
63,1 63,1
56,8
71,1
6461,1
53,2 52,149,7
41,3 41,5
47,543,9 43,8
41,7
47,2
0
10
20
30
40
50
60
70
80
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2106 2017 2018
% o
fp
atie
nts
Automated Peritoneal Dialysis usage (%)31st December 1998 - 2018
Portuguese Registry of Dialysis and Transplantation 2018
0
50
100
150
200
250
300
North Center South Lisbon Islands
266
143
78
234
66
Nu
mb
ero
f Pa
tien
ts
2010 2011 2012 2013 2014 2015 2016 2017 2018
Patients treated by peritoneal dialysisby region, 31st of December 2010 to 2018
N = 787 (2018)
Portuguese Registry of Dialysis and Transplantation 2018
50,3
50,9
51,5
50,1
52,2
53,7 53,9
54,5 54,554,8
55,1
47
48
49
50
51
52
53
54
55
56
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
Mea
nag
e (y
ears
)
Mean Age of patients treated by peritoneal dialysis31st of December 2008 – 2018
Portuguese Registry of Dialysis and Transplantation 2018
95,55%
1,78%
1,40%
1,27%
Neg HbsAg + AntiVHC + AntiHIV +
Viral status in PD prevalent patients31st December 2018
N = 787
Portuguese Registry of Dialysis and Transplantation 2018
IN OUT
New patients 229 Death 46
KTr failure 15 Transplant 74
HD to PD 53 PD to HD 123
Suspension 7
Renal Recovery 7
Mortality rate = 5,22 % (90 d mortality = 2,7%)
PD patients movement in 2018
Portuguese Registry of Dialysis and Transplantation 2018
8,93
7,09
5,62
6,79
6,73
5,54
5,425,33
7
5,16
5,22
4
5
6
7
8
9
10
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
Gro
ssm
ort
alit
yra
te(%
)
Gross mortality rate in peritoneal dialysis
2008 - 2018
Portuguese Registry of Dialysis and Transplantation 2018
Death causes in PD patients2018
CardioVasc44,2%
Sudden death14,0%
Infection (PD related)14,0%
Infection ( Not PD related)11,6%
Neoplasia9,3%
Cachexia4,7%
Others Known2,3%
N = 46
8 patients died until day 90;
2,7% of incidente patients and
17% of all deaths
Portuguese Registry of Dialysis and Transplantation 2018
Reasons for PD withdraw2018
N = 114
Infection33,3%
UF failure/Inadequacy28,9%
Mechanical problems17,5%
Non compliance8,8%
Others11,4%
Portuguese Registry of Dialysis and Transplantation 2018
Peritonitis episodes2018
N = 273
0,31 episodes / patients-2018
0,50,48
0,45 0,460,43
0,45
0,41
0,370,35
0,29 0,31
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
Per
ito
nit
is r
ate
Portuguese Registry of Dialysis and Transplantation 2018
49,3%
50,7%
YES NO
PD patients in waiting list for renal transplantation2018
Portuguese Registry of Dialysis and Transplantation 2018
39,0%
10,3%
50,7%
Normal and Urgent Temporary out No
PD patients in waiting list for renal transplantationActive ant temporary contraindication for transplantation
Portuguese Registry of Dialysis and Transplantation 2018
Portuguese Registry of Dialysis and Transplantation 2018
826 30
69 63
99 106
182199
260 256
304
367
286
346370
400382
309
367 358 359
398
355
436
380393
480
525
593573
530
429448 448
485513
527505
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
Ren
al T
ran
spla
nt
cou
nts
per
yea
r
Years
Renal Transplants performed1980-2018
Total = 13164
Portuguese Registry of Dialysis and Transplantation 2018
Renal transplantation activity characterization2018
0
100
200
300
400
500
Dec
ease
d d
on
or
Dec
ease
d d
on
or
/R
ece
pto
r <1
8y
Dec
ease
d d
on
or
/R
ece
pto
r>6
5y
Livi
ng
do
no
r
Livi
ng
do
no
r /
Rec
epto
r <1
8Y
Livi
ng
do
no
r /
Re
cep
tor
>65y
446
7
48 59
2 5
Nº
of P
atie
nts
27 pre-emptive
Portuguese Registry of Dialysis and Transplantation 2018
Portuguese Transplant Centers Activity2018
0
20
40
60
80
100
120
HGSA HSMaria HG Orta CHLO StC HS João HCCabral
HSM-Ped CHUC CVP
77
65
21
42
69
58
4
108
2
30
70
9 6 4 2 1 0
9
0 0 0 0
24
0 0 00 0 0 0 0 0 0 0 00 0 0 1 0 0 0 0 00 0 0 0 0 2 0 0 0
Pat
ient
num
ber
s
Título do EixoDeceased donor Living donor Kidney and Pancreas Kidney and Liver Kidney and Heart Pacreas after Kidney
446 tx deceased donor59 (11,6%) live donor35 multi-organ transplantstotal = 505
Portuguese Registry of Dialysis and Transplantation 2018
31
3735 34
38
34
41
3638
45,3
49,45
55,853,9
50,2
40,642,7 43
46,7549,53
51,1249,07
0
10
20
30
40
50
60
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
pm
p
Renal Transplants Performedper million population, 2008 - 2018
Portuguese Registry of Dialysis and Transplantation 2018
Renal Transplanted Patients
Previous renal replacement therapy, 2015-2018
N = 505 (2018)
375
65
17
377
101
25
414
82
31
398
80
27
0
50
100
150
200
250
300
350
400
450
Hemodialysis Peritoneal Dialysis Pre-emptive
2015
2016
2017
2018
Portuguese Registry of Dialysis and Transplantation 2018
N =505
Diabetes17,6%
Hypertension10,7%
Chronic GN32,5%
Policystic Disease16,6%
Hipoplasia/Displasia2,2%
Other Known20,3%
Primary renal disease of renal transplanted patientsduring 2018
Portuguese Registry of Dialysis and Transplantation 2018
Incidence of transplantationHow do we compare?
Portuguese Registry of Dialysis and Transplantation 2018
Portuguese Registry of Dialysis and Transplantation 2018
Portuguese Registry of Dialysis and Transplantation 2018
Patients with functioning graft and annual growth31st December 1998 - 2018
2843 29893256
34723673
38614140
4408 4538
5013 5151
57945976
6440 63596636 6618 6681
72427518
7716
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
98 99 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
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%2,6%
3,8%8,4%
0,9%
4,3%
Portuguese Registry of Dialysis and Transplantation 2018 N = 7716
285299
326 335353
369393
417 430
473 485
545562
610 602633 635 642
699729
749
200
300
400
500
600
700
800
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
20
18
pm
p
Prevalence of CKD patients with functioning graftcumulative per million population end of each year 1998 - 2018
Portuguese Registry of Dialysis and Transplantation 2018
Renal transplantation: living vs deceased donor
2018
9,7%
90,3%
Living donor Deceased donor N = 7716
Portuguese Registry of Dialysis and Transplantation 2018
-400 -300 -200 -100 0 100 200 300 400 500 600
8081828384858687888990919293949596979899
0123456789
101112131415161718
Number
Yea
rs
Lost grafts Transplantations
Renal transplantation activity1980 - 2018
2018: 101 patients died with functioning graft;
152 transferred to HD / 13 transferred to PD
Portuguese Registry of Dialysis and Transplantation 2018
Gabinete do Registo da Doença Renal Crónica
da
Sociedade Portuguesa de Nefrologia