Gabinete do Registo da Doença Renal Crónica Sociedade ...1984: nationalregistry forChronic Renal Insufficiency was created by Prof. Dr. Jacinto Simões, President of the Portuguese

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



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



Ana Galvão

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



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



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



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



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



Ana Galvão

Incidence How do we compare?



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



Ana Galvão



Ana Galvão



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



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



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



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



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



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



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



Ana Galvão

Prevalence How do we compare?



Ana Galvão



Ana Galvão



Ana Galvão

vol 2 Figure 11.9 Prevalence of treated ESRD (per million

population), by country, 2016




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



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



Ana Galvão

type of renal replacement therapy modality used by ESRD patients

How do we compare?



Ana Galvão

vol 2 Figure 11.12 Percentage distribution of type of renal

replacement therapy modality used by ESRD patients, by country, in

2016




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



Ana Galvão

2595,64

1482,7

pm

p

Man Women

Prevalence by gender, all RRT per million population 31st December 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



Ana Galvão

Diabetes in incident patients How do we compare?



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




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



Ana Galvão



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



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



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



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



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



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



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



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



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



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



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



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



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 %



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



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)



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



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



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



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



Ana Galvão

Diabetes 34,6%

Hypertension 13,6%

Chronic Gln 10,2%



Other Known 20,3%

Unknown 16,2%

Primary renal disease of patients accepted for hemodialysis during 2019

N = 2343 13 not available



Ana Galvão

Etiology of All patients accepted for hemodialysis during 2019

Diabetes 31,1%

Hypertension 12,2%

Chronic Gln 9,2%


Hipoplasia/Displasia 0,5% Other Known

18,3%

Unknown 14,6%

Tx/DP Failure 9,9%

N = 2601



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




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



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



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



Ana Galvão

Vascular access



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



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



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



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




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%




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



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



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



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



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



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



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%



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



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



Ana Galvão

Mortality - hemodialysis



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



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



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



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)



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



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



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



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



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



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


2009 - 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


in center treated patients, 2009 - 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



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



Ana Galvão

[PERCENTAGEM] (2614)

79,0%

YES NO

Waiting list for renal transplantation Hemodialysis patients, 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



Ana Galvão



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



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



Ana Galvão

80,7%

19,3%

Yes No N = 285

Previous follow-up by nephrology (> 3 months) PD patients, 31st of December 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



Ana Galvão

Diabetes 21,8%

Hypertension 8,5%

Chronic GN 24,6%



Other Known 18,0%

Unknown 15,1%

Primary renal disease of patients accepted for peritoneal dialysis during 2019

N = 284



Ana Galvão

Diabetes 16,9%

Hypertension 8,0%

Chronic GN 26,3%



Other Known 19,4%

Unknown 14,9%

Primary renal disease of prevalent peritoneal dialysis patients 31st December 2019

N = 852



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



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



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



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)



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



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



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



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



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



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%



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



Ana Galvão

49,5%

50,5%

YES NO

PD patients in waiting list for renal 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



Ana Galvão



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



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



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



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



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



Ana Galvão

N =514

Diabetes 17,0%

Hypertension 8,0%

Chronic GN 31,6%



Other Known 24,6%

Primary renal disease of renal transplanted patients during 2019



Ana Galvão

Incidence of transplantation How do we compare?



Ana Galvão



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



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



Ana Galvão

Renal transplantation: living vs deceased donor

2019

10,6%

89,4%

Living donor Deceased donor N = 7265



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



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




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


Gabinete do Registo da Doença Renal Crónica

da

Sociedade Portuguesa de Nefrologia

Documents

Gabinete do Registo da Doença Renal Crónica Sociedade ...1984: nationalregistry forChronic Renal Insufficiency was created by Prof. Dr. Jacinto Simões, President of the Portuguese