MO930BURDEN OF DISEASE IN INCIDENT DIALYSIS PATIENTS WAIT LISTED FOR KIDNEY TRANSPLANTATION 2008 – 2016 IN GERMANY. (29th May 2021)

• Record Type: Journal Article
• Authors: Wagner, Martin; Arns, Wolfgang; Rascher, Katherine; Cramer, Heyke; Schaller, Mathias; Bach, Dieter; Von Gersdorff, Gero
• Is Part Of: Nephrology dialysis transplantation. Volume 36(2021)Supplement 1
• Publication Date: 2021-05-29
• Subjects: Nephrology -- Periodicals; Hemodialysis -- Periodicals; Kidneys -- Transplantation -- Periodicals; Hemodialysis; Kidneys -- Transplantation; Nephrology; Periodicals; 616.61
• DOI: 10.1093/ndt/gfab110.009
• Languages: English
• ISSNs: 0931-0509

Abstract

Abstract: Background and Aims: Only a subset of all patients on dialysis is eligible for kidney transplantation (KTx) due to the large variation of mortality risk. It has been shown that the burden of disease is increasing over the last years in patients at dialysis inception. Moreover, the number of available kidney grafts is decreasing, resulting in a prolonged time on the waiting list. In our study we describe the burden of disease and 3-year mortality in a sample of incident dialysis patients in Germany, stratified by KTx status, including trends over time. Method: The QiN (Quality in Nephrology) dataset is a registry-based observational study in which >90% of all patients treated in dialysis centers of the non-profit kidney care provider KfH are enrolled. In our analyses we included all adult patients beginning dialysis treatment between 2008 and 2016. Primary outcome was 3-year all-cause death up until Dec 31, 2019. Patients were stratified by last available KTx- status: (a) KTx within 3 years, (b) on dialysis - on waiting list, (c) on dialysis - in evaluation for KTx, (d) on dialysis - KTx never planned, (e) on dialysis - KTx status missing. The burden of disease was assessed by the AROii score (Floege et al. 2015), a predictive model including patient characteristics, laboratory variables and dialysis parameters. Results: Of a total of n=25987 incident patients analyzed, 3.2% underwent KTx within 3 years, 10.6% were listed for KTx, and 13.4% were in evaluation. In 49.5% KTx was never planned and in 23.3% KTx status was missing. These groups differed significantly in median AROii score, reflecting their burden of disease at dialysis inception: KTx never planned or missing (AROii score 10) as compared to KTx (AROii score 1), listed (AROii score 3) and in evaluation (AROii score 4) (p<0.001). Similarly, 3-year observed mortality (n=8059 [31%]) differed widely across KTx strata (log rank p<0.001), ranging from 11% in listed patients to 44% (HR 5, 982; [5.335; 6.707]) in those with missing KTx status (figure ). In the period 2008-2019 the number of KTx within 3 years decreased, but the proportion of patients on the waiting list and the proportion of patients in evaluation increased. In all patients on dialysis the burden of disease at dialysis inception increased over time across KTx strata (p<0.05). Conclusion: About three quarters of patients started dialysis with a very high mortality risk and at least half of them were considered ineligible for KTx. Patients listed or in evaluation for KTx in Germany have become sicker over the last decade. With decreasing numbers of KTx in Germany the time on the waiting list is prolonged. Longer waiting times and the increasing burden of disease result in advanced risk at the time of transplantation.