DANSK NEFROLOGISK SELSKAB

Transkript

1 . DANSK NEFROLOGISK SELSKAB Landsregister for patienter i aktiv behandling for kronisk nyresvigt Rapport for Danmark 2002 Danish National Registry Report on Dialysis and Transplantation in Denmark 2002 The Danish Society of Nephrology

2 DANSK NEFROLOGISK SELSKAB Landsregister for patienter i aktiv behandling for kronisk nyresvigt Rapport for Danmark 2002 Danish National Registry Report on Dialysis and Transplantation in Denmark 2002 The Danish Society of Nephrology

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4 Forord Aktiv behandling af kronisk nyresvigt omfatter dialyse og nyretransplantation. Formålet med Dansk Nefrologisk Selskabs Landsregister (L) er at indhente relevante kliniske og para-kliniske oplysninger om disse patienter og videregive en vurdering heraf. I 1993 udkom den første rapport, som omfattede perioden fra 1/1-90 til 1/1-93. Siden er rapporteringen foregået årligt. Registrets officielle navn er: Den landsdækkende kliniske database for patienter i aktiv behandling for kronisk nyresvigt. Registret ejes af og er hjemmehørende i Københavns Amt. er ansvarlig for indsamling af talmaterialet og behandling af de indsamlede data. Dette organiseres af et registerudvalg nedsat af. Formanden er den til enhver tid siddende formand for. Fast medlem af udvalget er den registeransvarlige, som formelt har ansvaret for datasikkerhed over for såvel som Københavns Amt. Udvalgets øvrige medlemmer består af læger med speciel interesse for registrering og epidemiologisk forskning. Udvalgets nuværende medlemmer er: Overlæge Bo Feldt-Rasmussen. Formand for registerudvalget. Er ansvarlig for dets funktion og tilfredsstillende relationer til bestyrelse og medlemmer. Overlæge Tom Buur med speciel interesse for registrering af hæmodialyse. Overlæge James Heaf med speciel interesse for P-dialyse. Overlæge Hans Løkkegaard. Registeransvarlig og ansvarlig for drift, kontakt med ansvarlige myndigheder, kontakt til andre registre (Scandiatransplant, Nordiske uræmiregistre, Cancerregister, ERA-EDTA), Datakonsulenter (Uni-C) og endelig udformning af den årlige rapport. Overlæge Niels Løkkegaard med speciel interesse for Hæmodialyse og relationer til Cancerregistret. Overlæge Melvin Madsen med speciel interesse for nyretransplantationer. Den nye udgave af den landsdækkende kliniske database er et Windows-baseret program med de tekniske fordele, den moderne teknik muliggør. Dette program anvendes i år for tredie gang. Indføring af ny teknik skaber ofte problemer og i de sidste par år har vi måttet igennem en periode med tilretning af tekniske mangler. Dette er nu overstået takket være bl.a. økonomisk støtte fra Nyreforeningen, som vi bringer en varm tak. Vi har bevaret den oprindelige organisation med indtastning af data på de enkelte centre og årlig tilførsel af data centralt via diskette. Den tekniske udformning af databasen tillader anvendelse af Internettet og Uni-C har foreslået en løsning, som vil tillade direkte indtastning på nettet. Alt nyt efterlader ofte en periode med især tekniske problemer og organisationen omkring indsamling af data er meget følsom for dette. Vi derfor fundet det nødvendigt at forholde os afventende. 3

5 Registret indeholder nu data på 8670 patienter, som 1/1 90 enten var eller siden er påbegyndt behandling. Der ydes på de nefrologiske afdelinger en betydelig indsats med indtastning af data og der er god grund til at takke de mange, som har været involveret i dette betydelige arbejde. I 1997 lykkedes det at etablere samarbejde med Scandiatransplant og Cancerregistret. Der er siden udvekslet data mellem L og nævnte registre. I 1997 muliggjorde dataudvekslingen en analyse af vævstypernes betydning for 8 års nyretransplantation. I 1998 resulterede samarbejdet med Cancerregistret i den første analyse af cancerudviklingen hos patienter med terminal nyresvigt. Samarbejdet med de to registre er planlagt at fortsætte og datatilsynet har givet sit samtykke til udveksling af data. Et samarbejde mellem de nordiske uræmiregistre er under opbygning. Endelig fortsætter samarbejdet med ERA-EDTA registret, som hvert år modtager data via L. Registret indeholder en række para-kliniske parametre beregnet til at vurdere kvaliteten af forskellige terapeutiske tiltag. Indtil videre er antallet beskedent, et forhold som næppe ændres før den moderne teknik tillader automatisk overførsel af laboratorieresultater fra sygehusenes EDB-systemer - en udvikling, som må formodes at accelerere de nærmeste år. Disse parametre vil med tiden være værdifulde værktøjer til at sikre en ensartet god behandlingskvalitet i Danmark. Registrering af patientdød har vist sig at være et svagt punkt i registreringen. Vi har derfor valgt også i år at samkøre registrets data med CPR-registret. Denne usikkerhed er hermed bragt ud af verden. April 2003 Hans Løkkegaard 4

6 Preface The Danish Registry on Regular Dialysis and Transplantation was founded in 1990, and since then all patients actively treated for end-stage renal disease (ESRD) have been registered now including 8670 patients. Data is input using identical software programs in all renal centres, and once yearly data are sent to a central database. Here the material is checked for errors, and appropriate corrections are made in dialogue with the reporting centres. Finally, a national report is prepared, and data are transferred to the registry maintained by the European Dialysis and Transplant Association (EDTA), the Danish Cancer Registry and Scandiatransplant. Data exchange with the Danish Cancer Registry and Scandiatransplant was started in In 1998 this collaboration resulted in a report concerning the influence of tissue typing on graft survival in Denmark since Moreover, in 1999 the first report on development of cancer in Danish ESRD patients was published. The registry was founded and is maintained by the Danish Society of Nephrology (). Reports are published annually. April 2003 Hans Løkkegaard National Co-ordinator 5

7 Indholdsfortegnelse Table of Contents Side 3-5 Side 8 Side 9 Forord/Preface Almene oplysninger Danske nefrologiske centre General information Renal centres in Denmark Befolkningsunderlag for de nefrologiske centre Population and renal centres in Denmark Prævalensdata Side 10 Patienter i aktiv behandling for kronisk nyresvigt Patients in active treatment for ESRD Side 11 Fordeling og udskiftning mellem de forskellige patientgrupper i 2002 Changes in the number of patients in therapy for ESRD during 2002 Side Prævalens for HD, PD og TX og en prognostisk vurdering Prevalence for HD, PD and TX and calculated prognostic values Side 14 Prævalens for hjemme- og centerdialyse i Danmark Prevalence for home and centre-dialysis in Denmark Side 14 Fordeling af dialysemetoder i 2002 Treatment modalities for ESRD 2002 Side 15 Behandlingsformer for ESRD Treatment modalities for ESRD Incidensdata Side 16 Tilkomne patienter på de enkelte centre New patients in the renal centres Side 17 Procentiske aldersfordeling af nye patienter i 2002 Percentage age distribution of new patients in 2002 Side 18 Antal patienter over og under 60 fra 1990 til 2002 Age distribution above/below 60 years since 1990 Aldersfordeling for pt. som påbegyndte behandling i 2002 Age distribution for patients starting treatment in 2002 Renale diagnoser/renal diagnoses Side 19 Renale diagnoser i 1990 og 2002 Renal diagnoses 1990 and 2002 Side 20 Renale diagnoser 2002 Renal diagnoses 2002 Side 21 Renale diagnoser Renal diagnoses

8 Dialyse/Dialysis Side 22 Side 22 Side 23 Side 24 P-dialyse. KTV, HB, P-kreatinin og P-albumin P-dialysis. KTV, HB, P-creatinin and P-albumin Overlevelse. Betydning af HB Survival in relation to HB Overlevelse. Betydning af KTV og P-albumin Survival in relation to KTV and P-albumin Overlevelse. Betydning af P-kreatinin Survival in relation to P-creatinin Nyretransplantation/Renal Transplantation Side 25 Nyretransplantation 2002 og Renal transplantation 2002 and Side 26 Nyretransplantation Renal transplantation Side 26 Levende donor Living donor Side 27 Follow up - nyretransplantations centre Side 28 TX follow up centres Vævstypning og nyretransplantation Tissue typing and renal transplantation Side 29 Tidspunkt for start af nyrefunktion år 2002 Onset of function 2002 Side Patient og graftoverlevelse Patient and graftsurvival Dødsårsager/Causes of death Side 32 Dødsårsager 2002 Causes of death 2002 Side 33 Death rate HD, PD og TX Death rate HD, PD and TX Side 34 Death rate Death rate Side 35 Referencer References Prognostiske vurderinger/prognostic considerations Side Prognoser for dialyse- og nyretransplantationsaktiviteten i Danmark Prognosis for dialysis and kidney transplant activity in Denmark Peter Vestergaard 7

9 Fig. 1. Renal centres in Denmark

10 Renal Centres and Population in Denmark Transpl. County Dialysis Population Centre center Skejby Århus Skejby Nordjylland Aalborg Ringkøbing Holstebro Viborg Viborg Total Skejby Odense Fyn Odense Ribe Esbjerg Sønderjylland Sønderborg Vejle Fredericia Total Odense Herlev Københavns amt Herlev Total Herlev Rigshospitalet Bornholm Rønne RH Frederiksberg RH Frederiksborg Hillerød Færørerne RH Grønland RH København RH Roskilde Roskilde Storstrøm Nykøbing F Vestsjælland Holbæk Total RH Total population Table 1. Population and renal centres in Denmark as of Statistical Yearbook

11 Prevalence of ESRD Patients on dialysis or with a functioning graft Treatment CAPD APD Center-IPD PD + HD Home-IPD Center-HD Lim. Care Home-HD In dialysis Home PD HD PD+HD Center Transpl In treatment Table 2. Treatment modalities for ESRD The number of patients on dialysis has increased steadily from 1991 through In 2002 the prevalence in Denmark of patients on dialysis and with a functioning renal graft was 413 and 268 per million inhabitants, respectively. 10

12 New PD patients 193 New ESDR patients New HD patients 488 New patients All PD patients All HD patients In treatment Transplanted patients 1469 Lost to follow Recovery 5 Lost to follow 2 Decreased 513 Recovery 14 Lost to follow 12 Out of treatment Fig. 2. Changes in the number of patients treated for ESRD during 2002 status as of patients started treatment (HD, PD, RAT) in At the end of the year 3828 patients were on dialysis or had a functioning renal allograft. 11

13 Number Hemodialysis - registry data and prognosis - Denmark Registry Prognosis A Prognosis B Year Fig. 3 Peritoneal dialysis - registry data and prognosis - Denmark Number Registry Prognosis A Prognosis B Year Fig. 4 12

14 Renal transplantation - registry data and prognosis - Denmark Number 2000 Registry Prognosis A og B Year Fig. 5 Fig. 3, 4 and 5. Prognostic calculations concerning the number of hemodialysis, peritoneal dialysis and transplanted patients from to The calculations are based on data from Two different prognoses are shown. Prognosis A is based on the assumption, that the incidence continues to increase as a linear trend curve in the period from 2002 to 2010 and with unchanged mortality and changes between treatment modalities. So far, this seems to be the case. Prognosis B is based on the assumption, that the incidence has reached a maximum, but with unchanged mortality and changes between treatment modalities. There has been no increase in incidence from 2001 to See Peter Vestergaard: Prognosis for dialysis and kidney transplant activity in Denmark (page 35) and table 2 (page 10) for further details. 13

15 Prevalence - Center and Homedialysis from Denmark Number Home dialysis Centre dialysis Year Fig. 6 Number 2000 Dialysis Methods - Distribution of 2359 patients CAPD APD+IPD Centre-HD Lim-Care Home-HD PD+HD Fig. 7 14

16 Treatment of ESRD Distribution of 3828 patients With graft function Centre-dialysis Home-dialysis Fig. 8 Treatment of ESRD Distribution of 656 diabetic patients With graft function Centre-dialysis Home-dialysis Fig. 9 15

17 Incidence of ESRD Centre No. Inc. No. Inc. No. Inc. No. Inc. No. Inc. No. Inc. No. Inc. No. Inc. No. Inc. No. Inc. No. Inc. No. Inc. No. Inc. Esbjerg Fredericia Herlev Hillerød Holbæk Holstebro Hvidovre Nykøbing F 9 RH Odense Rigshosp Roskilde Rønne RH Skejby Sønderbg Viborg Ålborg Denmark Table 3. New patients (number per million per year) in the renal centres. The incidence in Denmark was rather stable from about 100. Since then the incidence has increased and is now about

18 Age distribution Year >=80 %>= Population Table 4. Percentage age distribution of patients starting treatment for ESRD For comparison the age distribution of the Danish population is also indicated. 17

19 Age distribution (%) Percent Fig % >=60 % < Year Age distribution for ESRD starting treatment in 2002 Number No. of patients Fig

20 Renal diagnosis in 1990 and 2002 Etiology of ESRD in 330 and 698 patients Unknown etiology Glomerulonephr. Pyelo/Interst. Cystic disease Vascular Diabetes Heriditary Systemic Fig

21 Renal Diagnoses 2002 Age Renal diagnosis All ESRD, unknown causes Glomerulonephritis Pyelo/interst. Nephritis Cystic renal diseas E Alport disease Other heriditary disease Renal hypoplasia Renal vascular disease Renal vasculitis Diabetes (IDDM) Diabetes (NIDDM) Systemic disease Other renal diseases Sum Table 5. Renal diagnosis in patients starting treatment for ESRD in The patients are stratified according to age. 20

22 Renal Diagnoses Year SUM Renal diagnosis ESRD,unknown causes Glomerulonephritis Pyelo/interst. Nephritis Cystic renal disease Alport disease Other heriditary disease Renal hypoplasia Renal vascular disease Renal vasculitis Diabetes (IDDM) Diabetes (NIDDM) Systemic disease Other renal diseases Sum Table 6. Renal diagnoses in patients starting treatment

23 Peritoneal dialysis - quality control PD Modality Hgb (mmol/l) CAPD 7.38 ± ± ±0.8 APD 7.39 ± ± ±0.9 Albumin (µmol/l) CAPD 531 ± ± ±69 APD 533 ± ± ±74 Creatinine (µmol/l) CAPD 745 ± ± ±240 APD 795 ± ± ±257 KT/V (/week) CAPD 2.26 ±0, ± ±0.6 APD 2.34 ± ± ±0.7 Table 7. Quality Control variables for PD patients Hemoglobin and Patient Survival 454 PD Patients Cumulative Proportion Surviving 1,00 NS 0,95 0,90 0,85 Hgb 2000 ( mol/l) < >8.0 0,80 0,75 0,70 0,65 0,0 0,5 1,0 1,5 2,0 Time (years) Fig. 13. Peritoneal dialysis-patients. Survival in relation to hemoglobin concentration. 22

24 KT/V and Patient Survival 352 PD Patients Cumulative Proportion Surviving 1,0 p<0.01 0,9 KT/ V 2000 < >2.5 0,8 0,7 0,6 0,0 0,5 1,0 1,5 2,0 Time Fig. 14 Peritoneal dialysis patients. Survival in relation to KT/V. Plasma Albumin and Patient Survival 250 PD Patients Cumulative Proportion Surviving 1,0 p< ,9 0,8 0,7 Albumin 2000 ( m ol/l ) < >600 0,6 0,5 0,4 0,0 0,5 1,0 1,5 2,0 Time Fig. 15. Survival in relation to P-albumin 23

25 Plasma Creatinine and Patient Survival 388 PD Patients Cumulative Proportion Surviving 1,0 p<0.02 0,9 0,8 Creatinine 2000 ( m ol/l) < >1000 0,7 0,6 0,0 0,5 1,0 1,5 2,0 Time Fig. 16. Survival in relation to P-creatinin 24

26 Renal transplantation Cadaver and living donors Cadaver Living Fig. 17 Renal Transplantation 2002 Renal transplantation 2002 Cadaver kidney Living donor kidney Center Sum Skejby RH Odense Herlev Total Table 8. Renal transplantations 2002, stratified according to source of organ donor organ, transplantation number (1-4) and transplantation center. 25

27 Renal transplantation Renal transplantation Cadaver kidney Living donor kidney Year Sum Table 9. Renal transplantations , stratified according to source of donor organ, transplantation number (1-4) and year of transplantation. Living donor-relation between donor and recipient Year Parents Siblings Other Unre- Sum related lated Shared haplotypes Ident. Twins Table 10. Transplantation with living donor kidneys Stratified according to donor-recipient relationship and year of transplantation. 26

28 Transplantation follow-up centres in 2002 Center No Center No. Esbjerg 6 Rigshospitalet 434 Fredericia 0 Roskilde 29 Herlev 236 Rønne 0 Hillerød 1 Holbæk 16 Sønderb. 3 Holstebro 54 Viborg 58 Nykøbing F 0 Aalborg 108 Odense 257 Skejby 267 Table 11. The distribution of ambulatory follow up of 1469 Danish renal transplant patients in 15 nephrological centres. It can be seen that most nephrological centres are involved in controlling of stable renal transplant patients. The four transplantation centres are marked. 27

29 Tissue Types Number of mismatches on HLA, A, B and DR Sum Year A mis A mis A mis A mis A mis A mis A mis A mis B mismatch B mismatch B mismatch DR mismatches A mis Total number of TX Table 12 28

30 160 Onset of function in 171 tx - Denmark delay/no to 9 10 to to to 50 > Fig. 18. Onset of function in 171 kidney transplantations in kidneys didn t function either due to delayed or no function. 29

31 Survival analysis renal transplantation Cumulative survival % Graft survival 1. Cadaver kidney End-point: 1st event graft loss or death (n=1187) Time (years) 1st Tx (n=334) 1st Tx (n=296) 1st Tx (n=262) 1st Tx (n=295) Fig. 19. Graft survival following first renal transplantation with cadaver kidneys. Graft loss includes death with functioning graft. Cumulative survival % Graft survival Living donor kidney End-point: 1st event graft loss or death (n=445) Time (years) 1st Tx (n=98) 1st Tx (n=133) 1st Tx (n=117) 1st Tx (n=97) Fig. 20. Graft survival following renal transplantation with living donor kidneys. Graft loss includes death with functioning graft. 30

32 Cumulative survival % Patient survival Cadaver kidney 1.Tx End-point: Death (n=1187) Time (years) 1st Tx (n=334) 1st Tx (n=296) 1st Tx (n=262) 1st Tx (n=295) Fig. 21. Patient survival after first cadaver kidney transplantation. The material has been stratified in four periods. Survival has improved with time. Patient survival Living donor kidney 1.Tx End-point: Death Cumulative survival % (n=445) Time (years) 1st Tx (n=98) 1st Tx (n=133) 1st Tx (n=117) 1st Tx (n=97) Fig. 22. Patient survival after living donor kidney transplantation. The material has been stratified in four periods. No change in survival with time. 31

33 Causes of death Causes of death 2002 Hemodialysis P-dialysis Renal-Tx Sum Cardiac Vascular Infection Malignancy Other causes Sum Table 13. Causes of death in 513 patients who died in Cardiac includes acute myocardial infarction, hyper- and hypokalaemia, hypertensive heart failure, fluid overload and cardiac arrest of unknown cause. Vascular causes includes mainly cerebro-vascular disease. Infection includes all bacterial and viral diseases. 140 Causes of death in 513 patients who died during HD PD TX 8 11 Cardiac Infection Other Vascular Malign. Fig. 23. Causes of death in 513 patients who died during

34 Death rate A more precise method to calculate death rate has been used this year: Death rate = Number of death x 100 / Person-years of observation For comparison death rate from previous years has been changed and the results shown in table 14. Death rate for 2002 Hemodialysis: Number Dead 400 Number of patients treated in Average number of days in treatment 267 Number of person years 1711 Death rate in 100 person years 23.4 Peritoneal dialysis: Number Dead 72 Number of patients treated in Average number of days in treatment 248 Number of person years 606 Death rate in 100 person years 11.9 Transplantation: Number Dead 41 Number of patients treated in Average number of days in treatment 332 Number of person years 1430 Death rate in 100 person years

35 Death rate from Year Hemodialysis Peritoneal dialysis Transplantation Death rate expressed in number per 100 person years Table 14 shows the variation in death rate during the last 11 years expressed in number of death per 100 person years. In earlier reports death rate has been expressed in % death of patients in treatment at the start of the year + patients started treatment during the year. For details see page 32. References 1. Renal Replacement Therapy in Finland Annual Report Aktiv Uremivård i Sverige Svensk Register for Aktiv Uremivård Årsrapport 2002 for Norsk Nefrologisk Register. 4. Vestergaard P and Løkkegaard H: Future trends in Danish renal replacement population. In: Løkkegaard H and Fugleberg S: Danish National Registry. Report on Dialysis and Transplantation in Denmark Vestergaard P. Løkkegaard H: Predicting future trends in the number of patients on renal replacement therapy in Denmark. Nephrol Dial Transplant 1997; 12: Vestergaard P: A prognosis for the number of patients on hemo- dialysis, peritoneal dialysis and renal transplantation in Denmark. Danish National Registry. Report on Dialysis and Transplantation in Denmark Vestergaard P: Dialysis and kidney transplant activity in Denmark between 1990 and 1999, and prognosis. Danish National Registry. Report on Dialysis and Transplantation in Denmark

36 Prognosis for dialysis and kidney transplant activity in Denmark Peter Vestergaard Background: The present work is based on three previous prognoses. The first prognosis used the figures for incidence and migrations between treatment modalities for the period 1990 to 1995 (Danish Society for Nephrology, Report for 1995). It used assumptions concerning the number of patients entering and leaving hemodialysis (HD) and peritoneal dialysis (PD). The calculations were made separately for HD and PD. This prognosis predicted an increase in the number of patients in active treatment with renal replacement therapy (RRT) even with an unchanged incidence of new patients. The second prognosis was based on the period 1990 to 1997 (Danish Society for Nephrology, Report for 1997) and did - in contrast to the first prognosis - consider the migrations between the different treatment modalities (HD, PD and patients with renal grafts). The third prognosis (Danish Society for Nephrology, Report for 1999) extended the second prognosis by modelling different scenarios for the future changes in incidence rates. The methods used have been presented previously (Nephrol Dial Transplant 1997: 12: ). Due to changing incidence rates, new prognoses have become necessary, and the present prognosis is based on the incidence rates for 1990 to Prognoses: The prognostic model uses the assumption that the number of patients in treatment in a given year is the sum of new patients minus the number of patients leaving therapy plus the number in therapy in the previous year. Assuming that 100 patients were on RRT in a given year and that 10 new patients entered therapy during the following year while 5 patients left therapy, the number of patients in therapy the following year must be: = 105. It is assumed that the number leaving therapy can be described as a constant fraction of those in therapy. E.g. assuming that 5% of patients die each year, 0.05 * 100 = 5 will die out of the 100 in treatment. Analysis of the incidence and migrations between 1990 and 2002: Incidence of new patients: Previous analyses pointed at an increase in the number of new patients starting therapy, in particular in the group of patients aged 60 years or more. This resulted in a larger fraction of new patients being 60 years or more. From 1990 to 2002, the incidence rate of new patients per million inhabitants increased almost linearly in the age group 60 years or more (fig. 1 with superimposed linear trend). In the age group less than 60 years, no significant increase was present, and a small decrease was seen in 2001 and 2002 (fig. 1). 35

37 In the age group 60 years or more, the incidence rate increased by approximately 30 per million per year for each year (from 116 per million per year in 1990 to approximately 442 per million per year in 2002). The squared Pearson correlation coefficient for a linear association was 0.95, i.e. a high degree of explanation. In the age group less than 60 years, the incidence rate increased borderline significantly (from approximately 50 in 1990 to approximately 67 in 2002). The squared Pearson correlation coefficient was 0.74 for this linear relationship. However, due to the decline in incidence rates in the last year (2002 fig. 1) an alternative prognosis was calculated. Prognoses: Two prognostic models were examined: A) The first prognostic model (worst-case scenario) is based on the following assumptions (based on the changes in the rates between 1990 and 2002): 1) The incidence of new patients entering haemodialysis increases linearly for both subjects above and below 60 years 2) The incidence of new patients entering peritoneal dialysis is stable for subjects <60 years and increases linearly for subjects 60 years. 3) The rates of migration between treatment modalities and the rates of death are the average of the last five years including the number of patients receiving renal transplants. In the following cases the average of the last three years was applied: a) The rate of subjects migrating from haemodialysis to peritoneal dialysis in all age groups (due to a decline), and b) The rate of subjects <60 years migrating from peritoneal dialysis to haemodialysis (due to a decline), while the rate was constant for those 60 years where the last five years was used. Mortality rates remained stable. The result of these considerations is the prognosis shown in table 1 and fig. 2. With these assumptions the crude incidence rate of new patients would increase from approximately 145 per million inhabitants in the year 2003 to approximately 202 per million inhabitants in B) The second prognostic model was calculated using the assumptions that the incidence for new patients entering haemodialysis and peritoneal dialysis was the average for the last three years. Other than that, the assumptions were the same as in model A. Discussion: The incidence of new patients seems to be increasing linearly, most pronounced in the age group 60 and mortality rates did not change. This resulted in an increase in patients on therapy, most pronounced for patients on haemodialysis. The increase in patients in peritoneal dialysis and subjects living with a functioning renal graft increased less than for haemodialysis due to changes in migration patterns. The two models deviated by approximately 10% in overall number of patients on treatment mainly due to a difference in the number of haemodialysis patients. 36

38 Fig. 1. Incidence rate of new patients expressed as number of patients per million inhabitants in actual age group in each year. An example of a linear trend curve has been inserted for subjects older than 60 years at treatment start. Incidence (/mio/year) Incidence rates <60 Year >60 Linear (>60) 37

39 Fig. 2. Prevalence of patients and prognosis stratified by treatment modality. Number of patients H P Deterministic model T Total Year A) Linear increasing incidence Number of patients H P Deterministic model T Total Year B) Incidence rates stable 38

40 Table 1: Expected total number of patients in treatment per January 1 in each year. Year Hd. Pd. Tx. Total A) Linear increase in incidence rates Year Hd. Pd. Tx. Total B) Stable incidence rates 39

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42 Landsregister for patienter i aktiv behandling for kronisk nyresvigt Rapport for Danmark 2002 ISBN NR Tryk: Paritas Grafik A/S