17° RIUNIONE ANNUALE del REGISTRO DIALISI DEL LAZIO
L’EMODIALISI nel LAZIO
in ETA’ PEDIATRICA
Stefano Picca
Dipartimento di Nefrourologia, Unità di Dialisi
Ospedale “Bambino Gesù” , Ist. di Ricerca Scientifica
ROMA, Italia.
Demographics of CKD due to CAKUT:
Insights from the ERA/EDTA Registry
•Elke Wühl, M.D.
•Center for Pediatrics and Adolescent Medicine,
University of Heidelberg, Germany
• large longitudinal database of patients receiving
RRT throughout Europe
• complete population-based information from birth
to adulthood available from 12 countries covering
150 million people
Spectrum of Primary Renal Diagnoses
ESCAPE and 4C-Study
4C
ESCAPE
Hereditary
and other
17%
CAKUT
Hypo/Dysplasia
43%
Obstructive Urop. 39%
VUR
50%
other
5%
Glomerular disease
14%
69%
Glomerulo- Polycystic
pathies
kidney
8%
disease 6%
CAKUT
63%
Vasculitis
Other
2%
Unknown
6%
Metabolic
5%
Nephronophthisis
4%
HUS 3%
Interstitial
nephropathy
2%
Post-ischemic
1%
Nefropatie di base all’ingresso (coorte 1995-2010)
45
43.2
Età media (DS) all’ingresso per nefropatia
• CAKUT: 10,3 (4,9)
• Glomerulopathies: 8,6 (6,2)
• Hereditary: 11,0 (5,2)
• Other: 7,7 (6,2)
40
35
30
24.0
25
19.2
20
15
13.6
10
5
0
Congenital Abnormalities Kidney
Urinary Tract
Glomerulopathies
Hereditary
Other
Incidence rates of RRT
in the ERA-EDTA Registry
by age per million population
300
Diabetic or hypertensive GN
GN
250
Cakut
CKD
200
Hered.NP
IRF
150
HUS
unknown
Metabolic
Vasculitis
100
Misc
unknown
GN
50
PN_other
+
85
-8
4
80
-7
9
75
-7
4
70
-6
9
64
-6
4
60
-5
9
54
-5
4
50
-4
9
45
-4
4
40
-3
9
35
-3
4
30
-2
9
25
-2
4
20
-1
9
15
-1
4
10
59
04
0
CAKUT
CAKUT Diagnosis Codes
ERA-EDTA Annual Report 2009
CODE
•
Pyelonephritis associated with neurogenic bladder
21
•
Pyelonephritis due to congenital obstructive uropathy w/o VUR
22
•
Pyelonephritis due to VUR without obstruction
24
•
Renal hypoplasia (congenital) – unspecified
60
•
Oligomeganephronic hypoplasia
61
•
Congenital renal dysplasia w/o urinary tract malformation
62
•
Syndrome of agenesis of abdominal muscles (prune belly)
66
Characteristics of RRT Patients
in the ERA-EDTA Registry
ALL
CAKUT
947.5
44.9
212 930
4 765
Gender (% male)
61.5
61.5
CAKUT diagnoses (%)
2.2
100
Prevalence 2009 (cases pmp)
Incidence (no of patients)
1.1.1999-31.12.2009
Neurogenic PN
5.6
Obstructive PN
22.9
Refluxive PN
41.9
Hypoplasia
17.3
Dysplasia
12.3
Caratteristiche deio pazienti pediatrici del RRDTL
ALL
CAKUT
167
42.9
12 576
54
Gender (% male)
62.6
64.8
CAKUT diagnoses (%)
1.5
100
Incidence 2010 (cases pmp)
Incidence (no of patients)
1.1.1995-31.12.2010
Neurogenic PN
11.9
Refluxive PN
64.4
Hypoplasia
22.7
Prune Belly
1.0
Age Distribution at Start of RRT
Percent of patients starting RRT at given age groups
16
Other diagnoses
12
CAKUT
10
8
6
4
2
10 9
-1
15 4
-1
20 9
-2
25 4
-2
30 9
-3
35 4
-3
40 9
-4
45 4
-4
50 9
-5
54 4
-5
60 9
-6
64 4
-6
70 9
-7
4
5-
4
0
0-
Percent Patients
14
Age
17
16.1
16
15.4
15
14
altre nefropatie
CAKUT
13.2
13
12
10.7
11
10.3
10.3
9.8
10
9.3
9
8.2
8
7.3
6.7
7
6.7
6.7
6.0
5.7
6
5
4.6
4
5.7
5.0
4.6
4.6
3.6
3.4
3.1
4.9
4.6
3.6
2.7
3
2.1
2
1.5
1.3
0.8
1
0.2
0.1
0.2
0.3
10-14
15-19
0.5
0
0-4
5-9
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85+
0.75
1.00
Kaplan-Meier survival estimates
0.50
63%
0.00
0.25
37%
0
12
24
36
48
60
72
analysis time
cakut = 0
84
cakut = 1
96
108
120
0.40 0.50 0.60 0.70 0.80 0.90 1.00
Kaplan-Meier survival estimates
0
12
24
36
analysis time
c
h
48
g
o
60
0.40 0.50 0.60 0.70 0.80 0.90 1.00
Kaplan-Meier survival estimates
0
12
24
36
analysis time
00_05
12_14
48
06_11
15_17
60
Anno di incidenza. RRDTL 1995-2010
15
14
13
13
12
12
11
10
10
10
10
10
9
9
9
8
8
8
7
6
5
5
5
5
4
4
4
4
3
2
1
0
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Età all’ingresso, per sesso. RRDTL 1995-2010
16
15
femmine
14
maschi
5
13
12
3
11
10
9
8
6
5
7
2
4
3
4
6
11
5
10
3
1
4
2
1
1
4
1
5
3
6
1
5
5
4
2
3
3
1
3
3
5
4
3
2
2
1
0
0
1
2
3
4
5
6
7
8
9
ETA'
10
11
12
13
14
15
16
17
Metodica dialitica per anno. RRDTL, 1995-2010
emodialisi bicarbonato
emodiafiltrazione
dialisi peritoneale
100%
1
95%
90%
1
1
2
1
1
85%
3
4
1
80%
4
75%
2
2
5
2
1
70%
65%
60%
2
55%
5
50%
9
8
12
45%
40%
7
8
7
3
35%
8
6
30%
25%
2
5
5
2002
2003
2004
3
3
2
20%
15%
10%
5%
0%
1995
1996
1997
1998
1999
2000
2001
2005
2006
2007
2008
2009
2010
Età all’ingresso per metodica dialitica.
RRDTL 1995-2010
Metodica
Media
DS
Mediana
RIQ
HD
10,9
5,0
12
9-15
DP
4,7
5,0
4
0-8
Totale
9,5
5,6
11
5-14
Centro dialisi all’ingresso. RRDTL 1995-2010
Centro Dialisi all'ingresso
Bambino Gesù Roma
Diagest Roma
San Benedetto Alatri
Aurelia Hospital Roma
Grassi Ostia Roma
Life Hospital Roma
Nomentana Hospital Mentana
Nuova Villa Claudia Roma
Policlinico Umberto I Roma
San Giovanni Evangelista Tivoli
Annunziatella Roma
Bernardini Palestrina
Città di Roma
Civile Anagni
Diaverum Fondi
Nuova Itor Roma
Ospedali Riuniti Anzio-Nettuno
Parodi Delfino Colleferro
Riabilitazione Assistenza Nepi
San Giacomo Roma
sconosciuto
Totale
N
%
83
65,9
3
2,4
3
2,4
2
1,6
2
1,6
2
1,6
2
1,6
2
1,6
2
1,6
2
1,6
1
0,8
1
0,8
1
0,8
1
0,8
1
0,8
1
0,8
1
0,8
1
0,8
1
0,8
1
0,8
13
10,3
126 100,0
CENTR
Paese di nascita. RRDTL 1995-2010
Paese di nascita
Italia
Romania
Albania
Bosnia-Erzegovina
Bulgaria
Etiopia
Filippine
Marocco
Moldavia
sconosciuto
Totale
N
%
105 83,3
3,2
4
2,4
3
0,8
1
0,8
1
0,8
1
0,8
1
0,8
1
0,8
1
6,3
8
126 100,0
Paese di nascita per anno. RRDTL 1995-2010
ITALIA
ESTERO
100%
95%
1
1
1
1
1
90%
2
1
85%
3
80%
4
2
2
75%
2
70%
65%
60%
55%
50%
10
5
45%
4
8
11
8
12
9
7
40%
7
3
35%
7
30%
6
3
3
25%
2
20%
15%
10%
5%
0%
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Tipologia di accesso vascolare per anno. RRDTL, 2002-2010
Prima FAV all'arto superiore, distale
FAV prossimale all'arto superiore
CV Temporaneo
Cv Permanente
100%
95%
1
90%
2
85%
2
1
1
80%
2
75%
1
4
70%
1
65%
2
60%
55%
50%
1
2
45%
40%
3
5
35%
30%
5
3
25%
3
1
3
20%
1
15%
10%
5%
0%
2002
2003
2004
2005
2006
2007
2008
2009
2010
Incidenza cumulativa di trapianto per nefropatia.
RRDTL, 1995-2010
Mesi
12
24
36
48
60
Cakut Glomerulopathies Hereditary Other
0.28
0.29
0.08
0.08
0.52
0.45
0.39
0.17
0.74
0.66
0.39
0.41
0.81
0.83
0.39
0.41
0.88
0.87
0.51
0.41
0.00
0.25
0.50
0.75
1.00
Kaplan-Meier failure estimates
0
6
12
18
24
30
36
analysis time
CAKUT
Hereditary
42
48
Glomerulopathies
Other
54
60
Incidenza cumulativa di trapianto per quartili
di età all’ingresso. RRDTL, 1995-2010
1.00
Kaplan-Meier failure estimates
0-5
0.11
0.16
0.46
0.52
0.66
6-11 12-14
0.31 0.30
0.48 0.45
0.72 0.65
0.77 0.71
0.77 0.83
15-17
0.19
0.65
0.73
0.84
0.88
0.00
0.25
0.50
0.75
Mesi
12
24
36
48
60
0
6
12
18
24
30
36
analysis time
0-5
12-14
42
6-11
15-17
48
54
60
Dialysis Unit, “Bambino Gesù” Pediatric Hospital
Roma, Italy.
Doctor:
S. Picca
Headnurse:
A. Tancredi
Nurses:
N. Avari
V. Bandinu
D. Ciullo
E. Iacoella
P. Lozzi
F. Paolucci
C. Pia
Transplant
Coordinators:
S. Tesei
I. Pannacci