[MA 2023 13] Trends in the incidence and prevalence of kidney replacement therapy for the most common primary kidney diseases
Amsterdam UMC, location AMC, Department of Medical Informatics
Proposed by: Anneke Kramer [a.kramer@amsterdamumc.nl]
Introduction
Particular diseases, such as diabetes, hypertension and glomerulonephritis may result in a decline of kidney function. When the kidney function progresses to below a certain minimum, patients develop end-stage kidney disease, and kidney replacement therapy is required to sustain life. Kidney replacement therapy consists of dialysis or kidney transplantation.
The ERA Registry is a European Registry collecting data on patients on kidney replacement therapy. This data is used for audit purposes (e.g. by publication of an annual report), but also for research [1].
Description of the SRP Project/Problem
During this SRP project we would like to focus on the worldwide trends in the kidney replacement therapy for end-stage kidney disease due to the most common primary kidney diseases. Nowadays diseases like diabetes and hypertension, both with a high risk of kidney disease, occur more and more often. On the other hand, treatment is increasingly aimed at preserving kidney function and therefore the progression of kidney disease may be delayed. It is therefore important to stay up-to-date with trends in the occurrence of underlying diseases in the general population and any changes over time in the need for kidney replacement therapy. A previous study [2] has reported on the trends in the number of patients starting kidney replacement therapy (the incidence) for end-stage kidney disease due to diabetes, hypertension, glomerulonephritis and ADPKD up to 2014. In this study it was shown that the incidence of kidney replacement therapy for patients with diabetes was by far the highest in the US. However, in Malaysia the incidence was increasing steeply, nearing that in the US. It is therefore relevant to know how the incidence of kidney replacement therapy has developed since 2014 for the different primary kidney diseases. As a result, also the distribution of primary kidney diseases among the total group of patients receiving kidney replacement therapy (prevalent patients) may have changed.
The COVID-19 pandemic has resulted in a decrease of the number of patients starting kidney replacement therapy in 2020 and 2021. Currently, it is unknown for which patients kidney replacement therapy was postponed or not initiated because of the COVID-19 pandemic. However, the difference in the composition of primary renal diseases in 2020-2021 when compared to the time period before the pandemic may shed light on this.
Research questions
To be able to explain the changes in the incidence of patients starting kidney replacement therapy due to the most common primary renal diseases we need to know (1) the trends in the occurrence of these diseases in the general population, and (2) the trends in the ability to delay the progression of the kidney disease. Therefore, the first step of this project will be to perform a (literature) search. Research questions for this part of the project will be:
• What are the current trends in the general population prevalence of the diseases that contribute most to the incidence of kidney replacement therapy, i.e. diabetes and hypertension?
• What are the recent trends in the progression of kidney disease in patients suffering from these diseases?
Secondly, to examine recent changes in the incidence of kidney replacement therapy by primary renal disease, annual reports from kidney replacement therapy registries across the world [1,3] will be used. For Europe, data from the ERA Registry will be analysed. Research questions for this part of the project will be:
• What are the recent trends in the incidence of kidney replacement therapy for the most common primary kidney diseases, overall and by age group and sex?
• What are the recent trends in the prevalence of kidney replacement therapy for the most common primary kidney diseases, overall and by age group and sex?
• How did the COVID-19 pandemic influence the distribution of primary renal diseases?
Expected results
To be able to answer these research questions a literature search will be performed. In addition, analyses will be performed using the ERA Registry database [1], and using annual reports from other registries across the world [3]. We expect an overview and discussion of the results of the literature search, and all analyses to be finished. The results could be used as input for a scientific paper.
Time period (usually 7 months)
7 months
References
1. Boenink R, Astley ME, Huijben JA, et al. The ERA Registry Annual Report 2019: summary and age comparisons. Clin Kidney J. 2021 Dec 15;15(3):452-472.
2. Stel VS, Awadhpersad R, Pippias M, Ferrer-Alamar M, et al. International comparison of trends in patients commencing renal replacement therapy by primary renal disease. Nephrology (Carlton). 2019 Oct;24(10):1064-1076.
3. United States Renal Data System: 2022 USRDS Annual Data Report: Epidemiology of kidney disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2022. Available at: https://usrds-adr.niddk.nih.gov/2022