Geographical variability of patient characteristics and treatment patterns affect outcomes for incident hemodialysis patients

Alejandro Martin-Malo, Menelaos Papadimitriou, Joao Cruz, Jesus Bustamante, Dierik Verbeelen, Alain Nony, Raymond Vanholder, Stefan H. Jacobson, Jesus Montenegro, Thierry Hannedouche, Volker Wizemann, Francesco Locatelli, F. Locatelli, V. La Milia, M. Pozzi, S. Di Filippo, G. La Greca, C. Ronco, A. Brendolan, C. CrepaldiS. Stefoni, G. Ciancialo, O. Baraldi, G. Maschio, C. Loschiavo, C. Barbieri, F. Milanesi, B. Redaelli, A. Stella, M. R. Viganò, T. Stellato, G. Villa, S. Segagli, G. Montagna, F. Quarello, A. Vallero, G. Forneris, M. Borghi, M. Tagliaferri, G. Palmerio, E. Imbasciati, M. Farina, R. Bucci, C. Stallone, F. Aucella, C. Bellazzi, A. De Vincenti, M. Giannattasio, F. Detomaso, F. Malberti, For the Membrane Permeability Outcome (MPO) Study Group

Research output: Contribution to journalArticle

Abstract

Background: Geographical differences in disease prevalence and mortality have been described in the general population and in chronic kidney disease patients in Europe. In this secondary analysis of the Membrane Permeability Outcome (MPO) study, we addressed differences in patient and treatment patterns, and whether these affect patient outcomes. Methods: Participating countries were grouped according to geographical location; thus study centers in France, Greece, Italy, Portugal and Spain were allocated to southern Europe (n=499), and those in all other countries (Belgium, Germany, Poland and Sweden) to northern Europe (n=148). Descriptive analysis of patient and treatment patterns at study start, as well as survival analysis, was performed. Results: In patients from the northern European countries, a higher prevalence of diabetes mellitus and of cardiovascular disease was observed than in those from southern Europe (diabetes 35.1% vs. 21.0%, p=0.0007; cardiovascular disease 40.5% vs. 22.8%, p<0.0001). In northern Europe, 23% of patients started hemodialysis with a catheter for vascular access, while in southern European centers, only 13% did so (p=0.0042). Kaplan-Meier survival analysis revealed a lower probability for both all-cause and cardiovascular mortality in southern Europe (log-rank test p<0.001). In a Cox proportional hazards model, a higher mortality risk was estimated for the northern European patients after adjustment for age, sex, membrane permeability, comorbidity index and vascular access (hazard ratio = 1.831; 95% confidence interval, 1.282-2.615; p=0.0009). Conclusions: Our study patients from northern Europe showed a higher risk profile than those from southern Europe. However, only some of the factors can be modified in attempts to lower the mortality risk in this geographical area.

Original languageEnglish
Pages (from-to)119-128
Number of pages10
JournalJournal of Nephrology
Volume26
Issue number1
DOIs
Publication statusPublished - Jan 1 2013

Fingerprint

Renal Dialysis
Mortality
Therapeutics
Survival Analysis
Permeability
Cardiovascular Diseases
Vascular Access Devices
Membranes
Portugal
Greece
Belgium
Kaplan-Meier Estimate
Poland
Chronic Renal Insufficiency
Proportional Hazards Models
Sweden
Spain
Italy
France
Germany

Keywords

  • Comorbidities
  • Epidemiology
  • Europe
  • Hemodialysis
  • Mortality
  • Practice patterns

ASJC Scopus subject areas

  • Nephrology

Cite this

Martin-Malo, A., Papadimitriou, M., Cruz, J., Bustamante, J., Verbeelen, D., Nony, A., ... For the Membrane Permeability Outcome (MPO) Study Group (2013). Geographical variability of patient characteristics and treatment patterns affect outcomes for incident hemodialysis patients. Journal of Nephrology, 26(1), 119-128. https://doi.org/10.5301/jn.5000116

Geographical variability of patient characteristics and treatment patterns affect outcomes for incident hemodialysis patients. / Martin-Malo, Alejandro; Papadimitriou, Menelaos; Cruz, Joao; Bustamante, Jesus; Verbeelen, Dierik; Nony, Alain; Vanholder, Raymond; Jacobson, Stefan H.; Montenegro, Jesus; Hannedouche, Thierry; Wizemann, Volker; Locatelli, Francesco; Locatelli, F.; La Milia, V.; Pozzi, M.; Di Filippo, S.; La Greca, G.; Ronco, C.; Brendolan, A.; Crepaldi, C.; Stefoni, S.; Ciancialo, G.; Baraldi, O.; Maschio, G.; Loschiavo, C.; Barbieri, C.; Milanesi, F.; Redaelli, B.; Stella, A.; Viganò, M. R.; Stellato, T.; Villa, G.; Segagli, S.; Montagna, G.; Quarello, F.; Vallero, A.; Forneris, G.; Borghi, M.; Tagliaferri, M.; Palmerio, G.; Imbasciati, E.; Farina, M.; Bucci, R.; Stallone, C.; Aucella, F.; Bellazzi, C.; De Vincenti, A.; Giannattasio, M.; Detomaso, F.; Malberti, F.; For the Membrane Permeability Outcome (MPO) Study Group.

In: Journal of Nephrology, Vol. 26, No. 1, 01.01.2013, p. 119-128.

Research output: Contribution to journalArticle

Martin-Malo, A, Papadimitriou, M, Cruz, J, Bustamante, J, Verbeelen, D, Nony, A, Vanholder, R, Jacobson, SH, Montenegro, J, Hannedouche, T, Wizemann, V, Locatelli, F, Locatelli, F, La Milia, V, Pozzi, M, Di Filippo, S, La Greca, G, Ronco, C, Brendolan, A, Crepaldi, C, Stefoni, S, Ciancialo, G, Baraldi, O, Maschio, G, Loschiavo, C, Barbieri, C, Milanesi, F, Redaelli, B, Stella, A, Viganò, MR, Stellato, T, Villa, G, Segagli, S, Montagna, G, Quarello, F, Vallero, A, Forneris, G, Borghi, M, Tagliaferri, M, Palmerio, G, Imbasciati, E, Farina, M, Bucci, R, Stallone, C, Aucella, F, Bellazzi, C, De Vincenti, A, Giannattasio, M, Detomaso, F, Malberti, F & For the Membrane Permeability Outcome (MPO) Study Group 2013, 'Geographical variability of patient characteristics and treatment patterns affect outcomes for incident hemodialysis patients', Journal of Nephrology, vol. 26, no. 1, pp. 119-128. https://doi.org/10.5301/jn.5000116
Martin-Malo, Alejandro ; Papadimitriou, Menelaos ; Cruz, Joao ; Bustamante, Jesus ; Verbeelen, Dierik ; Nony, Alain ; Vanholder, Raymond ; Jacobson, Stefan H. ; Montenegro, Jesus ; Hannedouche, Thierry ; Wizemann, Volker ; Locatelli, Francesco ; Locatelli, F. ; La Milia, V. ; Pozzi, M. ; Di Filippo, S. ; La Greca, G. ; Ronco, C. ; Brendolan, A. ; Crepaldi, C. ; Stefoni, S. ; Ciancialo, G. ; Baraldi, O. ; Maschio, G. ; Loschiavo, C. ; Barbieri, C. ; Milanesi, F. ; Redaelli, B. ; Stella, A. ; Viganò, M. R. ; Stellato, T. ; Villa, G. ; Segagli, S. ; Montagna, G. ; Quarello, F. ; Vallero, A. ; Forneris, G. ; Borghi, M. ; Tagliaferri, M. ; Palmerio, G. ; Imbasciati, E. ; Farina, M. ; Bucci, R. ; Stallone, C. ; Aucella, F. ; Bellazzi, C. ; De Vincenti, A. ; Giannattasio, M. ; Detomaso, F. ; Malberti, F. ; For the Membrane Permeability Outcome (MPO) Study Group. / Geographical variability of patient characteristics and treatment patterns affect outcomes for incident hemodialysis patients. In: Journal of Nephrology. 2013 ; Vol. 26, No. 1. pp. 119-128.
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T1 - Geographical variability of patient characteristics and treatment patterns affect outcomes for incident hemodialysis patients

AU - Martin-Malo, Alejandro

AU - Papadimitriou, Menelaos

AU - Cruz, Joao

AU - Bustamante, Jesus

AU - Verbeelen, Dierik

AU - Nony, Alain

AU - Vanholder, Raymond

AU - Jacobson, Stefan H.

AU - Montenegro, Jesus

AU - Hannedouche, Thierry

AU - Wizemann, Volker

AU - Locatelli, Francesco

AU - Locatelli, F.

AU - La Milia, V.

AU - Pozzi, M.

AU - Di Filippo, S.

AU - La Greca, G.

AU - Ronco, C.

AU - Brendolan, A.

AU - Crepaldi, C.

AU - Stefoni, S.

AU - Ciancialo, G.

AU - Baraldi, O.

AU - Maschio, G.

AU - Loschiavo, C.

AU - Barbieri, C.

AU - Milanesi, F.

AU - Redaelli, B.

AU - Stella, A.

AU - Viganò, M. R.

AU - Stellato, T.

AU - Villa, G.

AU - Segagli, S.

AU - Montagna, G.

AU - Quarello, F.

AU - Vallero, A.

AU - Forneris, G.

AU - Borghi, M.

AU - Tagliaferri, M.

AU - Palmerio, G.

AU - Imbasciati, E.

AU - Farina, M.

AU - Bucci, R.

AU - Stallone, C.

AU - Aucella, F.

AU - Bellazzi, C.

AU - De Vincenti, A.

AU - Giannattasio, M.

AU - Detomaso, F.

AU - Malberti, F.

AU - For the Membrane Permeability Outcome (MPO) Study Group

PY - 2013/1/1

Y1 - 2013/1/1

N2 - Background: Geographical differences in disease prevalence and mortality have been described in the general population and in chronic kidney disease patients in Europe. In this secondary analysis of the Membrane Permeability Outcome (MPO) study, we addressed differences in patient and treatment patterns, and whether these affect patient outcomes. Methods: Participating countries were grouped according to geographical location; thus study centers in France, Greece, Italy, Portugal and Spain were allocated to southern Europe (n=499), and those in all other countries (Belgium, Germany, Poland and Sweden) to northern Europe (n=148). Descriptive analysis of patient and treatment patterns at study start, as well as survival analysis, was performed. Results: In patients from the northern European countries, a higher prevalence of diabetes mellitus and of cardiovascular disease was observed than in those from southern Europe (diabetes 35.1% vs. 21.0%, p=0.0007; cardiovascular disease 40.5% vs. 22.8%, p<0.0001). In northern Europe, 23% of patients started hemodialysis with a catheter for vascular access, while in southern European centers, only 13% did so (p=0.0042). Kaplan-Meier survival analysis revealed a lower probability for both all-cause and cardiovascular mortality in southern Europe (log-rank test p<0.001). In a Cox proportional hazards model, a higher mortality risk was estimated for the northern European patients after adjustment for age, sex, membrane permeability, comorbidity index and vascular access (hazard ratio = 1.831; 95% confidence interval, 1.282-2.615; p=0.0009). Conclusions: Our study patients from northern Europe showed a higher risk profile than those from southern Europe. However, only some of the factors can be modified in attempts to lower the mortality risk in this geographical area.

AB - Background: Geographical differences in disease prevalence and mortality have been described in the general population and in chronic kidney disease patients in Europe. In this secondary analysis of the Membrane Permeability Outcome (MPO) study, we addressed differences in patient and treatment patterns, and whether these affect patient outcomes. Methods: Participating countries were grouped according to geographical location; thus study centers in France, Greece, Italy, Portugal and Spain were allocated to southern Europe (n=499), and those in all other countries (Belgium, Germany, Poland and Sweden) to northern Europe (n=148). Descriptive analysis of patient and treatment patterns at study start, as well as survival analysis, was performed. Results: In patients from the northern European countries, a higher prevalence of diabetes mellitus and of cardiovascular disease was observed than in those from southern Europe (diabetes 35.1% vs. 21.0%, p=0.0007; cardiovascular disease 40.5% vs. 22.8%, p<0.0001). In northern Europe, 23% of patients started hemodialysis with a catheter for vascular access, while in southern European centers, only 13% did so (p=0.0042). Kaplan-Meier survival analysis revealed a lower probability for both all-cause and cardiovascular mortality in southern Europe (log-rank test p<0.001). In a Cox proportional hazards model, a higher mortality risk was estimated for the northern European patients after adjustment for age, sex, membrane permeability, comorbidity index and vascular access (hazard ratio = 1.831; 95% confidence interval, 1.282-2.615; p=0.0009). Conclusions: Our study patients from northern Europe showed a higher risk profile than those from southern Europe. However, only some of the factors can be modified in attempts to lower the mortality risk in this geographical area.

KW - Comorbidities

KW - Epidemiology

KW - Europe

KW - Hemodialysis

KW - Mortality

KW - Practice patterns

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