The increased risk of cancer in patients who have had kidney transplants has mainly been attributed to immunosuppressive therapy; however, the prior period of uraemia and dialysis has also been postulated as a cofactor. We analysed cancer risk retrospectively in a cohort of 4178 patients undergoing renal replacement therapy, of whom 3592 were treated with dialysis alone and 1821 later had transplants. We found that excess cancer risk in such patients occurred after transplantation and not during dialysis.
The existence of a national renal biopsy register and a national terminal uraemia status register in Denmark provides an opportunity to study the prognosis of glomerulonephritis (GN), and factors influencing prognosis.
Multivariate analysis of 2380 renal biopsies with GN performed between 1985 and 1997 was done to determine the influence of clinical and histological factors on prognosis.
The incidence of GN (39/mo/year) and individual diagnoses did not change during the period. After 10 years, 32%, were dead, 13% terminally uraemic, 5%, uraemic and 50% well. Older age increased mortality, but not the incidence of renal failure after the first year. Male sex increased both mortality and incidence of renal failure (34 vs 24% at 10 years, P
Among 224 cadaver kidney transplantations performed since Spring 1977, successful DR typing of both donor and recipient could be done in 149 cases. Assessment of DR match grade and clinical data was done independently. The minimum observation time was 3 months and the time of follow up was 1 December, 1980. There was an effect of DR matching which became significant when only 1. transplants were considered and high risk recipients (i.e. diabetics) excluded. Transfusions were of minor importance on graft survival and the difference was only obvious in the first year after transplantation. Matching for HLA-A, B antigen had no obvious effect on graft survival in this material.
1. During the period 1990-1999, 1,715 renal transplants were performed in Denmark, corresponding to 31.8 per million population per year. Seventy-five per cent were cadaver donor transplants; in 25%, a living donor kidney was used. 2. Living donors of 437 kidneys were mainly parents (54%) and siblings (36%). In 20 transplants, a kidney from a living-unrelated donor was used. 3. The overall actuarial patient survival rates at one and 5 years were 91.0% and 78.2%, respectively. The major causes of recipient death were cardiovascular disease and infection. 4. The overall actuarial graft survival rates at one and 5 years were 81.4% and 62.0%, respectively. The major single causes of graft loss were rejection (41%) and recipient death (32%). Graft survival has improved during the decade.
In recent years transplantation from living donors has accounted for 25-30% of all kidney transplants in Denmark corresponding to 40-45 per year. Most of these living donors are parents or siblings, although internationally an increasing number are unrelated donors. Donor nephrectomy is associated with only few complications. The long-term outcome for kidney donors is good without increase in mortality or risk for development of hypertension and renal failure; proteinuria may be seen. Living kidney transplantation is the optimal treatment of end-stage renal disease with better graft survival than in cadaver transplantation. The ethical and psychological aspects related to transplantation from a living donor are complex and need to be carefully evaluated when this treatment is offered to the patients.
A retrospective study of CAPD-related peritonitis revealed a frequency of 1.7 episodes per treatment year among 121 patients during a period of 7 years. Life-table methodology estimated a 44% probability of still remaining peritonitis-free after six months on CAPD, with no differences between subgroup populations according to sex, age (younger/older than 60 years) and primary disease (diabetic/non-diabetic). A marked improvement in probability of remaining peritonitis-free was evident in the last calendar period (1983-86). The predominant etiological microorganisms in peritonitis episodes were staphylococci. In 25% of the episodes, no microorganism could be isolated. One patient died from peritonitis; lethality 0.7% per year. Ten patients (8%) were transferred from CAPD because of either repeated episodes of peritonitis or a single complicated episode.
To predict the future prevalence of patients on renal replacement therapy due to chronic renal failure in Denmark.
Four thousand and nine terminal uraemic patients (median age 50.0 years, 15.2% diabetic) were treated in Denmark with renal replacement therapy in the period 1 January 1991 to 31 December 1995. Incidence rates and rates of transition between the treatment modalities (haemodialysis, peritoneal dialysis, and renal transplantation) were calculated. The prediction was made using a Markov model in three ways: (1) using the average rates (deterministic model), (2) using rates simulated with pseudorandom numbers based on the average rates (stochastic model), and (3) using increasing incidence rates in a deterministic model.
Using present rates both model types predicted a significant increase in the prevalence of renal transplant recipients or = 60 years (from 456 in 1995 to about 903 in 2006) while the prevalence of other treatment modalities would change less dramatically. The overall prevalence proportion would increase from 539 patients per million population (p.m.p.) in 1995 to about 777 p.m.p. in 2006. The stochastic model clearly demonstrated the uncertainties linked to the prognosis in contrast to the deterministic model. The deterministic model with increasing rates predicted a prevalence proportion of 1162 p.m.p. in 2006.
Even with present rates the prevalence of haemodialysis patients in Denmark will continue to increase. Mathematical models offers a good tool to study future trends and to plan future capacity.
A Markov model was applied in three ways: 1) a deterministic model with fixed rates, 2) a stochastic model using simulated varying rates and 3) a deterministic model with increasing rates. With present rates an increase in the prevalence of renal transplant recipients
The mortality of critically ill patients who develop acute renal failure (ARF) is persistingly high. We reviewed all patients who developed ARF that required dialysis in a single intensive care unit (n = 167) during the period 1977 to 1989, in order to identify variables with possible influence on outcome. Overall mortality within hospital was 75%. Age above 60 (p