Kidney Replacement Treatment in South-Western Italy (Campania): Population-Based Study on Gender and Residence Inequalities in Health Care Access
Abstract
:1. Introduction
2. Materials and Methods
2.1. Prevalence and Incidence
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- haemodialysis, if data of the hospital discharge records or outpatient nephrology records included code V560 or codes 39951–59 (ICD-IX CM);
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- peritoneal dialysis, if data of the hospital discharge records included code V451 or codes 54981–82 (ICD-IX CM) and/or if data of the drug prescription records included any of F00001678-73, LPB5262G-64G, LPB96564, LPB5268, or LCE8280-81 (Italian national formulary);
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- kidney transplant, if data of the hospital discharge records included codes V420 and/or 99681 (ICD-IX CM) and/or if data of the outpatient nephrology records included code 897 (ICD-IX CM).
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- A person was defined on dialysis treatment if he/she was on treatment for haemodialysis and/or peritoneal dialysis. In the case of multiple treatments, priority was given to the treatment with lower frequency. Therefore, priority was given to peritoneal dialysis when haemodialysis and peritoneal dialysis were prevalent or incident in the same year and was given to kidney transplant when dialysis and kidney transplant were prevalent or incident in the same year. Prevalence data of the year 2014 were used only for the definition of KRT incidence in 2015 and were not reported. The de novo incidence of KRT and the type of incident KRT were defined for years 2015–2018 if data of that year included the codes listed above for prevalence and if the patients were without prevalent KRT in the previous year. As per the definition, the de novo incidence of KRT did not include patients receiving kidney transplant after a period of dialysis and/or patients reinitiating dialysis after kidney transplant failure.
2.2. Outcomes
2.3. Statistics
3. Results
3.1. Prevalence and Incidence
3.2. Associations with Gender and Age
3.3. Outcomes
3.4. Correlates of Mortality and Kidney Transplant
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Calendar Year | |||||
---|---|---|---|---|---|
2015 | 2016 | 2017 | 2018 | ||
Prevalence | |||||
KRT | N pmp (95%CI) | 8057 1375 (1302–1447) | 8173 1397 (1324–1470) | 8218 1407 (1334–1481) | 8167 1414 (1340–1487) |
Haemodialysis | N pmp (95%CI) | 5861 1000 (938–1062) | 5939 1015 (953–1078) | 5853 1002 (940–1064) | 5806 1005 (943–1067) |
Peritoneal dialysis | N pmp (95%CI) | 115 20 (11–28) | 133 23 (13–32) | 125 21 (12–30) | 116 20 (11–29) |
Kidney transplant | N pmp (95%CI) | 2081 355 (318–392) | 2101 359 (322–396) | 2240 384 (345–422) | 2245 389 (350–427) |
Incidence | |||||
KRT | N pmp (95%CI) | 1022 174 (148–200) | 1088 186 (159–213) | 1121 192 (165–219) | 958 166 (141–191) |
Haemodialysis | N pmp (95%CI) | 993 169 (144–195) | 1035 177 (151–203) | 1079 185 (158–211) | 922 160 (135–184) |
Peritoneal dialysis | N pmp (95%CI) | 29 5 (1–9) | 53 9 (3–15) | 42 7 (2–12) | 36 6 (1–11) |
Kidney transplant * | N pmp (95%CI) | 159 27 (17–37) | 191 33 (21–44) | 187 32 (21–43) | 172 30 (19–40) |
Dependent variable: mortality (n patients = 11,713, n events = 3666) | ||
Independent variables | Uni-variate HR (95%CI) | multi-variate HR (95%CI) |
Female gender, y-n = 1–0 | 1.05 (0.98–1.12) | 0.95 (0.89–1.02) |
Age at entry in datafile, years | 1.06 (1.06–1.06) | 1.05 (1.05–1.05) |
Type of KRT | ||
Haemodialysis | 4.06 (3.61–4.56) | 1 (reference) |
Peritoneal dialysis, y − n = 1–0 | 0.80 (0.64–1.01) | 0.88 (0.70–1.10) |
Kidney transplant, y − n = 1–0 | 0.19 (0.17–0.21) | 0.41 (0.37–0.47) |
Local authority of residence | ||
City of Naples | 0.94 (0.86–1.02) | 1 (reference) |
Suburban areas of Naples* | 1.05 (0.98–1.12) | 1.13 (1.03–1.24) |
Avellino | 1.22 (1.08–1.37) | 1.15 (1.01–1.32) |
Benevento | 1.09 (0.93–1.27) | 1.05 (0.89–1.25) |
Caserta | 1.02 (0.93–1.12) | 1.09 (0.97–1.22) |
Salerno | 0.88 (0.81–0.96) | 1.00 (0.90–1.11) |
De novo incidence of dialysis, y − n = 1–0 | 1.54 (1.43–1.66) | 1.08 (1.01–1.17) |
Dependent variable: kidney transplant (n patients = 8473, n events = 549) | ||
Independent variables | Uni-variate HR (95%CI) | multi-variate HR (95%CI) |
Female gender, 1–0 | 0.82 (0.70–0.95) | 0.79 (0.67–0.92) |
Age at entry in datafile, years | 0.94 (0.93–0.94) | 0.94 (0.93–0.94) |
Type of KRT | ||
Haemodialysis | 0.26 (0.20–0.34) | 1 (reference) |
Peritoneal dialysis, y − n = 1–0 | 2.42 (1.84–3,19) | 1.22 (0.91–1.63) |
Local authority of residence | ||
City of Naples | 1.05 (0.88–1.26) | 1 (reference) |
Suburban areas of Naples * | 0.99 (0.85–1.15) | 0.80 (0.65–0.98) |
Avellino | 0.91 (0.68–1.23) | 0.88 (0.63–1.23) |
Benevento | 1.22 (0.87–1.71) | 1.24 (0.86–1.79) |
Caserta | 1.03 (0.84–1.26) | 0.83 (0.64–1.06) |
Salerno | 0.93 (0.76–1.12) | 0.79 (0.62–1.01 |
De novo incidence of dialysis **, y − n = 1–0 | 0.65 (0.54–0.79) | 0.59 (0.49–0.71) |
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Cirillo, M.; Palladino, R.; Ciacci, C.; Atripaldi, L.; Fumo, M.G.; Giordana, R.; Triassi, M. Kidney Replacement Treatment in South-Western Italy (Campania): Population-Based Study on Gender and Residence Inequalities in Health Care Access. J. Clin. Med. 2021, 10, 449. https://doi.org/10.3390/jcm10030449
Cirillo M, Palladino R, Ciacci C, Atripaldi L, Fumo MG, Giordana R, Triassi M. Kidney Replacement Treatment in South-Western Italy (Campania): Population-Based Study on Gender and Residence Inequalities in Health Care Access. Journal of Clinical Medicine. 2021; 10(3):449. https://doi.org/10.3390/jcm10030449
Chicago/Turabian StyleCirillo, Massimo, Raffaele Palladino, Carolina Ciacci, Lidia Atripaldi, Maria Grazia Fumo, Roberta Giordana, and Maria Triassi. 2021. "Kidney Replacement Treatment in South-Western Italy (Campania): Population-Based Study on Gender and Residence Inequalities in Health Care Access" Journal of Clinical Medicine 10, no. 3: 449. https://doi.org/10.3390/jcm10030449