Taiwan Society of Nephrology. Incidence, prevalence and mortality trends of dialysis end-stage renal disease in Taiwan from 1990 to 2001: The impact of national health insurance
ABSTRACT Incident and prevalent (I&P) rates in dialysis end-stage renal disease (ESRD) patients in Taiwan increased rapidly following the launch of National Health Insurance (NHI) in 1995. Our aim was to explore the impact of NHI on the status and trends of ESRD epidemiology in Taiwan.
This study was conducted using retrospective cohort analysis of data collected from the Taiwan national dialysis registry.
From 1990 to 2001, I&P rates of ESRD patients increased 2.6 times from 126 to 331 per million populations (pmp) and 3.46 times from 382 to 1322 pmp, respectively. Increasing ESRD was seen in patients who were middle-aged, elderly and who had diabetic nephropathy as their primary renal disease. The mean age of I&P patients increased by 7.2 years and 7.1 years, respectively. All of these parameters increased markedly in 1995, the year of NHI implementation. First-year mortality decreased to 7.8 per 1000 patient-months in 1994, and then increased to 18.0 in 2001. The cumulative survival rate of the elderly subgroup (age >65) in the incident 1990-1994 cohort was greater than in the 1995-1999 cohort. These data indicated that NHI implementation significantly influenced the inflow and the mortality of ESRD patients.
In addition to presenting ESRD epidemiology in Taiwan, this study demonstrated that NHI implementation stimulated the growth of treated ESRD populations. Preventive plans mounted against chronic kidney diseases will be essential to reduce the growth of ESRD patient numbers and consequent economic burdens.
- SourceAvailable from: Junne Ming Sung
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- "Mortality in patients with end-stage renal diseases (ESRDs) remains high mainly because of their high cardiovascular disease burden   . The kidney disease outcome quality initiative (KDOQI) guidelines recommend that conventional echocardiography should be performed at the initiation of dialysis and every 3 years thereafter in all ESRD patients for cardiac risk stratification and optimization of therapies    . "
ABSTRACT: Using a speckle-tracking echocardiography (STE), we recently demonstrated that a left ventricular (LV) global longitudinal strain (GLS) ≥ -15% and the serum cardiac troponin T (cTnT) concentration are associated with mortality in stable hemodialysis patients with preserved LV ejection fraction (LVEF). In this study, we explored the relationship between cTnT and echocardiographic parameters and evaluated whether the prognostic value provided by cTnT is independent of a GLS ≥ -15% and vice versa. Eighty-eight stable hemodialysis patients with preserved LVEF were followed for 31 months. STE studies and measurements of cTnT were performed at baseline. CTnT concentration had a modest correlation with GLS (r s = 0.44; P < 0.001) but had a weak or nonsignificant correlation with other echocardiographic parameters. Adjusting for clinical parameters, hazard ratios for each increase of 0.01 ng/mL in cTnT, and a GLS ≥ -15% on mortality were 1.13 (P = 0.009) and 3.09 (P = 0.03) without significant interaction between cTnT and GLS ≥ -15%. In addition, an increased cTnT concentration, a GLS ≥ -15%, or their combination showed significant additional predictive value for mortality when included in models consisting of clinical parameters. Therefore, both cTnT and a GLS ≥ -15% are independent predictors of mortality and are useful for risk stratification.BioMed Research International 05/2014; 2014:217290. DOI:10.1155/2014/217290 · 2.71 Impact Factor
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- "The increase in the prevalence of hemodialysis in Taiwan occurred mostly in the elderly (Yang et al., 2008). However, MNA has not been widely tested for monitoring nutritional status of these patients. "
ABSTRACT: BACKGROUND: The Mini-Nutritional Assessment (MNA) and Subjective Global Assessment (SGA) are two frequently used tools in nutritional assessment. OBJECTIVES: This study aimed to evaluate the feasibility of applying the MNA with population-specific anthropometric modifications and to compare the predictive ability of MNA with that of the SGA in patients with hemodialysis. DESIGN: Purposive sampling. METHODS: This study was conducted in the Hemodialysis Unit of E-Da Hospital in Kaohsiung, Taiwan. A total of 192 patients with hemodialysis were evaluated their nutritional status concomitantly with the SGA and the MNA in two versions-MNA Taiwan version-I adopted population-specific anthropometric cut points, and MNA Taiwan version-II had body mass index (BMI) omitted. RESULTS: The SGA graded 1% malnourished and 51% at risk of malnutrition for patients with hemodialysis; MNA Taiwan version-I graded 3% and 41%, respectively, whereas MNA Taiwan version-II graded 5% and 36%, respectively. There were significant differences between patterns of nutritional status predicted with the SGA and the MNA versions (P<0.05). The scores predicted with both tools correlated positively with appetite, serum albumin and creatinine levels, BMI, and mid-arm and calf circumferences, and negatively with number of emergency visits. However, only MNA versions negatively correlated with length of hospital stay (all P<0.05). Linear regression analysis revealed that the MNA Taiwan version-I, -II and SGA scores were positively associated with BMI and serum albumin level, and negatively associated with number of emergency visits after adjusting for confounders (all P<0.05). However, only MNA Taiwan version-I and -II were negatively associated with C-reactive protein (CRP) level (P<0.05). The associations of MNA Taiwan version-II with albumin and CRP levels were stronger than those obtained using MNA Taiwan version-I and SGA. CONCLUSIONS: The present study suggests that both the modified MNA versions can evaluate nutritional risk of patients with hemodialysis in Taiwan. The MNA Taiwan version-II which adopted population-specific anthropometric cut values without BMI is better able to assess nutritional status and reflect health status of patients with hemodialysis than MNA Taiwan version-I and SGA.International journal of nursing studies 09/2010; 48(3). DOI:10.1016/j.ijnurstu.2010.07.015 · 2.25 Impact Factor
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ABSTRACT: Whether HbA1c is a predictor of end-stage renal disease (ESRD) in type 2 diabetes patients remains unclear. This study evaluated relationship between HbA1c and ESRD in Chinese patients with type 2 diabetes. Patients aged ≥ 30 years who were free of ESRD (n = 51 681) were included from National Diabetes Care Management Program from 2002-2003. Extended Cox proportional hazard model with competing risk of death served to evaluate association between HbA1c level and ESRD. A total of 2613 (5.06%) people developed ESRD during a follow-up period of 8.1 years. Overall incidence rate of ESRD was 6.26 per 1000 person-years. Patients with high levels of HbA1c had a high incidence rate of ESRD, from 4.29 for HbA1c of 6.0%-6.9% to 10.33 for HbA1c ≥ 10.0% per 1000 person-years. Patients with HbA1c < 6.0% particularly had a slightly higher ESRD incidence (4.34 per 1000 person-years) than those with HbA1c of 6.0%-6.9%. A J-shaped relationship between HbA1c level and ESRD risk was observed. After adjustment, patients with HbA1c < 6.0% and ≥ 10.0% exhibited an increased risk of ESRD (HR: 1.99, 95% CI: 1.62-2.44; HR: 4.42, 95% CI: 3.80-5.14, respectively) compared with those with HbA1c of 6.0%-6.9%. Diabetes care has focused on preventing hyperglycemia, but not hypoglycemia. Our study revealed that HbA1c level ≥ 7.0% was linked with increased ESRD risk in type 2 diabetes patients, and that HbA1c < 6.0% also had the potential to increase ESRD risk. Our study provides epidemiological evidence that appropriate glycemic control is essential for diabetes care to meet HbA1c targets and improve outcomes without increasing the risk to this population. Clinicians need to pay attention to HbA1c results on diabetic nephropathy.PLoS ONE 10(6):e0130828. DOI:10.1371/journal.pone.0130828 · 3.53 Impact Factor