Background: The aim of this study was to describe the trends in the incidence, prevalence and survival of patients on kidney replacement therapy (KRT) for end-stage kidney disease (ESKD) across Europe from 2008 to 2017.Methods: Data from renal registries in 9 countries and 16 regions that provided individual patient data to the ERA Registry from 2008 to 2017 were included. These registries cover 34% of the general population in Europe. Crude and standardized incidence and prevalence per million population (pmp) were determined. Trends over time were studied using Joinpoint regression. Survival probabilities were estimated using Kaplan–Meier analysis and hazard ratios (HRs) using Cox regression analysis.Results: The standardized incidence of KRT was stable [annual percentage change (APC): −1.48 (−3.15; 0.21)] from 2008 (146.0 pmp) to 2011 (141.6 pmp), followed by a slight increase [APC: 1.01 (0.43; 1.60)] to 148.0 pmp in 2017, although trends in incidence varied across countries. This increase was primarily due to a rise in the incidence of KRT in men older than 65 years. Moreover, as a cause of kidney failure, diabetes mellitus is increasing. The standardized prevalence increased from 2008 (990.0 pmp) to 2017 (1166.8 pmp) [APC: 1.82 (1.75; 1.89)]. Patient survival on KRT improved in the time period 2011–13 compared with 2008–[adjusted HR: 0.94 (0.93; 0.95)].Conclusion: This study showed an overall increase in the incidence and prevalence of KRT for ESKD as well as an increase in the KRT patient survival over the last decade in Europe.

Kitty J Jager, Anders Åsberg, Frederic Collart, Cécile Couchoud, Marie Evans, Patrik Finne, Ileana Peride, Ivan Rychlik, Ziad A Massy; A snapshot of European re

Although peritoneal dialysis (PD) is recognized as an effective renal replacement therapy (RRT) alternative to haemodialysis (HD), its prevalence is around 15% in most of the industrialized countries. In the French-speaking part of Belgium, PD is clearly underused with a prevalence of 8.7% in 2009. The main objectives of this work were to evaluate the nephrologists' perceived obstacles to PD implementation and reflect on possible actions towards PD development. A computer-based 33-item questionnaire was sent by e-mail to all nephrologists affiliated to the French-speaking association. Among 120 adult nephrologists targeted by this inquiry, 97 completed the online questionnaire (response rate 80.8%). Among them, 29% had little experience with PD (treating less than five patients) and 39% reported no specific training with this modality of RRT. However, 88% of responders claimed PD prevalence should be around 20–25%. Half of the responders would choose PD as a first RRT option if they required RRT for themselves. The three main reasons given to the low prevalence of PD were an easy access to HD, patient refusal and lack of nephrologist motivation. Almost all the nephrologists insisted on the need for a dedicated nursing team delivering an effective educational programme and PD management and care. They believe that PD could and should be implemented in Belgium. Enhanced nephrologist motivation and training in PD were identified as predominant factors to be upgraded, as well as patient education programmes.

Key Points: A simplified lung ultrasound (LUS)–guided management approach safely reduced pulmonary congestion in patients undergoing hemodialysis. LUS may be performed by nurses and paramedics, making it even easier to integrate it into routine practice. LUS may contribute to better BP control in patients undergoing hemodialysis. Background: Pulmonary congestion (PC) is frequent in hemodialysis patients and is associated with deleterious prognosis. Lung ultrasound (LUS) accurately quantifies PC; however, many methods exist to evaluate PC using LUS. Here, we validate a simplified LUS-guided protocol for managing PC in patients undergoing hemodialysis and explore its impact on BP control. Methods: We enrolled 100 hemodialysis patients from six dialysis units in three countries in a multicenter randomized controlled trial. All patients had LUS after their mid-week session on days 1, 15, 30, 45, and 60. LUS was performed using the eight-zone method to obtain a global B-line score (BLS). Doctors and nurses performed LUS at the bedside. Dry weight was adjusted according to the standard of care in the control group, while it was reduced by 500 g if BLS was above five on day 1 and by 500 g further on day 15 if BLS was still above five in the active group. BP home monitoring was obtained weekly. Results: The mean BLS on day 1 (13±9) decreased to 8±5 on day 60 ( P < 0.001) in the active group. By contrast, the control group showed no significant changes in BLS on day 60 compared with baseline. Home blood pressure monitoring on day 60 was similar to the baseline in both groups. Applying this protocol did not increase the intradialytic hypotension frequency. Conclusions: This simplified LUS-guided protocol for managing PC was effective and safe in hemodialysis patients and could be considered for inclusion in standard care practices. Nurses and advanced caregivers may perform LUS in hemodialysis units. LUS-guided management may have a positive impact on BP control. Clinical Trial registry name and registration number: ClinicalTrials.gov, NCT06296160.

Background and hypothesis: The prevalence of antiphospholipid antibody (aPL) is high among hemodialysis (HD) patients compared to the general population and is inconsistently associated with arteriovenous fistula (AVF) thrombosis or stenosis. The association with maturation failure has never been investigated. This study aims to evaluate native AVF complications (thrombosis, stenosis, and maturation failure) and primary patency in aPL positive HD patients. Methods: We retrospectively identified 116 HD patients with native AVF. We collected the aPL profiles, the clinical and biological data potentially involved in AVF maturation failure, thrombosis, and stenosis, and investigated the association of these complications and aPL positivity. Kaplan–Meier survival analysis was performed. Results: In our cohort, the prevalence of aPL persistent positivity was 32.7% and this was strongly associated with AVF maturation failure defined by ultrasound. aPL persistent positivity was a strong predictor in multivariate analysis and this association was independent of AVF stenosis or thrombosis during maturation process. There was no association with primary and functional primary patency, and stenosis. However, aPL persistent positivity according to ACR/EULAR classification criteria was associated with thrombosis when compared to strictly negative aPL patients. Conclusions: In our cohort, aPL persistent positivity was significantly associated with AVF maturation failure and thrombosis but not with AVF stenosis. To our knowledge, we report for the first time, a statistically significant association between aPL positivity and delay or absence of native AVF maturation.

Aim To compare patient and graft survival of kidney transplant recipients who received a kidney from a living‐related donor (LRD) or living‐unrelated donor (LUD). Methods Adult patients in the ERA‐EDTA Registry who received their first kidney transplant in 1998‐2017 were included. Ten‐year patient and graft survival were compared between LRD and LUD transplants using Cox regression analysis. Results In total, 14,370 patients received a kidney from a living donor. Of those, 9,212 (64.1%) grafts were from a LRD, 5,063 (35.2%) from a LUD and for 95 (0.7%) the donor type was unknown. Unadjusted five‐year risks of death and graft failure (including death as event) were lower for LRD transplants than for LUD grafts: 4.2% (95% confidence interval [CI]: 3.7‐4.6) and 10.8% (95%CI: 10.1‐11.5) versus 6.5% (95%CI: 5.7‐7.4) and 12.2% (95%CI: 11.2‐13.3), respectively. However, after adjusting for potential confounders, associations disappeared with hazard ratios of 0.99 (95%CI: 0.87‐1.13) for patient survival and 1.03 (95%CI: 0.94‐1.14) for graft survival. Unadjusted risk of death‐censored graft failure was similar, but after adjustment it was higher for LUD transplants (1.19; 95%CI: 1.04‐1.35). Conclusion Patient and graft survival of LRD and LUD kidney transplant recipients was similar, whereas death‐censored graft failure was higher in LUD. These findings confirm the importance of both living kidney donor types.