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        "titulo" => "Informe de Situaci&#243;n de Di&#225;lisis y Trasplante en Espa&#241;a&#44; 2005"
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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">I</span><span class="elsevierStyleBold">NTRODUCTION</span></p><p class="elsevierStylePara">In 1975 the Spanish Society of Nephrology &#40;SEN&#41; performed the first register of patients with renal disease with data obtained from dialysis and transplant centers&#46; Later on the report on dialysis and transplant that was published by the SEN was generated from the database of the EDTA register&#46; In 1995&#44; only a 60&#37; of the Spanish centers sent information to the ERA-EDTA&#44; which limited the validity of the results&#46; It was necessary to find out other paths to obtain reliable information about the situation of End-Stage Chronic Renal Disease &#40;ESCRD&#41; in Spain&#46; The way was initiated through the Autonomic Registers&#46;</p><p class="elsevierStylePara">During the 1990s&#44; several Autonomies initiated and maintained their dialysis and transplant register &#191;Andalusia&#44; Catalonia&#44; the Basque Country&#44; Valencia&#44; Galicia&#44; Asturias and the Balearic Islands&#191;&#46; Thanks to these registers the 1996 Report on Dialysis and Transplant could be generated&#44;<span class="elsevierStyleSup">1</span> together with the collaboration of other autonomies lacking a register &#191;Madrid&#44; Castile-La Mancha&#44; Ceuta and Melilla&#191;&#44; of the Nephrology Societies and of Transplant Coordination Centers &#191;Asturias&#44; the Canary Islands&#44; Castile and Leon&#44; Cantabria&#44; Navarra&#44; Extremadura&#44; La Rioja and Murcia&#191;&#46; The included information referred only to prevalence and incidence&#46;</p><p class="elsevierStylePara">For the report of the year 1998&#44; the collected information was broadened&#44; and included the age at the beginning of replacement therapy&#44; the etiology and mortality causes&#46; In 2001&#44; eleven autonomic registers collaborated in the report on dialysis and transplant&#58; in addition to the registers that were already active&#44; in 2001 the registers of Castile and Leon and Extremadura were created&#44; and the registers of the Canary Islands and Castile-La Mancha&#44; although not legally constituted&#44; collaborated in the report and were considered completely functioning registers&#46;</p><p class="elsevierStylePara">In 2005&#44; the SEN arranged with the Company COHS&#44; Human Sciences Consulting&#44; to perform a descriptive and comparative analysis on the situation of already functioning and incipient autonomic registers&#46; In this way&#44; the actual status of the Registers of Patients with Renal Disease of each Autonomy&#44;<span class="elsevierStyleSup">2</span> the administrative situation&#44; the methods&#44; as well as the procedures and definitions could be known&#46; The publication of the resulting report allowed progressing in the register homogenization&#46; Moreover&#44; COHS&#44; Human Sciences Consulting&#44; was in 2004 responsible for the data collection and the generation of the report on the situation of dialysis and transplant&#44; supervised by the Group of Autonomic Registers &#40;GREG&#41;&#46;</p><p class="elsevierStylePara">The present report was again generated by COHS&#44; Human Sciences Consulting&#44; supervised by the National Transplant Organization &#40;NTO&#41; and promoted by the SEN&#46; Functioning Registers in Spain in 2005&#44; as well as Transplant Coordination Centers&#44; Autonomic Nephrology Societies and dialysis and transplants centers from Madrid have also collaborated&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">REPORT SCOPE</span></p><p class="elsevierStylePara">The covered population in this report is 32&#44;600&#44;056 habitants&#44; 76&#37; of the total Spanish population&#46;<span class="elsevierStyleSup">3</span></p><p class="elsevierStylePara">In the Autonomy of the Balearic Island information of 6 out 7 centers was collected&#46; In the Canary Islands the information of patients on dialysis is complete&#44; but the age distribution of the patients with functioning transplant is unknown&#46; The data from Catalonia were not delivered due to technical issues in the Register of Patients with Renal Disease of Catalonia &#40;RMRC&#41;&#46; Incidence and prevalence rates were calculated from the population that was covered by the collected centers&#46; The Autonomy of Madrid has contributed with information for the second consecutive year&#46;</p><p class="elsevierStylePara">Although we speak about Spain&#44; all mentioned data &#40;incidence&#44; prevalence&#44; mortality&#44; treatment modality&#44; etc&#46;&#41; refer to the Autonomies having provided information&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">METHODS</span></p><p class="elsevierStylePara">For the data collection homogeneous procedures were used&#44; though there were different data sources&#58; Autonomic Registers&#44; Nephrology Societies&#44; Coordinations of Transplant and Dialysis Centers&#44; and Hospitals&#46; In all cases the information referred to aggregated data&#46;</p><p class="elsevierStylePara">A spreadsheet with aggregated data was created&#46; In this sheet the following data were collected&#58; global data&#44; data on incident patients &#40;grouped by age&#44; sex&#44; primary renal disease and first treatment&#41;&#44; data on prevalent patients referring to December 31st&#44; 2005 &#40;grouped by age&#44; sex&#44; primary renal disease and first treatment&#41;&#44; and data on deceased patients &#40;grouped by last treatment and cause of death&#41;&#46;</p><p class="elsevierStylePara">The reference population for each Autonomy was added&#44; grouped by age and sex&#46; The same spreadsheet&#44; which was sent to all Communities&#44; had several automatic validation procedures&#46; A check protocol compared the different data introduced in the spreadsheet and contrasted them&#46; This procedure has shown to be efficacious to detect incongruence and partial omissions&#46;</p><p class="elsevierStylePara">Several calculation procedures allowed the user knowing the annual cumulative incidence and the current prevalence at December 31st&#44; taking as reference the Spanish population&#46;<span class="elsevierStyleSup">4&#44;5</span> Data from 2005 were also compared with those of previous years &#40;temporal coherence&#41; and those reported by the registers themselves&#46;</p><p class="elsevierStylePara">Once the data of each Community were accepted as valid&#44; age&#44; sex&#44; treatments&#44; etc&#46; were aggregated&#46; These data were treated as global data&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">INCIDENCE</span></p><p class="elsevierStylePara">According to the data collected&#44; 4125 patients initiated replacement therapy in 2005&#44; that is an incidence of 126 patients per million population &#191;142 pmp in older than 15 years&#191; with a trend to remain stable in the last years&#44;<span class="elsevierStyleSup">6&#44;7</span> and with differences among the Autonomies&#46; The Autonomies with the greatest incidences are the Canary Islands &#40;187 pmp&#41; and Cantabria &#40;156 pmp&#41; and those with the lowest incidences are the Balearic Islands &#40;103 pmp&#41;&#44; Asturias &#40;104 pmp&#41;&#44; Castile and Leon &#40;104 pmp&#41;&#46;</p><p class="elsevierStylePara">The highest incidence was observed in groups of elderly patients&#44; especially between 65 and 74 years &#40;407 pmp&#41;&#44; followed by the group of older than 75 years &#40;395 pmp&#41;&#46; The specific incidence was also different among the Autonomies&#46;</p><p class="elsevierStylePara">There is still a high percentage of primary renal disease of unknown origin&#44; particularly in the elderly&#46; The most frequent known cause of chronic renal failure requiring replacement therapy is diabetes mellitus&#44; which accounts for 23&#37; of all incident patients&#46; There are great differences among Autonomies&#44; the incidence of diabetes being the highest in the Canary Islands &#40;80 pmp&#41;&#46;</p><p class="elsevierStylePara">The causes of ESCRD have a different frequency in the different age groups&#46; In this sense&#44; glomerulonephritis is more frequent among patients aged 15-44 years &#40;28&#37;&#41;&#46; In patients older than 65 years&#44; the most frequent causes are renal vascular disease and those of unknown etiology&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">PREVALENCE</span></p><p class="elsevierStylePara">The prevalence of ESCRD treated in 2005 is 903 patients per million population&#46; This indicator differs in the Autonomies&#44; from 806 pmp in Cantabria to 1&#44;057 pmp in Valencia&#46;</p><p class="elsevierStylePara">The highest prevalence was observed in the oldest groups of patients&#44; especially between 65 and 74 years &#40;2&#44;348 pmp&#41;&#44; followed by the group of older than 75 years &#40;1&#44;851 pmp&#41;&#46; The specific incidence was also different among the Autonomies&#46;</p><p class="elsevierStylePara">Forty-four percent of the patients are on hemodialysis&#44; 6&#37; on peritoneal dialysis and 50&#37; have a functioning transplant&#46; There are differences in treatment distribution between the Autonomies&#44; because of the different transplant rate in each region&#46;</p><p class="elsevierStylePara">There are differences in the modality of therapy in the different age groups&#44; and the situation of previous years remains stable&#46; The transplant is more frequent in younger patients&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">MORTALITY</span></p><p class="elsevierStylePara">Mortality rate among patients with ESCRD was 8&#46;7&#37; in 2005&#46; When considering the last modality of treatment&#44; the mortality of patients on dialysis was 13&#46;8&#37;&#46; Among patients who have received a renal transplant&#44; the mortality rate remains low&#44; below 2&#37;&#46; There are differences in the causes of death between patients on dialysis and those with a functioning graft &#40;fig&#46; 5&#41;&#46;</p><p class="elsevierStylePara">There are differences concerning the modality&#58; the rate is similar in patients on peritoneal dialysis and hemodialysis and lower in those with a renal transplant&#46; When interpreting these results it should be taken into account that the considered modality of treatment is the one present when the patient died&#44; independently of its previous duration&#46;</p><p class="elsevierStylePara">The most frequent cause of death is cardiovascular disease&#44; which accounts for more than 30&#37; at all ages and treatment groups&#44; a bit lower among the patients with a transplant&#46; The next cause is infection diseases&#44; which are present in 20&#37; of the cases&#46; In patients with a transplant&#44; cancer is the second cause of death in 17&#37; of the cases&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">INTERNATIONAL COMPARISON</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold"></span>Compared with other European countries&#44; the incidence of chronic renal failure requiring renal replacement therapy is intermediate&#44; being higher than that of countries such as Iceland &#40;75 pmp&#41;&#44; Finland &#40;94 pmp&#41;&#44; Norway &#40;100 pmp&#41; and the Netherlands &#40;105 pmp&#41;&#44; and lower than Greece &#40;195 pmp&#41; and Austria &#40;159 pmp&#41;&#46;<span class="elsevierStyleSup">8</span></p><p class="elsevierStylePara">The prevalence of treated ESCRD in Spain is middle-high&#44; higher as that in Iceland &#40;479 pmp&#41;&#44; Finland &#40;685 pmp&#41;&#44; Norway &#40;708 pmp&#41; and lower as that in Greece &#40;922 pmp&#41; and Germany &#40;989 pmp&#41;&#46; The distribution by etiology in Spain is similar as that presented by the countries participating in the EDTA Register&#44; though Spain shows a lower prevalence of diabetes mellitus&#46;</p><p class="elsevierStylePara">The relation between incidence and prevalence highly depends on the mortality rate of patients on renal replacement therapy&#44; and that is very different between European countries&#44;<span class="elsevierStyleSup">9</span> and explained in part by the mortality in the general population&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara">The population covered by this report was approximately 80&#37; of the Spanish population at January 1st of 2005&#46;</p><p class="elsevierStylePara">The incidence of new patients seems to remain stable&#44; about 126 pmp&#46; It is predictable that&#44; in case of no changes in the tendency&#44; the incidence in Spain will be 123-131 pmp in the following years&#46;</p><p class="elsevierStylePara">The incidence is variable between the different Autonomies&#44; although the differences in the incidence could be related either to methodological issues in data collection or to actual differences in the nephropathies leading to renal replacement therapy&#46; This incidence trend may also be observed at a level below the Autonomy level&#46;<span class="elsevierStyleSup">10-12</span> In Spain&#44; these differences can not be the cause since almost all collaborating Autonomies have a register with reliable and validated data&#46; It is true that the Canary Islands has one of the highest incidences of patients with diabetes &#40;80 pmp in 2005&#41;&#44; but in the other Autonomies the differences in the nephropathies leading to renal failure are not clear&#46;</p><p class="elsevierStylePara">Renal failure affects mainly old people&#46; The risk in each age group is not expected to vary for the next years&#44; but population aging will determine the number of patients who will initiate renal replacement therapy and in part also the etiology&#46;</p><p class="elsevierStylePara">Although the incidence in Spain is intermediate among European countries&#44; the prevalence falls within the high range&#46; A possible explanation is that the mortality in patients with transplant is lower as compared with that of patients on replacement therapy&#44; and the proportion of prevalent patients with transplant is high in Spain&#46; Other studies point out that the mortality in patients on replacement therapy is closely related to the mortality in the general population&#44; and the mortality is lower in Mediterranean countries&#46;<span class="elsevierStyleSup">9</span></p><p class="elsevierStylePara">Given that the disease is a chronic condition and that the ratio of incident and dead patients is higher than 1&#44; the prevalence will keep on increasing in the next years&#44; though this increase will be affected by the demographic movements that are expected in the next years in Spain&#46;<span class="elsevierStyleSup">3</span> The decrease of the birth rate and the increase in the death rate let us predict that the population in 2030 will be 43&#44;500&#44;000 habitants&#44; with a constant trend to decrease&#46; At the same time&#44; the arrival of immigrants&#44; approximately 100&#44;000 per year for the period 2008-2030 will strongly influence the prevalence in the next years&#46;<br></br></p>"
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        "resumen" => "En 2005&#44; el tratamiento renal sustitutivo &#40;di&#225;lisis y trasplante&#41; es necesario para unas 40&#46;000 personas&#44; sin que se conozca con precisi&#243;n el n&#250;mero ni caracter&#237;sticas b&#225;sicas&#44; tales como&#58; el tiempo en tratamiento&#44; la modalidad o los cambios de tratamiento&#46; Los datos presentados cubren el 76&#37; de la poblaci&#243;n espa&#241;ola&#44; resultado de la cooperaci&#243;n de los t&#233;cnicos de registros&#44; nefr&#243;logos y coordinaciones de trasplante&#46; La procedencia de datos de registros ha pasado de ser un 38&#37; a un 76&#37; en 2005&#46; Durante 2005 iniciaron tratamiento sustitutivo 4&#46;125 personas&#44; lo que supone una incidencia de 126 pac&#47;pmp y respecto a otros pa&#237;ses europeos nos sit&#250;a en una zona intermedia&#46; La incidencia parece mantenerse estable en los &#250;ltimos a&#241;os si bien hay grandes diferencias entre comunidades &#40;de 104 pac&#47;pmp en Castilla y Le&#243;n a 186 pac&#47;pmp en las Islas Canarias&#41;&#46; La Diabetes es la causa de enfermedad renal primaria m&#225;s diagnosticada en 2005&#44; en m&#225;s del 20&#37; de los pacientes&#44; seguida de las causas vasculares&#46; Espa&#241;a presenta una prevalencia de 903 pac&#47;pmp&#44; con grandes variaciones entre comunidades &#40;de 806 pac&#47;pmp en Cantabria a 1&#46;056 pac&#47;pmp en la Comunidad Valenciana&#41;&#46; El 46&#44;7&#37; de los pacientes estudiados est&#225; trasplantado&#46; La mortalidad en di&#225;lisis es del 13&#44;7&#37;&#44; del 10&#44;8 en di&#225;lisis peritoneal y del 1&#44;3&#37; en trasplante&#44; siendo &#233;ste uno de los &#237;ndices m&#225;s bajos registrados hasta la fecha&#46; La mortalidad en tratamiento sustitutivo est&#225; en torno al 5&#37; entre los pacientes de 45 a 64 a&#241;os&#44; al 11&#37; entre 65 y 74 a&#241;os y es del 19&#37; entre los pacientes mayores de 75 a&#241;os&#46;"
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        "resumen" => "In 2005&#44; renal replace treatment &#40;dialysis and transplant&#41; was necessary for about 40&#44;000 people&#44; without being known the number accurate and either their basic characteristics&#44; such as&#58; time in treatment&#44; modality or treatment changes&#46; The presented data cover the 76&#37; of the Spanish population and are the result of the cooperation among technicians of registries&#44; nephrologists and transplant coordinations&#46; 4&#44;125 people started RRT in 2005&#44; the total estimated acceptance rate for renal replacement therapy in adults in Spain was 126 pmp and regarding other European countries it locates us in an intermediate area&#46; The incidence rate seems to keep stable in the last years although there were some differences among communities &#40;from 104 pmp in Castile and Leon to 186 pmp in Canary Islands&#41;&#46; Diabetes Mellitus is the most diagnosed cause of renal failure in 2005&#44; more than 20&#37; of patients&#44; followed by vascular diseases&#46; The estimated prevalence of renal replacement therapy in Spain at the end of 2005 was 903 pmp&#44; with important variations among communities &#40;from 806 pmp in Cantabria to 1&#44;056 pmp in Valencia Region&#41;&#46; The 47&#37; of prevalent RRT patients had a functioning transplant&#46; Mortality on haemodialysis and peritoneal dialysis was 13&#46;7&#37; and 10&#46;8&#37; respectively&#46; Mortality on transplant was 1&#46;3&#37;&#44; one of the lowest values registered so far&#46; Mortality on renal replacement therapy was around 5&#37; among patients from 45 to 64 years&#44; 11&#37; between 65 and 74 years and 19&#37; among the patients older than 75 years&#46;"
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                  "referenciaCompleta" => "Instituto Nacional de Estadística, INE (http://www.ine.es/)."
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                  "referenciaCompleta" => "García Bazaga M de A, Ramos Aceitero JM, Álvarez Díaz M. Enfermos renales en tratamiento renal sustitutivo en Extremadura. 2005. Junta de Extremadura. Consejería de Sanidad y Consumo, 2007."
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