The European Renal Association (ERA) Registry collects data on patients with kidney failure receiving kidney replacement therapy (KRT). This paper presents a summary of the ERA Registry Annual Report 2023, and focuses specifically on comparisons by age. The complete ERA Registry Annual Report 2023 is available in the Supplementary information. For 2023, data were collected from 34 countries in Europe and countries bordering the Mediterranean Sea. Using these data, incidence and prevalence of KRT, kidney transplantation rates, survival probabilities, and expected remaining lifetimes were calculated. In 2023, the ERA Registry covered 519 million people in the participating countries. The incidence of KRT was 151 per million population (pmp). Among incident patients, 29% were aged ≥75 years, 64% were male, and the most common primary renal disease (PRD) was diabetes mellitus (22%). Most patients (83%) started KRT with haemodialysis (HD), 11% started with peritoneal dialysis (PD), and 6% underwent pre-emptive kidney transplantation. On 31 December 2023, the prevalence of KRT was 1101 pmp. Among prevalent patients, 24% were aged ≥75 years, 62% were male, and the most common PRD was of miscellaneous origin (18%). Moreover, 56% of prevalent patients received HD, 5% received PD, and 39% were living with a functioning graft. In 2023, the kidney transplantation rate was 43 pmp, with 69% of kidneys coming from deceased donors. For patients starting KRT between 2014 and 2018, 5-year survival probability was 51%. The proportions of incident and prevalent patients aged ≥75 varied considerably across European countries. In addition, incident patients aged ≥75 were more often male, and had more often hypertension as PRD compared with younger patients. Only 1% of incident patients aged ≥75 received a pre-emptive kidney transplant, while among prevalent patients of the same age, 22% was living with a functioning graft.
BACKGROUND:Intravascular ultrasound (IVUS) guidance during percutaneous coronary intervention (PCI) has been associated with increased stent optimization and reduced adverse events among patients with complex coronary-artery lesions, but adoption of this strategy in Western countries remains low. Although practice guidelines recommend intracoronary imaging for anatomically complex lesions, evidence from current European practice is limited. METHODS:In this investigator-initiated, international, open-label, randomized, controlled trial, we assigned patients undergoing complex PCI to either IVUS-guided PCI, performed with the use of prespecified stent-optimization criteria, or angiography-guided PCI. The primary end point was target-vessel failure, defined as a composite of death from cardiac causes, target-vessel myocardial infarction, or clinically indicated target-vessel revascularization. RESULTS:Of the 2020 patients who underwent randomization, 1010 in the IVUS-guided PCI group and 1009 in the angiography-guided PCI group were included in the primary analysis. The mean age of the patients was 69 years, 79.4% were men, and 27.4% presented with an acute coronary syndrome. The mean procedure duration was 88.8 minutes with IVUS-guided PCI and 66.2 minutes with angiography-guided PCI. Dilation with balloon angioplasty after stent implantation was performed in 91.3% of the IVUS-guided PCI procedures and in 84.5% of the angiography-guided PCI procedures. At a median follow-up of 19.0 months (interquartile range, 15.2 to 23.4), target-vessel failure had occurred in 140 patients (13.9%) in the IVUS-guided PCI group and in 112 patients (11.1%) in the angiography-guided PCI group (hazard ratio, 1.25; 95% confidence interval, 0.97 to 1.60; P = 0.08). Procedural complications occurred in 11.3% of the IVUS-guided PCI procedures and in 10.2% of the angiography-guided PCI procedures. The frequency of adverse events appeared to be similar in the two groups. CONCLUSIONS:Among patients undergoing complex high-risk PCI, a strategy of routine IVUS-guided PCI performed with the use of prespecified stent-optimization criteria was not associated with a lower risk of target-vessel failure than angiography-guided PCI alone. (Funded by Boston Scientific; IVUS-CHIP ClinicalTrials.gov number, NCT04854070.).
Background The Peritoneal Cancer Index recorded at laparotomy is based on visual and palpable inspection of peritoneal surfaces for disease. This study aimed to analyze interobserver variation in assigning the lesion score (LS) and morphologic term (MT) to characterize peritoneal lesions (PL) and predict the probability of malignancy (POM) among surgeons with expertise in cytoreductive surgery (CRS) for peritoneal malignancies. Methods The study selected 80 intraoperative images of PLs depicting different morphologic appearances of PLs arising from different primary tumors in various peritoneal regions. In the study, 50 expert peritoneal malignancy surgeons were asked to assign an LS to the region in question, select the MT or MTs to describe the PL, and predict the POM. Information on the presence of disease on histopathology was not provided at this point. Inter-observer reliability was evaluated using Krippendorff's alpha (alpha). A consensus was reached if any option received more than 75% of the votes. Results The study participants comprised 41 (82%) of 50 experts. Consensus on LS was achieved for 18 images (22.5%), with low agreement (alpha = 0.174). For MTs, a consensus was reached for 21 images (26.5%; alpha = 0.0902, denoting low and unreliable agreement. Of these 21 images, the MT used was "tumor nodule" for 90.4% of the images (p < 0.001). The POM was accurately predicted in 52.5% of the cases (alpha = 0.155). Administration of neoadjuvant chemotherapy had no impact on the surgeons' assessment of the three parameters. Conclusions Even the most experienced CRS surgeons showed high interobserver variation and unreliable agreement in the description and accurate characterization of PLs on pictorial records. A Delphi consensus to standardize the MT used and scoring of PL could reduce discordance.
BACKGROUND:This article compares the incidence and prevalence of kidney replacement therapy (KRT), kidney transplantation rates and mortality on KRT between Europe and the USA, including sex comparisons. METHODS:Data were derived for 2022 from the population-based European Renal Association (ERA) Registry and the United States Renal Data System (USRDS). RESULTS:In 2022, the KRT incidence in the USA [388.7 per million population (pmp)] was 2.7-fold higher than in Europe (146.2 pmp), with a greater difference for women (3.2-fold) than for men (2.4-fold). The proportion of women initiating KRT was lower in Europe (35%) than in the USA (41%). Between 2013 and 2022, the KRT incidence in Europe was stable in women (+0.1% annually) but increased in men (+1.1%). In the USA, the KRT incidence increased similarly in women (+0.2%) and men (+0.3%). On 31 December 2022, the KRT prevalence was 2-fold (women 2.2-fold, men 1.9-fold) higher in the USA (2444.2 pmp) than in Europe (1218.6 pmp). The proportion of women was lower in Europe (38%) than in the USA (41%). The kidney transplantation rate was 1.7-fold higher in the USA (79.1 pmp) than in Europe (45.4 pmp), 1.9-fold for women and 1.7-fold for men, with women accounting for 37% of the recipients versus 39% in the USA. The KRT mortality rate was 1.5 times higher in the USA [145.0 per 1000 patient-years (py)] compared with Europe (100.5 per 1000 py): 1.6-fold for women and 1.4-fold for men. In Europe, mortality was lower for women receiving KRT (93.7 per 1000 py) than for men (104.6 per 1000 py), whereas in the USA the reverse was true (women 148.9 per 1000 py, men 142.2 per 1000 py). CONCLUSION:The US had a notably higher KRT incidence, prevalence, kidney transplantation rate and mortality compared with Europe. Differences between Europe and the USA were larger for women than for men.
A traumatic spinal cord injury (SCI) severely damages the nerve tissue of the spinal cord, often leading to long-term impairment of motor, sensory and autonomic functions. During a secondary injury phase, an inflammatory immune response is initiated. Current evidence points toward involvement of B cells and the macrophage migration inhibitory factor (MIF)/CD74 axis in SCI pathology. This study aimed to map the complete MIF/CD74 axis across the immune system and analyze its impact on B cell function after traumatic SCI. Peripheral blood samples were obtained from a total cohort of 90 healthy controls (HC) and 70 SCI patients. SCI samples were collected longitudinally in the acute (0 weeks post-SCI), subacute (2 weeks post-SCI), intermediate (3–18 weeks post-SCI) and chronic (26–52 weeks post-SCI) phases post-injury. MIF levels in plasma of SCI patients and HC were measured using ELISA. Relative and absolute levels of immune and B cell subsets, as well as expression of members of the MIF/CD74 axis, were studied using high-dimensional flow cytometry. The functional relevance of MIF/CD74 axis signaling on B cell functions was investigated using in vitro blocking assays. SCI triggered an early immune cell reduction, characterized by decreased absolute numbers of total and MIF/CD74 axis-expressing B cells and immune cells. In contrast, the MIF/CD74 axis was upregulated as MIF receptor surface expression on B cell subsets, as well as frequencies of CD74+, CD44+ and CXCR4+ B cells, were increased during the subacute/intermediate phase post-SCI. MIF plasma levels were increased in SCI patients, yet MIF expression levels were reduced within circulating immune cells, suggesting that the injured spinal cord is the main source of MIF. Importantly, decreased B cell proliferation, activation and cytokine production were observed after blocking of CD74, CD44 or MIF in primary B cells of SCI patients and HC. The observed effects were more pronounced in SCI B cells, highlighting their stronger dependence on MIF/CD74 axis signaling. In conclusion, the complete MIF/CD74 axis plays an important role in post-SCI B cell responses. Our findings warrant further investigation of the MIF/CD74 axis as a potential target for immunomodulatory strategies in SCI treatment.
