Transcript Survival analysis

8th Conference of Kidney Disease in Disadvantaged Populations
Satellite Symposium of the World Congress of Nephrology,
Victoria, British Columbia, Canada
April 12th – April 14th, 2011
László Rosivall 1,2, Miklós Molnár 2 Judit Béres 3, Shahrokh MirzaHosseini 4
Multiple Disadvanteged People, Hungarian Example
1. Hungarian Kidney Foundation
2. Institute of Pathophysiology, Faculty of Medicine, PhD School of
Medical Sciences, Semmelweis University,
3. Department of the Hungarian Congenital Abnormality Registry and
Surveillance, National Center for Healthcare Audit and Inspection,
4. Avicenna International College, Budapest, Hungary.
Gypsies in Europe
• Multiple arrivals in Europe from India centuries ago
• Different populations
• Stretching across country borders
• A number of genetic disorders seen
(assumed that galactokinase deficiency and the
congenital glaucoma mutations: Indian origin)
Roma Education Level in Hungary (%)
Subject
Total
Male
Female
Incomplete
elementary
30,2
24,2
36,1
Elementary
36,4
37,9
34,9
Vocational
20,6
26,6
14,7
High school
11,4
10,5
12,4
Higher
education
1,3
0,9
1,8
Job Status Before Global Recession
Nonsegregated
Segregated
Getto
Just studies
6,1
3,8
2,7
Active Worker
31,0
28,2
13,9
Unemployed
30,8
36,8
44,2
Maternity leave
10,2
16,6
18,5
Pension
5,2
5,7
5,3,
Disabled
16,7
13,0
15,5
Frequent Genetic Diseases of Gypsies
• Primary Congenital Glaucoma (1/10000 vs. 1/1200), with strong
regional differences
• Congenital Myasthenia Syndrome (AChR, epsilon mutation, almost
exclusively in Roma population)
• Spinal Mucsular Atrophy
• Inherited Limb Muscular Dystrophy (type 2C)
• Epidermolysis Bullosa
• Galactokinase deficiency
• Glanzman Thrombasthenia
• Autosomal Dominant Polycystic Kidney
(ADPKD 2 in a certain region x 20 higher)
Gypsies - Hungary
• One of the declared goals of Hungarian EU
presidency is to address the integration issue of
the Roma population all over the Europe.
East-North Hungary: A Sample Dialysis Center Data
(B.Braun)
Total No patients: 222 (Gypsy: 14; 6%)
Hemodialysis Patients : 183 (11 Gypsy, 6%)
CAPD : 39 (3 Gypsy, 8%)
Background Disease:
•Diabetes mellitus : 6 pax
•Chronic Nephritis : 8 pax (3 TIN, 2 nephrosclerosis, 3 GLN)
Transplantation-Related Characteristics of Group A
(Caucasians) and Group B (Gypsies)
Pretransplant
PRA% (± SD)
Group A (n = 1825)
Group B (n = 93)
PRA >20%
Acute rejections
*
Irreversible
acute rejections
Chronic
rejections
Noncompliance
graft loss
Polycystic
kidney disease
Diabetes
mellitus
*
*
*
*
0%
Age, yr ± SD HLA mismatches ± SD
Group A (n = 1825)
42
2,89
Group B (n = 93)
34
3,06
10%
20%
30%
40%
50%
60%
70%
Langer et al, Transplantation Proceedings, 37, 729–730 (2005)
Patient and Graft Survival in Group A (Caucasians)
and Group B (Gypsies)
%
Patient Survival
100
100
90
90
80
80
70
70
60
60
50
50
40
40
30
30
20
20
10
10
0
0
1 year 3 years 5 years 10 years
n Caucasians n Gypsies
Graft Survival
%
*
*
*
*
1 year 3 years 5 years 10 years
Langer et al, Transplantation Proceedings, 37, 729–730 (2005)
Quality of Life inTransplanted patients
Score of different HRQOL domains in TransQoL-HU Study (n=1067) -2002
90
Gypsys
Non Gypsys
p>0.05 in all domains
Mean of KDQOL point
80
70
60
50
40
30
y
rg
/fa
tig
ue
c
B
lW
nt
lf
D
K
s
of
na
io
ot
e
En
Em
ca
si
n
om
pt
ep
y
Ph
e
Sl
m
Sy
de
ur
B
D
fK
to
ec
t
en
s
hy
m
12
p
12
f
Ef
sf
sf
There is not much difference (unpublished)
Depression
CESD score (median, IQR) from TransQoL-HU Study (n=1067) - 2002
25
20
p=0.06
p=0.06
15
10
5
0
Gypsy
1
Non 2Gypsy
(Unpublished)
Prevalence of depression
%
40
p=0.03
35
30
25
20
15
10
5
0
1
Gypsy
2
Non Gypsy
(Unpublished)
Survival analysis
TransQoL-HU-2002-2010
(Unpublished)
Graft Survival analysis
TransQoL-HU-2002-2010
(Unpublished)
Further clinical observations
• ESRD more frequent, similar to Afro-Americans
• Recive blood transfusion from non-Roma blood donors
• Have many children, possibly from different fathers
• B blood group is more frequent among them
• HLA incompatibility is more frequent
• Cultural, social, economical disadvantage are contributory
factors
• Living kidney donors are recommended
ISU usage in MINIT-HU Study (n=993) -2007
Immuno-biological Differences?
100
90
80
70
60
50
40
30
20
10
0
*
Gypsy
Non Gypsy
us
e
oli
m
us
us
e
Ev
er
e
ro
lim
us
us
Si
Az
a
us
e
M
M
F
us
e
ro
Ta
c
clo
Cy
St
er
oid
us
us
e
e
*: p<0.05
Conclusion
• Differences in outcome of the renal
transplantation and frequency of different renal
diseases are due to genetical, economical,
social and cultural differences.
• Because of this complex background, the
improvement in their health status is also
complex and needs a holistic approach.