Recent trends in kidney replacement therapy in Latvia: room for improvement

Background and Aims
Important parameters characterizing a high-quality national kidney replacement therapy (KRT) program include comprehensive predialysis care, timely formation of dialysis access, and planned start of dialysis itself. This retrospective study aimed to assess these key parameters in patients receiving KRT in Latvia.

Method
The Latvian Kidney Patients Database (LKPD) collects demographic and clinical data from 33 KRT centres, covering ∼92% of KRT patients in Latvia. In this study, we analysed LKPD data on all KRT patients from 2022 and 2023. Microsoft Excel was used for data processing and analysis.

Results
There were 1046 and 1142 prevalent KRT patients in 2022 and 2023, respectively. In 2023, KRT modality distribution was as follows: 568 (49.7%) kidney transplant recipients, 470 (41.1%) patients on haemodialysis, and 105 (9.2%) on peritoneal dialysis. There was a consistent male predominance, with 55.8% and 55.4% male patients in 2022 and 2023, respectively. The mean patient age was 56±15 years.
A total of 115 new patients (60% male, 40% female; mean age 59±15 years) started KRT in 2022, increasing to 184 (53.8% male, 46.2% female; mean age 61±15 years) in 2023. The leading cause of end-stage kidney disease was glomerulonephritis in 59 (19.7%) patients, diabetes mellitus in 57 (19%), hypertension/renal vascular disease in 37 (12.3%), autosomal dominant polycystic kidney disease in 34 (11.4%), and pyelonephritis in 25 (8.3%) patients, with the remaining cases attributed to other specific or unknown causes.
Among incident patients, 246 (82.3%) started haemodialysis, 48 (16%) started peritoneal dialysis, and five (1.7%) underwent pre-emptive kidney transplantation. Out of all incident patients, only 44.8% had regular nephrology consultations for at least 6-12 months before starting KRT, while 25.4% were in regular nephrology follow-up for less than 6 months. For 29.7% patients, there was no pre-KRT data. Only 53 (21.5%) of incident haemodialysis patients started dialysis using an arteriovenous fistula or arteriovenous graft. Overall, 199 (66.5%) patients started KRT in an acute setting.

Conclusion
This study highlights several significant gaps in pre-dialysis care in Latvia, such as timely nephrology referral, structured pre-dialysis education, and improved dialysis access planning to ensure a more structured and timely transition to KRT. In response, a nationwide project to improve KRT quality was launched in November 2024, aiming to address these challenges and improve patient outcomes.