ESRD incidence is much lower in. The relative risk for progression from CKD stages 3 or 4 to ESRD in US white patients compared with Norwegian patients was 2.5. This was only modestly modified by adjustment for age, gender, and diabetes. Age and GFR at start of dialysis were similar, hypertension and cardiovascular mortality in the populations were comparable, but US white patients were referred later to a nephrologist and had higher prevalence of obesity and diabetes. In conclusion, CKD prevalence in Norway was similar to that in the United States, suggesting that lower progression to ESRD rather than a smaller pool of individuals at risk accounts for the lower incidence of ESRD in Norway.J Am Soc Nephrol 17: 2275 -2284, 2006 . doi: 10.1681 T here has been a dramatic rise in the number of patients with ESRD in both Europe and North America during the past decades. There is significant disparity, however, in ESRD incidence rates between the two continents: Incidence rates are three times higher in the United States compared with Norway and Great Britain (1,2). Data on the prevalence of chronic kidney disease (CKD) in Europe are limited, making it unclear whether the higher ESRD incidence in the United States reflects a higher burden of all stages of CKD (3,4).The relationship between the prevalence of earlier stages of CKD and the incidence of ESRD is complex (5-9): US CKD prevalence has been relatively stable in the past decade, whereas ESRD incidence has increased significantly, and US black patients have a three times higher incidence of ESRD despite similar prevalences of CKD. This can be due to differences in other mechanisms, such as more rapid progression or greater initiation of dialysis. Early stages of CKD also result in a higher risk for complications, cardiovascular disease, and mortality, which pose a larger absolute risk than ESRD. Furthermore, identifying and treating individuals with early stages of CKD is increasingly proposed for prevention of ESRD and cardiovascular disease (9,10). This requires solid documentation of a high prevalence of preclinical disease. Thus far, European studies on CKD prevalence have been hampered by selection bias or incomplete data for defining CKD stages (11-13).Therefore, there is a need for more information on the prevalence of CKD in European populations as well as a better understanding of the relationship of CKD prevalence to ESRD incidence. The second Health Survey of Nord-Trondelag County (HUNT II) is a large, population-based, cross-sectional study that was conducted in central Norway with a high participation rate (14). We used HUNT II data to assess the prevalence of CKD using calibrated serum creatinine values and repeated measurements of albuminuria. Combining these prevalence estimates with available information on ESRD, health care, and population characteristics, we also examined the extent to which the low incidence of ESRD in Norway compared with the United States reflects a difference in the earlier stages of CKD between the two countries. Material...

Adults with acute lymphoblastic leukemia (ALL) do worse than children. From 7/2008 to 12/2014, Nordic and Baltic centers treated 1509 consecutive patients aged 1-45 years with Philadelphia chromosome-negative ALL according to the NOPHO ALL2008 without cranial irradiation. Overall, 1022 patients were of age 1-9 years (A), 266 were 10-17 years (B) and 221 were 18-45 years (C). Sixteen patients (three adults) died during induction. All others achieved remission after induction or 1-3 intensive blocks. Subsequently, 45 patients (12 adults) died, 122 patients relapsed (32 adults) with a median time to relapse of 1.6 years and 13 (no adult) developed a second malignancy. Median follow-up time was 4.6 years. Among the three age groups, older patients more often had higher risk ALL due to T-ALL (32%/25%/9%, P<0.001), KMT2A rearrangements (6%/5%/3%, P<0.001) and higher day 29 residual leukemia for B-lineage (P<0.001), but not T-ALL (P=0.53). Event-free survival rates (pEFS) were 89±1% (A), 80±3% (B) and 74±4% (C) with significant differences only for non-high risk groups. Except for thrombosis, pancreatitis and osteonecrosis, the risk of 19 specified toxicities was not enhanced by age above 10 years. In conclusion, a pediatric-based protocol is tolerable and effective for young adults, despite their increased frequency of higher risk features.

Even if identical diagnostics, treatment, and risk stratification are implemented, more adults will be stratified to high-risk therapy, which should be considered when comparing pediatric and adult outcomes.

No abstract

Several TRDs were potentially preventable and future efforts should be directed towards patients at risk.