Data from the ERA-EDTA Registry were examined for trends in excess mortality in European adults on kidney replacement therapy

Rianne Boenink*, Vianda S. Stel, Bård E. Waldum-Grevbo, Frederic Collart, Julia Kerschbaum, James G. Heaf, Johan de Meester, Patrik Finne, Sergio A. García-Marcos, Marie Evans, Patrice M. Ambühl, Mustafa Arici, Carole Ayav, Retha Steenkamp, Aleix Cases, Jamie P. Traynor, Runolfur Palsson, Carmine Zoccali, Ziad A. Massy, Kitty J. JagerAnneke Kramer

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)

Abstract

The objective of this study was to investigate whether the improvement in survival seen in patients on kidney replacement therapy reflects the enhanced survival of the general population. Patient and general population statistics were obtained from the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) Registry and the World Health Organization databases, respectively. Relative survival models were composed to examine trends over time in all-cause and cause-specific excess mortality, stratified by age and modality of kidney replacement therapy, and adjusted for sex, primary kidney disease and country. In total, 280,075 adult patients started kidney replacement therapy between 2002 and 2015. The excess mortality risk in these patients decreased by 16% per five years (relative excess mortality risk (RER) 0.84; 95% confidence interval 0.83-0.84). This reflected a 14% risk reduction in dialysis patients (RER 0.86; 0.85-0.86), and a 16% increase in kidney transplant recipients (RER 1.16; 1.07-1.26). Patients on dialysis showed a decrease in excess mortality risk of 28% per five years for atheromatous cardiovascular disease as the cause of death (RER 0.72; 0.70-0.74), 10% for non-atheromatous cardiovascular disease (RER 0.90; 0.88-0.92) and 10% for infections (RER 0.90; 0.87-0.92). Kidney transplant recipients showed stable excess mortality risks for most causes of death, although it did worsen in some subgroups. Thus, the increase in survival in patients on kidney replacement therapy is not only due to enhanced survival in the general population, but also due to improved survival in the patient population, primarily in dialysis patients.

Original languageEnglish
Pages (from-to)999-1008
Number of pages10
JournalKidney International
Volume98
Issue number4
DOIs
Publication statusPublished - Oct 2020

Bibliographical note

Funding text 1
We would like to thank the patients and the staff of the dialysis and transplant units for contributing the data via their national and regional renal registries. Furthermore, we gratefully acknowledge the following registries and persons for their contribution of the data: Austrian Dialysis and Transplant Registry [OEDTR] (R. Kramar); Dutch speaking Belgian Society of Nephrology [NBVN] (M. Couttenye and F. Schroven); French speaking Belgian Society of Nephrology [GNFB] (J. M. des Grottes); Danish Nephrology Registry [DNS]; Finnish Registry for Kidney Diseases (A. Pylsy and P. H. Groop); France: The Epidemiology and Information Network in Nephrology [REIN] (M. Lassalle and C. Couchoud); Hellenic Renal Registry (N. Afentakis); Icelandic End-Stage Renal Disease Registry; Norwegian Renal Registry (T. Leivestad, A. V. Reisæter, and A. Åsberg); Swedish Renal Registry [SRR] (K. G. Prütz, M. Stendahl, S. Schön, T. Lundgren, and M. Segelmark); Dutch Renal Registry [RENINE] (L. Heuveling, S. Vogelaar, and M. Hemmelder); UK Renal Registry (all the staff of the UK Renal Registry and of the renal units submitting data); Scottish Renal Registry [SRR] (all of the Scottish renal units); and the regional registries of Andalusia [SICATA] (P. Castro de la Nuez; on behalf of all users of SICATA), Aragon (F. Arribas Monzón, J. M. Abad Diez, and J. I. Sanchez Miret), Asturias (R. Alonso de la Torre, J. R. Quirós, and RERCA Working Group), Basque country [UNIPAR] (Á. Magaz, J. Aranzabal, M. Rodrigo, and I. Moina), Cantabria (J. C. Ruiz San Millán, O. Garcia Ruiz, and C. Piñera Haces), Castile and León (M. A. Palencia García), Catalonia [RMRC] (E. Arcos, J. Comas, and J. Tort), and Valencian region [REMRENAL] (M. Ferrer Alamar, N. Fuster Camarena, and J. Pérez Penadés); and the other ERA-EDTA registry committee members not mentioned above for their advice in the analyses and the drafting of this paper: J. Harambat, L. Mercadal, M. Nordio, S. S. Sørensen, and E. Vidal; and M. Pippias in the AMC Registry office for data collection and management. The ERA-EDTA Registry is funded by the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA). Finally, we would like to thank B. Foster and X. Zhang for explaining their analyses.
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Funding text 2
We would like to thank the patients and the staff of the dialysis and transplant units for contributing the data via their national and regional renal registries. Furthermore, we gratefully acknowledge the following registries and persons for their contribution of the data: Austrian Dialysis and Transplant Registry [OEDTR] (R. Kramar); Dutch speaking Belgian Society of Nephrology [NBVN] (M. Couttenye and F. Schroven); French speaking Belgian Society of Nephrology [GNFB] (J. M. des Grottes); Danish Nephrology Registry [DNS]; Finnish Registry for Kidney Diseases (A. Pylsy and P. H. Groop); France: The Epidemiology and Information Network in Nephrology [REIN] (M. Lassalle and C. Couchoud); Hellenic Renal Registry (N. Afentakis); Icelandic End-Stage Renal Disease Registry; Norwegian Renal Registry (T. Leivestad, A. V. Reis?ter, and A. ?sberg); Swedish Renal Registry [SRR] (K. G. Pr?tz, M. Stendahl, S. Sch?n, T. Lundgren, and M. Segelmark); Dutch Renal Registry [RENINE] (L. Heuveling, S. Vogelaar, and M. Hemmelder); UK Renal Registry (all the staff of the UK Renal Registry and of the renal units submitting data); Scottish Renal Registry [SRR] (all of the Scottish renal units); and the regional registries of Andalusia [SICATA] (P. Castro de la Nuez; on behalf of all users of SICATA), Aragon (F. Arribas Monz?n, J. M. Abad Diez, and J. I. Sanchez Miret), Asturias (R. Alonso de la Torre, J. R. Quir?s, and RERCA Working Group), Basque country [UNIPAR] (?. Magaz, J. Aranzabal, M. Rodrigo, and I. Moina), Cantabria (J. C. Ruiz San Mill?n, O. Garcia Ruiz, and C. Pi?era Haces), Castile and Le?n (M. A. Palencia Garc?a), Catalonia [RMRC] (E. Arcos, J. Comas, and J. Tort), and Valencian region [REMRENAL] (M. Ferrer Alamar, N. Fuster Camarena, and J. P?rez Penad?s); and the other ERA-EDTA registry committee members not mentioned above for their advice in the analyses and the drafting of this paper: J. Harambat, L. Mercadal, M. Nordio, S. S. S?rensen, and E. Vidal; and M. Pippias in the AMC Registry office for data collection and management. The ERA-EDTA Registry is funded by the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA). Finally, we would like to thank B. Foster and X. Zhang for explaining their analyses. This article was written by R. Boenink et al. on behalf of the ERA-EDTA Registry, which is an official body of the ERA-EDTA (European Renal Association ? European Dialysis and Transplant Association). The support for this study was provided by ERA-EDTA.

Publisher Copyright:
© 2020 International Society of Nephrology

Other keywords

  • dialysis
  • excess mortality
  • kidney replacement therapy (KRT)
  • kidney transplantation
  • survival

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