The changing trends and outcomes in renal replacement therapy: Data from the ERA-EDTA Registry

Maria Pippias*, Kitty J. Jager, Anneke Kramer, Torbjørn Leivestad, Manuel Benítez Sánchez, Fergus J. Caskey, Frederic Collart, Cécile Couchoud, Friedo W. Dekker, Patrik Finne, Denis Fouque, James G. Heaf, Marc H. Hemmelder, Reinhard Kramar, Johan De Meester, Marlies Noordzij, Runolfur Palsson, Julio Pascual, Oscar Zurriaga, Christoph WannerVianda S. Stel

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

84 Citations (Scopus)


Background :This study examines the time trends in incidence, prevalence, patient and kidney allograft survival and causes of death (COD) in patients receiving renal replacement therapy (RRT) in Europe. MethodsEighteen national or regional renal registries providing data to the European Renal Association-European Dialysis and Transplant Association Registry between 1998 and 2011 were included. Incidence and prevalence time trends between 2001 and 2011 were studied with Joinpoint and Poisson regression. Patient and kidney allograft survival and COD between 1998 and 2011 were analysed using Kaplan-Meier and competing risk methods and Cox regression. ResultsFrom 2001 to 2008, the adjusted incidence of RRT rose by 1.1% (95% CI: 0.6, 1.7) annually to 131 per million population (pmp). During 2008-2011, the adjusted incidence fell by 2.2% (95% CI: -4.2, -0.2) annually to 125 pmp. This decline occurred predominantly in patients aged 45-64 years, 65-74 years and in the primary renal diseases diabetes mellitus type 1 and 2, renovascular disease and glomerulonephritis. Between 2001 and 2011, the overall adjusted prevalence increased from 724 to 1032 pmp (+3.3% annually, 95% CI: 2.8, 3.8). The adjusted 5-year patient survival on RRT improved between 1998-2002 and 2003-2007 [adjusted hazard ratio (HRa) 0.85, 95% CI: 0.84, 0.86]. Comparing these time periods, the risk of cardiovascular deaths fell by 25% (HRa 0.75, 95% CI: 0.74, 0.77). However the risk of malignant death rose by 9% (HRa 1.09, 95% CI: 1.03, 1.16) in patients ≥65 years. ConclusionThis European study shows a declining RRT incidence, particularly in patients aged 45-64 years, 65-74 years and secondary to diabetic nephropathy. Encouragingly, the adjusted RRT patient survival continues to improve. The risk of cardiovascular death has decreased, though the risk of death from malignancy has increased in the older population.

Original languageEnglish
Pages (from-to)831-841
Number of pages11
JournalNephrology Dialysis Transplantation
Issue number5
Publication statusPublished - 1 May 2016

Bibliographical note

Publisher Copyright:
© 2015 The Author 2015. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

Other keywords

  • end-stage renal disease
  • Europe
  • incidence
  • renal replacement therapy
  • survival


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