Renal replacement therapy in Europe: a summary of the 2013 ERA-EDTA Registry Annual Report with a focus on diabetes mellitus

Abstract

Background: This article provides a summary of the 2013 European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) Registry Annual Report (available at http://www.era-edta-reg.org), with a focus on patients with diabetes mellitus (DM) as the cause of end-stage renal disease (ESRD).

Methods: In 2015, the ERA-EDTA Registry received data on renal replacement therapy (RRT) for ESRD from 49 national or regional renal registries in 34 countries in Europe and bordering the Mediterranean Sea. Individual patient data were provided by 31 registries, while 18 registries provided aggregated data. The total population covered by the participating registries comprised 650 million people.

Results: In total, 72 933 patients started RRT for ESRD within the countries and regions reporting to the ERA-EDTA Registry, resulting in an overall incidence of 112 per million population (pmp). The overall prevalence on 31 December 2013 was 738 pmp (n = 478 990). Patients with DM as the cause of ESRD comprised 24% of the incident RRT patients (26 pmp) and 17% of the prevalent RRT patients (122 pmp). When compared with the USA, the incidence of patients starting RRT pmp secondary to DM in Europe was five times lower and the incidence of RRT due to other causes of ESRD was two times lower. Overall, 19 426 kidney transplants were performed (30 pmp). The 5-year adjusted survival for all RRT patients was 60.9% [95% confidence interval (CI) 60.5-61.3] and 50.6% (95% CI 49.9-51.2) for patients with DM as the cause of ESRD.

Keywords: end-stage renal disease; incidence; prevalence; renal replacement therapy; survival.

Fig. 1.

Renal registries from countries and regions in Europe and bordering the Mediterranean Sea that contributed individual patient data or aggregated data to the ERA-EDTA Registry for 2013.

Fig. 2.

Unadjusted incidence of RRT pmp at Day 1 in 2013 by cause of ESRD. Data are from renal registries providing individual patient data (left panel) and from renal registries providing aggregated data (right panel). Data for Bulgaria, the Czech Republic, Lithuania, Slovakia and Switzerland only include dialysis patients. Registries from Dutch- and French-speaking Belgium, the Spanish regions of Cantabria, Castile and León and Castile-La Mancha and the UK (England, Northern Ireland and Wales) do not report on patients <20 years of age.

Fig. 3.

Unadjusted incidence of RRT pmp at Day 1 by cause of ESRD for the USA [4] and Europe. Data for Europe were based on those renal registries that had individual patient data available from 2004, including Austria, Belgium (Dutch-speaking and French-speaking), Denmark, Finland, Greece, Iceland, Norway, Spain (Andalusia, Aragon, Asturias, Basque country, Cantabria, Castile and León, Castile-La Mancha, Catalonia and Valencia Region), Sweden, The Netherlands and UK (all countries).

Fig. 4.

Unadjusted prevalence of RRT pmp on 31 December 2013 by cause of ESRD. Data are from renal registries providing individual patient data (left panel) and from renal registries providing aggregated data (right panel). Data for Israel, Slovakia and Switzerland only include dialysis patients. For Romania, the overall prevalence of RRT is underestimated by ∼3% due to an estimated 30% underreporting of patients living on a functioning graft. Registries from Dutch- and French-speaking Belgium, the Spanish regions of Cantabria, Castile and León and Castile-La Mancha and the UK (England, Northern Ireland and Wales) do not report on patients <20 years of age.

Fig. 5.

Kidney transplants pmp performed in 2013, unadjusted. Data are from renal registries providing individual patient data (left panel) and aggregated data (right panel). For Slovakia, data were obtained from the Slovak Centre of Organ Transplantation, and for Spain (18 of 19 regions), from the Organización Nacional de Transplantes. For Romania, the kidney transplantation activity reflects 70% of the total kidney transplantation activity in the country due to an underreporting of pre-emptive kidney transplantations. Registries from Dutch- and French-speaking Belgium, the Spanish regions of Cantabria, Castile and León and Castile-La Mancha and the UK (England, Northern Ireland and Wales) do not report on patients <20 years of age.