The European Renal Association - European Dialysis and Transplant Association Registry Annual Report 2014: a summary

Abstract

Background: This article summarizes the European Renal Association - European Dialysis and Transplant Association Registry's 2014 annual report. It describes the epidemiology of renal replacement therapy (RRT) for end-stage renal disease (ESRD) in 2014 within 35 countries. Methods: In 2016, the ERA-EDTA Registry received data on patients who in 2014 where undergoing RRT for ESRD, from 51 national or regional renal registries. Thirty-two registries provided individual patient level data and 19 provided aggregated patient level data. The incidence, prevalence and survival probabilities of these patients were determined. Results: In 2014, 70 953 individuals commenced RRT for ESRD, equating to an overall unadjusted incidence rate of 133 per million population (pmp). The incidence ranged by 10-fold; from 23 pmp in the Ukraine to 237 pmp in Portugal. Of the patients commencing RRT, almost two-thirds were men, over half were aged ≥65 years and a quarter had diabetes mellitus as their primary renal diagnosis. By day 91 of commencing RRT, 81% of patients were receiving haemodialysis. On 31 December 2014, 490 743 individuals were receiving RRT for ESRD, equating to an unadjusted prevalence of 924 pmp. This ranged throughout Europe by more than 10-fold, from 157 pmp in the Ukraine to 1794 pmp in Portugal. In 2014, 19 406 kidney transplantations were performed, equating to an overall unadjusted transplant rate of 36 pmp. Again this varied considerably throughout Europe. For patients commencing RRT during 2005-09, the 5-year-adjusted patient survival probabilities on all RRT modalities was 63.3% (95% confidence interval 63.0-63.6). The expected remaining lifetime of a 20- to 24-year-old patient with ESRD receiving dialysis or living with a kidney transplant was 21.9 and 44.0 years, respectively. This was substantially lower than the 61.8 years of expected remaining lifetime of a 20-year-old patient without ESRD.

Keywords: ESRD; dialysis; epidemiology; kidney transplantation; survival analysis.

Fig. 1

Unadjusted incident rates per million population by country/region at day 1 in 2014. The incident rates for Bulgaria and the Czech Republic only include patients receiving dialysis.

Fig. 2

Unadjusted (left panel) and adjusted (right panel) incident rates per million population by country/region at day 1 in 2014. Registries providing individual patient data are shown as dark bars and registries providing aggregated data as light bars. The incident rate for Bulgaria and the Czech Republic only includes patients receiving dialysis.

Fig. 3

Unadjusted incident percentages by (A) gender, (B) age and (C) primary renal diagnosis at day 1 in 2014. See Appendix 1 for a list of countries and regions supplying individual patient level or aggregated level data.

Fig. 4

Unadjusted incident percentages of (A) established therapy overall, and established therapy by (B) gender, (C) age and (D) primary renal diagnosis at day 91 in 2014. (B)–(D) are only based on data from registries providing individual patient data. See Appendix 1 for a list of countries and regions supplying individual patient level or aggregated level data. HD, haemodialysis; PD, peritoneal dialysis; Tx, transplant; DM, diabetes mellitus.

Fig. 5

Unadjusted prevalence per million population by country/region on 31 December 2014. The prevalence rates for Israel, Slovakia, Switzerland and Tunisia (Sfax region) only include patients receiving dialysis. For Romania, the overall prevalence of RRT is underestimated by 3% due to an estimated 30% underreporting of patients living on a functioning graft.

Fig. 6

Unadjusted (left panel) and adjusted (right panel) prevalence per million population by country/region on 31 December 2014. Registries providing individual patient data are shown as dark bars and registries providing aggregated data as light bars. The prevalence rates for Israel, Slovakia, Switzerland and Tunisia (Sfax region) only include patients receiving dialysis. For Romania, the overall prevalence of RRT is underestimated by 3% due to an estimated 30% underreporting of patients living on a functioning graft.

Fig. 7

Unadjusted prevalent percentages by (A) gender, (B) age and (C) primary renal diagnosis on 31 December 2014. See Appendix 1 for a list of countries and regions supplying individual patient level or aggregated level data.

Fig. 8

Unadjusted prevalent percentages of (A) established therapy overall, and established therapy by (B) gender, (C) age and (D) primary renal diagnosis on 31 December 2014. (B)–(D) are only based on data from registries providing individual patient data. See Appendix 1 for a list of countries and regions supplying individual patient level or aggregated level data. HD, haemodialysis; PD, peritoneal dialysis; Tx, transplant; DM, diabetes mellitus.

Fig. 9

Kidney transplants performed in 2014, as counts and per million population (unadjusted) by country/region. Registries providing individual patient data are shown as dark bars and registries providing aggregated data as light bars. Data based on patients aged ≥20 years in Dutch-speaking Belgium, French-speaking Belgium, Montenegro, the Spanish regions of Cantabria, Castile and León, Castile-La Mancha and Navarre, and the UK: England, Northern Ireland and Wales. The total count for Austria is based on residents and non-residents. For Romania the transplantation activity reflects 70% of the total transplantation activity in the country due to an underreporting of pre-emptive transplantation.

Fig. 10

Unadjusted deceased donor (left panel) and living donor (right panel) kidney transplants per million population performed in 2014 by country/region. Registries providing individual patient data are shown as dark bars and registries providing aggregated data as light bars. Data based on patients aged ≥20 years in Dutch-speaking Belgium, French-speaking Belgium, Montenegro, the Spanish regions of Cantabria, Castile and León, Castile-La Mancha and Navarre, and the UK: England, Northern Ireland and Wales. The total count for Austria is based on residents and non-residents. For Romania, the transplantation activity reflects 70% of the total transplantation activity in the country due to an underreporting of pre-emptive transplantation.

Fig. 11

Percentage of kidney transplants performed in 2014 by kidney donor type. See Appendix 1 for a list of countries and regions supplying individual patient level or aggregated level data.

Fig. 12

The 5-year adjusted survival probability of incident dialysis patients (commencing RRT between 2005 and 2009) and patients receiving a first transplant (between 2005 and 2009) from day 91 by modality, adjusted for age, gender and primary renal diagnosis. Survival on dialysis was examined using the Cox regression method, with transplantation as a censored event (see the ERA-EDTA 2014 Annual Report for the full methods). Analyses were adjusted using fixed values: age (60 years), gender (60% men) and primary renal diagnosis (20% diabetes mellitus, 17% hypertension/renal vascular disease, 15% glomerulonephritis and 48% other causes). This figure is based on data from the following registries providing individual patient data: Austria, Belgium (Dutch-speaking), Belgium (French-speaking), Denmark, Finland, France, Greece, Iceland, Norway, Spain (Andalusia), Spain (Aragon), Spain (Asturias), Spain (Basque country), Spain (Cantabria), Spain (Castile and León), Spain (Castile-La Mancha), Spain (Catalonia), Spain (Extremadura), Spain (Galicia), Spain (Valencian region), Sweden, the Netherlands and the UK (all countries).

Fig. 13

Expected remaining lifetimes of the general population in 2013 and 2014, and of prevalent dialysis and transplant patients in 2013 and 2014 (includes mortality in the first 90 days), by age and gender. This figure is based on data from the following registries providing individual patient data: Austria, Belgium (Dutch-speaking), Belgium (French-speaking), Bosnia and Herzegovina, Denmark, Estonia, Finland, France, Greece, Iceland, Norway, Spain (Andalusia), Spain (Aragon), Spain (Asturias), Spain (Basque country), Spain (Cantabria), Spain (Castille and León), Spain (Castille-La Mancha), Spain (Catalonia), Spain (Extremadura), Spain (Galicia), Spain (Community of Madrid), Spain (Region of Murcia), Spain (Valencian region), Sweden, the Netherlands and the UK (all countries).