Renal replacement therapy in Europe-a summary of the 2009 ERA-EDTA Registry Annual Report

Abstract

Introduction: This study provides a summary of the 2009 ERA-EDTA Registry Report, with a focus on the differences in the incidence and prevalence of haemodialysis (HD), peritoneal dialysis (PD) and renal transplantation between countries and over time.

Methods: For this report, 56 data sets on renal replacement therapy (RRT) from national and regional registries in 30 countries in Europe and bordering the Mediterranean Sea were available. Data sets with individual patient data were received from 26 registries, whereas 19 registries contributed data in aggregated form. For both types of registries, we present incidence, prevalence and transplant rates. Survival analysis is based on individual patient records.

Results: In 2009, the overall incidence rate of RRT for end-stage renal disease (ESRD) among all registries reporting to the ERA-EDTA Registry was 125 per million population (p.m.p.). Incidence rates varied from 259 p.m.p. in Turkey to 19 p.m.p. in Ukraine and the mean age of patients starting RRT in 2009 ranged from 47.6 years in Russia to 69.5 year in Dutch-speaking Belgium. When examining the relative change of the HD, PD and transplantation distribution (at Day 91 after the start of RRT) between 2005 and 2009, we found overall a 0.5% decrease in HD, 1.4% decrease in PD utilization and an 1.8% increase of the share of patients living on a functioning graft. The overall prevalence of RRT for ESRD as of 31 December 2009 was 730 p.m.p. The highest prevalence was reported by Portugal (1507 p.m.p.) and the lowest by Ukraine (101 p.m.p.). In Norway, 70% of the patients on RRT were living with a functioning graft (591 p.m.p.) at 31 December 2009. The number of transplants performed p.m.p. in 2009 was highest in Spain (Cantabria) (78 p.m.p.). For the cohort 2000-04, the adjusted 1-, 2- and 5-year survival of patients on RRT was 87.4% (95% confidence interval: 87.2-87.7), 78.5% (95% confidence interval: 78.2-78.8) and 56.3% (95% confidence interval: 55.9-56.7), respectively.

Keywords: dialysis; incidence; prevalence; survival; transplantation.

Fig. 1.

Incidence of RRT p.m.p. at Day 1, 2009. B&H, Bosnia–Herzegovina; FYROM, former Yugoslav Republic of Macedonia.

Fig. 2.

Incidence of RRT p.m.p. at Day 1 in 2009 for all patients and for patients with diabetes mellitus as PRD and mean age (years), unadjusted. Figures include data from renal registries providing individual patient data (left figure) and aggregated data (right figure).

Fig. 3.

Relative change in HD, PD and Tx at Day 91 in 2009 compared to 2005. HD, haemodialysis; PD, peritoneal dialysis; Tx, kidney transplantation.

Fig. 4.

Prevalence of RRT p.m.p. at Day 1 in 2009 for all patients and for patients with diabetes mellitus as PRD and mean age (years), unadjusted. Figures include data from renal registries providing individual patient data (left figure) and aggregated data (right figure). Data from Czech Republic, Israel, Italy (14 of 20 regions) and Slovakia include dialysis patients only. In Italy, the prevalence of RRT is underestimated by ∼11%, due to an estimated 25–30% under-reporting of patients living on a functioning graft.

Fig. 5.

Survival of incident dialysis patients and of patients receiving a first transplant between 2000 and 2004, by treatment modality, adjusted for age, gender and PRD. Analyses regarding incident dialysis patients were adjusted for the fixed values: age (60 years), gender (60% men) and PRD (20% diabetes mellitus, 17% hypertension/renal vascular disease, 15% glomerulonephritis and 48% other cause). Analyses regarding first transplant recipients were adjusted for the fixed values: age (45 years), gender (60% men) and PRD (10% diabetes mellitus, 8% hypertension/renal vascular disease, 28% glomerulonephritis and 54% other cause).

Fig. 6.

Survival of incident HD patients in 2000–04, from Day 91, by PRD, adjusted for age and gender. Analyses were adjusted for the fixed values: age (60 years) and gender (60% men).

Fig. 7.

Survival of incident PD patients in 2000–04, from Day 91, by PRD, adjusted for age and gender. Analyses were adjusted for the fixed values: age (60 years) and gender (60% men).