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. 2021 Aug;36(8):2337-2348.
doi: 10.1007/s00467-021-04928-w. Epub 2021 Jan 22.

Ten-year trends in epidemiology and outcomes of pediatric kidney replacement therapy in Europe: data from the ESPN/ERA-EDTA Registry

Marjolein Bonthuis  1 , Enrico Vidal  2 , Anna Bjerre  3 , Özlem Aydoğ  4 , Sergey Baiko  5 , Liliana Garneata  6 , Isabella Guzzo  7 , James G Heaf  8 , Timo Jahnukainen  9 , Marc Lilien  10 , Tamara Mallett  11   12 , Gabriel Mirescu  13   14 , Elena A Mochanova  15 , Eva Nüsken  16 , Katherine Rascher  17 , Dimitar Roussinov  18 , Maria Szczepanska  19 , Michel Tsimaratos  20 , Askiti Varvara  21 , Enrico Verrina  22 , Bojana Veselinović  23 , Kitty J Jager  24 , Jérôme Harambat  25
Affiliations

Ten-year trends in epidemiology and outcomes of pediatric kidney replacement therapy in Europe: data from the ESPN/ERA-EDTA Registry

Marjolein Bonthuis et al. Pediatr Nephrol. 2021 Aug.

Abstract

Background: For 10 consecutive years, the ESPN/ERA-EDTA Registry has included data on children with stage 5 chronic kidney disease (CKD 5) receiving kidney replacement therapy (KRT) in Europe. We examined trends in incidence and prevalence of KRT and patient survival.

Methods: We included all children aged <15 years starting KRT 2007-2016 in 22 European countries participating in the ESPN/ERA-EDTA Registry since 2007. General population statistics were derived from Eurostat. Incidence and prevalence were expressed per million age-related population (pmarp) and time trends studied with JoinPoint regression. We analyzed survival trends using Cox regression.

Results: Incidence of children commencing KRT <15 years remained stable over the study period, varying between 5.5 and 6.6 pmarp. Incidence by treatment modality was unchanged over time: 2.0 for hemodialysis (HD) and peritoneal dialysis (PD) and 1.0 for transplantation. Prevalence increased in all age categories and overall rose 2% annually from 26.4 pmarp in 2007 to 32.1 pmarp in 2016. Kidney transplantation prevalence increased 5.1% annually 2007-2009, followed by 1.5% increase/year until 2016. Prevalence of PD steadily increased 1.4% per year over the entire period, and HD prevalence started increasing 6.1% per year from 2011 onwards. Five-year unadjusted patient survival on KRT was around 94% and similar for those initiating KRT 2007-2009 or 2010-2012 (adjusted HR: 0.98, 95% CI:0.71-1.35).

Conclusions: We found a stable incidence and increasing prevalence of European children on KRT 2007-2016. Five-year patient survival was good and was unchanged over time. These data can inform patients and healthcare providers and aid health policy makers on future resource planning of pediatric KRT in Europe.

Keywords: Dialysis; ESPN/ERA-EDTA Registry; Epidemiology; Hemodialysis; Pediatrics; Peritoneal dialysis; Transplantation.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
European countries included in the study
Fig. 2
Fig. 2
Incidence of KRT by treatment modality and year. a Trends in the incidence rate of pediatric KRT by treatment modality (pmarp). Trends were calculated by the APC and its 95% confidence interval. b Distribution of first KRT modality by year. Abbreviations: KRT, kidney replacement therapy; pmarp, per million age-related population; APC, annual percentage change; HD, hemodialysis; PD, peritoneal dialysis; Tx, pre-emptive kidney transplantation
Fig. 3
Fig. 3
Incidence of KRT (pmarp) by age group and year. Trends were calculated by the APC and its 95% confidence interval. Abbreviations: KRT, kidney replacement therapy; pmarp, per million age-related population; APC, annual percentage change
Fig. 4
Fig. 4
Prevalence of KRT (pmarp) by treatment modality and year. Trends were calculated by the APC and its 95% confidence interval. Abbreviations: KRT, kidney replacement therapy; pmarp, per million age-related population; APC, annual percentage change, HD, hemodialysis; PD, peritoneal dialysis; Tx, kidney transplantation
Fig. 5
Fig. 5
Prevalence of KRT (pmarp) by age group and year. Trends were calculated by the APC and its 95% confidence interval. Abbreviations: KRT, kidney replacement therapy; pmarp, per million age-related population; APC, annual percentage change
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