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. 2023 Mar 31;38(4):1027-1040.
doi: 10.1093/ndt/gfac165.

Increasing numbers and improved overall survival of patients on kidney replacement therapy over the last decade in Europe: an ERA Registry study

Jilske A Huijben  1 , Anneke Kramer  1 , Julia Kerschbaum  2 , Johan de Meester  3 , Frederic Collart  4 , Olga Lucía Rodríguez Arévalo  5   6 , Jaakko Helve  7   8 , Mathilde Lassalle  9 , Runolfur Palsson  10   11 , Marc Ten Dam  12 , Anna Casula  13 , Shona Methven  14 , Alberto Ortiz  15 , Pietro Manuel Ferraro  16   17 , Mårten Segelmark  18   19 , Pablo Ucio Mingo  20 , Mustafa Arici  21 , Anna Varberg Reisæter  22 , Maria Stendahl  19 , Vianda S Stel  1 , Kitty J Jager  1
Affiliations

Increasing numbers and improved overall survival of patients on kidney replacement therapy over the last decade in Europe: an ERA Registry study

Jilske A Huijben et al. Nephrol Dial Transplant. .

Abstract

Background: The aim of this study was to describe the trends in the incidence, prevalence and survival of patients on kidney replacement therapy (KRT) for end-stage kidney disease (ESKD) across Europe from 2008 to 2017.

Methods: Data from renal registries in 9 countries and 16 regions that provided individual patient data to the ERA Registry from 2008 to 2017 were included. These registries cover 34% of the general population in Europe. Crude and standardized incidence and prevalence per million population (pmp) were determined. Trends over time were studied using Joinpoint regression. Survival probabilities were estimated using Kaplan-Meier analysis and hazard ratios (HRs) using Cox regression analysis.

Results: The standardized incidence of KRT was stable [annual percentage change (APC): -1.48 (-3.15; 0.21)] from 2008 (146.0 pmp) to 2011 (141.6 pmp), followed by a slight increase [APC: 1.01 (0.43; 1.60)] to 148.0 pmp in 2017, although trends in incidence varied across countries. This increase was primarily due to a rise in the incidence of KRT in men older than 65 years. Moreover, as a cause of kidney failure, diabetes mellitus is increasing. The standardized prevalence increased from 2008 (990.0 pmp) to 2017 (1166.8 pmp) [APC: 1.82 (1.75; 1.89)]. Patient survival on KRT improved in the time period 2011-13 compared with 2008-[adjusted HR: 0.94 (0.93; 0.95)].

Conclusion: This study showed an overall increase in the incidence and prevalence of KRT for ESKD as well as an increase in the KRT patient survival over the last decade in Europe.

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

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Conflict of interest statement

K.J.J. reports grants from the European Renal Association (ERA). All other authors declare no competing interests. The results presented in this paper have not been published previously in whole or part.

Figures

FIGURE 1:
FIGURE 1:
Standardized incidence and prevalence of kidney replacement therapy (KRT) per million population (pmp) in countries and regions in Europe over time (comparison of 2008 and 2017). For standardization the age and sex distribution of the EU28 population in 2015 was used. Dark red represents a higher incidence and prevalence pmp (more patients starting or receiving KRT in that country/region in that year compared with other countries/regions), while yellow represents a relatively lower incidence and prevalence pmp (fewer patients starting or receiving KRT in that country/region in that year compared with other countries/regions).
FIGURE 2:
FIGURE 2:
Standardized incidence of kidney replacement therapy (KRT) per million age-related population (pmarp) in men and women, stratified by age group. For standardization the age and sex distribution of the EU28 population in 2015 was used. Trends are indicated by the APC with corresponding 95% confidence interval. Bold numbers and an asterisk (*) indicate whether the APC was statistically significant (P < .05).
FIGURE 3:
FIGURE 3:
Standardized incidence of kidney replacement therapy (KRT) per million population (pmp), stratified by primary renal disease (PRD). For standardization the age and sex distribution of the EU28 population in 2015 was used. Trends are indicated by the APC with corresponding 95% confidence interval. Bold numbers and an asterisk (*) indicate whether the APC was statistically significant (P < .05). Mapping of the 2012 primary renal disease (PRD) codes to the old PRD codes might have influenced the trend of renal vascular disease (RVD); DM, diabetes mellitus; represents DM type I, DM type II and DM type unknown; GM, glomerulonephritis/sclerosis; HT, hypertension; Misc, miscellaneous; PKD, polycystic kidneys, adult type; PN, pyelonephritis; Unkn, unknown (PRD not identified).
FIGURE 4:
FIGURE 4:
Standardized prevalence of KRT pmarp (per million age-related population) in men and women, stratified by age group. For standardization the age and sex distribution of the EU28 population in 2015 was used. Trends are indicated by the APC with corresponding 95% confidence interval. Bold numbers and an asterisk (*) indicate whether the APC was statistically significant (P < .05).
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