The ERA Registry Annual Report 2021: a summary

Abstract

Background: The European Renal Association (ERA) Registry collects data on kidney replacement therapy (KRT) in patients with end-stage kidney disease (ESKD). This paper is a summary of the ERA Registry Annual Report 2021, including a comparison across treatment modalities.

Methods: Data was collected from 54 national and regional registries from 36 countries, of which 35 registries from 18 countries contributed individual patient data and 19 registries from 19 countries contributed aggregated data. Using this data, incidence and prevalence of KRT, kidney transplantation rates, survival probabilities and expected remaining lifetimes were calculated.

Result: In 2021, 533.2 million people in the general population were covered by the ERA Registry. The incidence of KRT was 145 per million population (pmp). In incident patients, 55% were 65 years or older, 64% were male, and the most common primary renal disease (PRD) was diabetes (22%). The prevalence of KRT was 1040 pmp. In prevalent patients, 47% were 65 years or older, 62% were male, and the most common PRDs were diabetes and glomerulonephritis/sclerosis (both 16%). On 31 December 2021, 56% of patients received haemodialysis, 5% received peritoneal dialysis, and 39% were living with a functioning graft. The kidney transplantation rate in 2021 was 37 pmp, a majority coming from deceased donors (66%). For patients initiating KRT between 2012-2016, 5-year survival probability was 52%. Compared to the general population, life expectancy was 65% and 68% shorter for males and females receiving dialysis, and 40% and 43% shorter for males and females living with a functioning graft.

Keywords: ESKD; dialysis; graft survival; kidney transplantation; patient survival.

Graphical Abstract

Figure 1:

Incidence per million population of KRT in 2021 on day 1 by country or region, unadjusted.

Figure 2:

Incidence per million population of KRT in 2021 on day 1 by country or region, unadjusted (left panel) and adjusted (right panel). Registries providing individual patient data are shown as dark bars and registries providing aggregated data as light bars. See Appendix 1 for a list of countries and regions providing individual patient or aggregated data. Adjustment was performed by standardizing the incidence to the age and sex distribution of the EU28 population.

Figure 3:

Distribution of (A) age, (B) sex, and (C) primary renal disease by type of data provided for incident patients accepted for KRT in 2021 on day 1, unadjusted.

Figure 4:

Distribution of treatment modality by (A) type of data provided, (B) age, (C) sex, and (D) primary renal disease (DM and non-DM) for incident patients accepted for KRT in 2021 on day 1, unadjusted. Panels (B), (C), and (D) are only based on the data from registries providing individual patient data. See Appendix 1 for a list of countries and regions providing individual patient or aggregated data. HD: haemodialysis; PD: peritoneal dialysis; Tx: transplant.

Figure 5:

Distribution of treatment modality by (A) type of data provided, (B) age, (C) sex, and (D) primary renal disease (DM and non-DM) for incident patients accepted for KRT in 2021 on day 91, unadjusted. Panels (B), (C), and (D) are only based on the data from registries providing individual patient data. See Appendix 1 for a list of countries and regions providing individual patient or aggregated data. HD: haemodialysis; PD: peritoneal dialysis; Tx: transplant.

Figure 6:

Prevalence per million population of KRT on 31 December 2021 by country or region, unadjusted.

Figure 7:

Prevalence per million population of KRT on 31 December 2021 by country or region, unadjusted (left panel) and adjusted (right panel). Registries providing individual patient data are shown as dark bars and registries providing aggregated data as light bars. See Appendix 1 for a list of countries and regions providing individual patient or aggregated data. Adjustment was performed by standardizing the incidence to the age and sex distribution of the EU28 population.

Figure 8:

Distribution of (A) age, (B) sex, and (C) primary renal disease by type of data provided for prevalent patients on KRT on 31 December 2021, unadjusted. See Appendix 1 for a list of countries and regions providing individual patient or aggregated data.

Figure 9:

Distribution of treatment modality by (A) type of data provided, (B) age, (C) sex, and (D) primary renal disease (DM and non-DM) for prevalent patients on KRT on 31 December 2021, unadjusted. Panels (B), (C), and (D) are only based on the data from registries providing individual patient data. See Appendix 1 for a list of countries and regions providing individual patient or aggregated data. HD: haemodialysis; PD: peritoneal dialysis; Tx: transplant.

Figure 10:

Kidney transplantations performed in 2021 counts and per million population by country or region, unadjusted. Registries providing individual patient data are shown as red bars and registries providing aggregated data as orange bars. See Appendix 1 for a list of countries and regions providing individual patient or aggregated data.

Figure 11:

Kidney transplantations performed in 2021 per million population by donor type and by country or region, unadjusted. Registries providing individual patient data are shown as dark bars and registries providing aggregated data as light bars. See Appendix 1 for a list of countries and regions providing individual patient or aggregated data.

Figure 12:

Donor type distribution for kidney transplantations performed in 2021 by type of data provided, unadjusted. See Appendix 1 for a list of countries and regions providing individual patient or aggregated data.

Figure 13:

Expected remaining years of life in the general population and for prevalent dialysis and kidney transplant patients (cohort 2017–2021), by sex. 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 (Community of Madrid), Spain (Extremadura), Spain (Galicia), Spain (Murcia), Spain (Navarre), Spain (Valencian Region), Sweden, the Netherlands, United Kingdom (England/Northern Ireland/Wales), and United Kingdom (Scotland).

Figure 14:

Incidence per million population of KRT in 2021 on day 1 by treatment modality, unadjusted. HD: haemodialysis; PD: peritoneal dialysis; Tx: transplant.

Figure 15:

Percentage of pre-emptive kidney transplantations for incident patients accepted for KRT in 2021 on day 1 by country or region, unadjusted.

Figure 16:

Distribution of (A) age, (B) sex, and (C) primary renal disease by treatment modality for incident patients accepted for KRT in 2021 on day 1, unadjusted. This figure is only based on data from registries providing individual patient data. HD: haemodialysis; PD: peritoneal dialysis; Tx: transplant.

Figure 17:

Prevalence per million population of KRT on 31 December 2021 by treatment modality, unadjusted. HD: haemodialysis; PD: peritoneal dialysis; Tx: transplant.

Figure 18:

Percentage of kidney transplantations for prevalent patients on KRT on 31 December 2021, unadjusted.

Figure 19:

Distribution of (A) age, (B) sex, and (C) primary renal disease by treatment modality for prevalent patients on KRT on 31 December 2021, unadjusted. This figure is only based on data from registries providing individual patient data. HD: haemodialysis; PD: peritoneal dialysis; Tx: transplant.

Figure 20:

Patient survival by modality (HD or PD) for incident dialysis patients accepted for KRT in 2021 on day 91 (cohort 2012–2016), unadjusted. This figure is based on data from registries providing individual patient data.

Figure 21:

Patient survival in first-time transplant recipients by donor type (deceased or living) from day of transplantation (cohort 2012–2016), unadjusted. This figure is based on data from registries providing individual patient data.

Figure 22:

Graft survival in first-time kidney transplant recipients by donor type (deceased or living) from day of transplant (cohort 2012–2016), unadjusted. This figure is based on data from registries providing individual patient data.