Renal replacement therapy in Europe: a summary of the 2012 ERA-EDTA Registry Annual Report

Abstract

Background: This article summarizes the 2012 European Renal Association-European Dialysis and Transplant Association Registry Annual Report (available at www.era-edta-reg.org) with a specific focus on older patients (defined as ≥65 years).

Methods: Data provided by 45 national or regional renal registries in 30 countries in Europe and bordering the Mediterranean Sea were used. Individual patient level data were received from 31 renal registries, whereas 14 renal registries contributed data in an aggregated form. The incidence, prevalence and survival probabilities of patients with end-stage renal disease (ESRD) receiving renal replacement therapy (RRT) and renal transplantation rates for 2012 are presented.

Results: In 2012, the overall unadjusted incidence rate of patients with ESRD receiving RRT was 109.6 per million population (pmp) (n = 69 035), ranging from 219.9 pmp in Portugal to 24.2 pmp in Montenegro. The proportion of incident patients ≥75 years varied from 15 to 44% between countries. The overall unadjusted prevalence on 31 December 2012 was 716.7 pmp (n = 451 270), ranging from 1670.2 pmp in Portugal to 146.7 pmp in the Ukraine. The proportion of prevalent patients ≥75 years varied from 11 to 32% between countries. The overall renal transplantation rate in 2012 was 28.3 pmp (n = 15 673), with the highest rate seen in the Spanish region of Catalonia. The proportion of patients ≥65 years receiving a transplant ranged from 0 to 35%. Five-year adjusted survival for all RRT patients was 59.7% (95% confidence interval, CI: 59.3-60.0) which fell to 39.3% (95% CI: 38.7-39.9) in patients 65-74 years and 21.3% (95% CI: 20.8-21.9) in patients ≥75 years.

Keywords: end-stage renal disease; incidence; prevalence; renal replacement therapy; survival.

Figures

Fig. 1.

(A) The unadjusted incidence of ESRD patients on RRT, pmp on Day 1, among all national and regional renal registries in 30 countries reporting to the ERA-EDTA Registry in 2012. The incidence data for Czech Republic and Slovakia include dialysis patients only. Dutch- and French-speaking Belgium, the Spanish regions of Cantabria, Castile and León and Castile-La Mancha and the UK; England, Northern Ireland and Wales do not report on patients younger than 20 years. (B) The unadjusted incidence of ESRD patients aged 75 years and older on RRT, per million age-related population (pmarp) at Day 1, among all national and regional renal registries in 17 countries providing individual level data to the ERA-EDTA Registry in 2012. B&H: Bosnia–Herzegovina; ME: Montenegro.

Fig. 2.

Incidence of RRT, pmp at Day 1 in 2012, unadjusted (black bars) and standardized to the age and gender distribution of the EU27 population in 2010 (grey bars) and the mean and median age (years) at the start of RRT. Data are from renal registries providing individual level patient data (left panel) and from renal registries providing aggregated data (right panel). The incidence data for the Czech Republic and Slovakia only include dialysis patients. The mean and median age for Slovakia is based on dialysis patients and for Turkey only on haemodialysis patients. Dutch- and French-speaking Belgium, the Spanish regions of Cantabria, Castile and León and Castile-La Mancha and the UK; England, Northern Ireland and Wales do not report on patients younger than 20 years.

Fig. 3.

Incidence of ESRD patients on RRT, pmarp, unadjusted at Day 1, in 2012 for patients aged 65–74 years (black bars) and 75 years and over (grey bars), and with the percentage of patients by the age group.

Fig. 4:

Prevalence of RRT, pmp on 31 December 2012, unadjusted (black bars) and standardized to the age and gender distribution of the EU27 population (grey bars) and the mean and median age (years). Data are from the renal registries providing individual level patient data (left panel) and from renal registries providing aggregated data (right panel). Data for Israel and Slovakia only include dialysis patients. Dutch- and French-speaking Belgium, the Spanish regions of Cantabria, Castile and León and Castile-La Mancha and the UK; England, Northern Ireland and Wales do not report on patients younger than 20 years.

Fig. 5.

Prevalence of RRT, pmp on 31 December 2012 for patients with ESRD aged 65–74 years (black bars) and 75 years and over (grey bars), and with the percentage of patients by the age group.

Fig. 6.

Renal transplants performed, pmp in 2012, unadjusted, with mean and median age at transplantation. Data are from renal registries providing individual patient level data and aggregated data. For the registries providing individual patient data, the percentage of patients aged over 65 years and percentage of patients aged over 75 years at the point of transplantation are presented. For some countries transplantation data were obtained from alternate sources: UK: NHS Blood and Transplant, Slovakia: Slovak Centre of Organ Transplantation, Spain (18 of 19 regions): Organización Nacional de Transplantes. For Romania the transplantation activity reflects 70% of the total transplantation activity in the country, due to an underreporting of pre-emptive transplantations. The mean/median age and percentage over 65 or over 75 years is limited to the adult patient cohort only.