The European Renal Association - European Dialysis and Transplant Association (ERA-EDTA) Registry Annual Report 2015: a summary

Abstract

Background: This article summarizes the European Renal Association - European Dialysis and Transplant Association (ERA-EDTA) Registry's 2015 Annual Report. It describes the epidemiology of renal replacement therapy (RRT) for end-stage renal disease (ESRD) in 2015 within 36 countries.

Methods: In 2016 and 2017, the ERA-EDTA Registry received data on patients who were undergoing RRT for ESRD in 2015, from 52 national or regional renal registries. Thirty-two registries provided individual patient-level data and 20 provided aggregated-level data. The incidence, prevalence and survival probabilities of these patients were determined.

Results: In 2015, 81 373 individuals commenced RRT for ESRD, equating to an overall unadjusted incidence rate of 119 per million population (pmp). The incidence ranged by 10-fold, from 24 pmp in Ukraine to 232 pmp in the Czech Republic. Of the patients commencing RRT, almost two-thirds were men, over half were aged ≥65 years and a quarter had diabetes mellitus as their primary renal diagnosis. Treatment modality at the start of RRT was haemodialysis for 85% of the patients, peritoneal dialysis for 11% and a kidney transplant for 4%. By Day 91 of commencing RRT, 82% of patients were receiving haemodialysis, 13% peritoneal dialysis and 5% had a kidney transplant. On 31 December 2015, 546 783 individuals were receiving RRT for ESRD, corresponding to an unadjusted prevalence of 801 pmp. This ranged throughout Europe by more than 10-fold, from 178 pmp in Ukraine to 1824 pmp in Portugal. In 2015, 21 056 kidney transplantations were performed, equating to an overall unadjusted transplant rate of 31 pmp. This varied from 2 pmp in Ukraine to 94 pmp in the Spanish region of Cantabria. For patients commencing RRT during 2006-10, the 5-year unadjusted patient survival probabilities on all RRT modalities combined was 50.0% (95% confidence interval 49.9-50.1).

Keywords: dialysis; end-stage renal disease; epidemiology; kidney transplantation; survival analysis.

Figures

Fig. 1.

Unadjusted incidence rates of RRT pmp, by country/region at Day 1 in 2015. The incidence rate for Bulgaria, the Czech Republic, Russia and Slovakia only includes patients receiving dialysis. For England (UK), the overall incidence of RRT is underestimated by ∼4%.

Fig. 2.

Unadjusted (left panel) and adjusted (right panel) incidence rates of RRT pmp by country/region at Day 1 in 2015. Registries providing individual patient data are shown as dark bars, and registries providing aggregated-level data as light bars. Adjustment of incidence rates was performed by standardizing the rates to the age and gender distribution of the EU27 population [5]. The incidence rate for Bulgaria, the Czech Republic, Russia and Slovakia only includes patients receiving dialysis. For England (UK), the overall incidence of RRT is underestimated by ∼4%.

Fig. 3.

Unadjusted incidence of RRT (%) by (A) gender, (B) age and (C) primary renal diagnosis at Day 1 in 2015. See Appendix 1 for a list of countries and regions supplying individual patient-level or aggregated-level data.

Fig. 4.

Unadjusted incidence (%) of (A) treatment modality overall, and treatment modality by (B) gender, (C) age and (D) primary renal diagnosis in 2015. (B–D) Only based on data from registries providing individual patient data. See Appendix 1 for a list of countries and regions supplying individual patient-level or aggregated-level data. HD, haemodialysis; PD, peritoneal dialysis; Tx, transplant; DM, diabetes mellitus.

Fig. 5.

Unadjusted incidence (%) of (A) treatment modality overall, and treatment modality by (B) gender, (C) age and (D) primary renal diagnosis at Day 91 in 2015. (B–D) Only based on data from registries providing individual patient data. See Appendix 1 for a list of countries and regions supplying individual patient-level or aggregated-level data. HD, haemodialysis; PD, peritoneal dialysis; Tx, transplant; DM, diabetes mellitus.

Fig. 6.

Unadjusted prevalence of RRT pmp by country/region on 31 December 2015. The prevalence for Israel, Slovakia and Tunisia (Sfax region) only includes patients receiving dialysis. For Romania, Switzerland and England (UK), the overall prevalence of RRT is underestimated by, respectively, 3, 6 and 1%.

Fig. 7.

Unadjusted (left panel) and adjusted (right panel) prevalence of RRT pmp by country/region on 31 December 2015. Registries providing individual patient data are shown as dark bars, and registries providing aggregated-level data as light bars. Adjustment of the prevalence was performed by standardizing the prevalence to the age and gender distribution of the EU27 population [5]. The prevalence for Israel, Slovakia and Tunisia (Sfax region) only includes patients receiving dialysis. For Romania, Switzerland and England (UK), the overall prevalence of RRT is underestimated by, respectively, 3, 6 and 1%.

Fig. 8.

Unadjusted prevalence (%) by (A) gender, (B) age and (C) primary renal diagnosis on 31 December 2015. See Appendix 1 for a list of countries and regions supplying individual patient-level or aggregated-level data.

Fig. 9.

Unadjusted prevalence (%) of (A) treatment modality overall, and treatment modality by (B) gender, (C) age and (D) primary renal diagnosis on 31 December 2015. (B–D) Only based on data from registries providing individual patient data. See Appendix 1 for a list of countries and regions supplying individual patient-level or aggregated-level data. HD, haemodialysis; PD, peritoneal dialysis; Tx, transplant; DM, diabetes mellitus.

Fig. 10.

Kidney transplants performed in 2015, as counts and pmp (unadjusted) by country/region. Registries providing individual patient-level data are shown as dark bars, and registries providing aggregated-level data as light bars. Data based on patients aged ≥20 years in Dutch-speaking Belgium, French-speaking Belgium, the Spanish regions of Cantabria, Castile and León, Castile-La Mancha and Navarre and the UK: England, Northern Ireland and Wales. The total count for Austria is based on residents and non-residents. For Romania, Switzerland and England (UK), the overall transplant rate is underestimated by, respectively, 30, 6 and 7%.

Fig. 11.

Percentage of kidney transplants performed in 2015 by kidney donor type. See Appendix 1 for a list of countries and regions supplying individual patient-level or aggregated-level data.

Fig. 12.

Unadjusted deceased donor (left panel) and living donor (right panel) kidney transplants performed in 2015 pmp, by country/region. Registries providing individual patient-level data are shown as dark bars, and registries providing aggregated-level data as light bars. Data based on patients aged ≥20 years in Dutch-speaking Belgium, French-speaking Belgium, the Spanish regions of Cantabria, Castile and León, Castile-La Mancha and Navarre and the UK: England, Northern Ireland and Wales. The total count for Austria is based on residents and non-residents. For Romania, Switzerland and England (UK), the overall transplant rate is underestimated by, respectively, 30, 6 and 7%.

Fig. 13.

Adjusted patient survival of patients starting haemodialysis and peritoneal dialysis between 2006 and 2010 from Day 91 (left panel) and patients receiving a first transplant from a living or deceased donor between 2006 and 2010 (right panel), adjusted for age, gender and primary renal diagnosis. Survival on dialysis was adjusted using the following fixed values: age (67 years), gender (63% men) and primary renal disease (24% diabetes mellitus, 19% hypertension/renal vascular disease, 11% glomerulonephritis and 46% other causes). Survival after kidney transplantation was adjusted using the following fixed values: age (50 years), gender (63% men) and primary renal disease (14% diabetes mellitus, 10% hypertension/renal vascular disease, 23% glomerulonephritis and 53% other causes). These figures are based on data from the following registries providing individual patient data: Austria, Belgium (Dutch-speaking), Belgium (French-speaking), Denmark, Finland, France, Greece, Iceland, Norway, Spain (Andalusia), Spain (Aragon), Spain (Asturias), Spain (Basque country), Spain (Cantabria), Spain (Castile and León), Spain (Castile-La Mancha), Spain (Catalonia), Spain (Extremadura), Spain (Galicia), Spain (Community of Madrid), Spain (Valencian region), Sweden, the Netherlands and UK (all countries).

Fig. 14.

Expected remaining lifetimes of the general population (cohort 2011–15), and of prevalent dialysis and transplant patients (cohort 2011–15), by age and gender. This figure is based on data from the following registries providing individual patient data: Austria, Belgium (Dutch-speaking), Belgium (French-speaking), Denmark, Finland, France, Greece, Iceland, Norway, Spain (Andalusia), Spain (Aragon), Spain (Asturias), Spain (Basque Country), Spain (Cantabria), Spain (Castile and León), Spain (Castile-La Mancha), Spain (Catalonia), Spain (Extremadura), Spain (Galicia), Spain (Community of Madrid), Spain (Valencian region), Sweden, the Netherlands, UK (England, Northern Ireland and Wales) and UK (Scotland).