title: Prevalence of co-morbidity in different European RRT populations and its effect on access to renal transplantation.
abstract: BACKGROUND
  This study compared the prevalence of co-morbidity in patients starting renal replacement therapy (RRT) between European countries and further examined how co-morbidity affects access to transplantation.
  
  
  METHODS
  In this ERA-EDTA registry special study, 17907 patients from Austria, Catalonia (Spain), Lombardy (Italy), Norway, and the UK (England/Wales) were included (1994-2001). Co-morbidity was recorded at the start of RRT.
  
  
  RESULTS
  The prevalence of co-morbidity was: diabetes mellitus (DM) (primary renal disease and co-morbidity) 28%, ischaemic heart disease (IHD) 23%, peripheral vascular disease (PVD) 24%, cerebrovascular disease (CVD) 14% and malignancy 11%. With exception of malignancy, the prevalence of co-morbidity was highest in Austria, but differences were small among other countries. With exception of DM, males suffered more often from co-morbidity than females. In general, the percentage of haemodialysis was higher in patients with co-morbidity, but treatment modality differed substantially between countries. Using a Cox regression with adjustment for demographics, country, year of start and other co-morbidities, the presence of each of the co-morbid conditions made it less likely [RR; 95%CI] to receive a transplant within 4 years: DM [0.79; 0.70-0.88], IHD [0.59; 0.50-0.70], PVD [0.57; 0.49-0.67], CVD [0.49; 0.39-0.61], and malignancy [0.32; 0.24-0.42]. The age, gender and year of start adjusted relative risk [95%CI] to receive a renal transplant within 4 years ranged from 0.23 [0.19-0.27] for Lombardy (Italy) to 3.86 [3.36-4.45] for Norway (Austria = reference). These international differences existed for patients with and without co-morbidity.
  
  
  CONCLUSIONS
  The prevalence of co-morbidity was highest in Austria but differences were small among other countries. The access to a renal graft was most affected by the presence of malignancy and least affected by the presence of DM. International differences in access to transplantation were only partly due to co-morbid variability.
authors.affiliation: ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, J1b 113.1, PO Box 22700, 1100 DE Amsterdam, The Netherlands. v.s.stel@amc.uva.nl
authors.forename: Vianda S
authors.initials: VS
authors.lastname: Stel
authors.forename: Paul C W
authors.initials: PC
authors.lastname: van Dijk
authors.forename: Jeannette G
authors.initials: JG
authors.lastname: van Manen
authors.forename: Friedo W
authors.initials: FW
authors.lastname: Dekker
authors.forename: David
authors.initials: D
authors.lastname: Ansell
authors.forename: Ferruccio
authors.initials: F
authors.lastname: Conte
authors.forename: Reinhard
authors.initials: R
authors.lastname: Kramar
authors.forename: Torbjørn
authors.initials: T
authors.lastname: Leivestad
authors.forename: Emili
authors.initials: E
authors.lastname: Vela
authors.forename: J Douglas
authors.initials: JD
authors.lastname: Briggs
authors.forename: Kitty J
authors.initials: KJ
authors.lastname: Jager
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000601:surgery; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology*; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors