title: The increase in renal replacement therapy (RRT) incidence has come to an end in Sweden-analysis of variations by region over the period 1991-2010.
abstract: BACKGROUND
  Renal replacement therapy (RRT) incidence has increased significantly in Sweden during the past decades. This study analyses variations in time and regional trends in RRT incidence in Sweden, adjusted for age and gender, focusing on the impact change in incidence during the last decade.
  
  
  METHODS
  Using data from the Swedish Renal Registry (SRR) (21 counties in Sweden, total population 9 million), we identified all incident subjects starting RRT from 1991 through 2010. Only individuals alive following 90 days of RRT start were included. Gender- and age-specific standardized RRT incidences on an annual and regional basis were calculated, and differences between counties and variations over time were examined. We compared the overall age and gender-adjusted RRT incidence rates for Sweden by calendar year. Furthermore, we also calculated the age and gender-adjusted RRT incidence in each county during two time periods (1991-1999 versus 2000-2010).
  
  
  RESULTS
  There were 20 172 new subjects treated with RRT between January 1991 and December 2010. The most common cause of end-stage renal disease (ESRD) was diabetes (24%) and hypertension/renal vascular disease (19%), followed by glomerulonephritis (16%). Sixty-four percent of new patients were male; the median age when commencing RRT was 66 years (10-90 percentiles; 39-80). The overall standardized RRT incidence reached its peak in 2000, and slowly decreased thereafter. A decrease in RRT incidence was observed over the study period in eight regions. The standardized RRT incidence varied between the different counties, from 0.82 to 1.19.
  
  
  CONCLUSIONS
  Adjusted for demographic changes in the population, an overall decrease in RRT incidence was observed from the year 2000 onwards-suggesting that the previously reported steady increase in RRT incidence is coming to an end in Sweden. Noteworthy differences were found between counties and in 8 out of 21 counties, a decreased incidence of RRT was found. Further studies need to identify the factors that contribute to this decrease.
authors.affiliation: Division of Baxter Novum, Department of Clinical Science , Intervention and Technology at Karolinska Institute , Stockholm , Sweden.
authors.forename: Abdul Rashid
authors.initials: AR
authors.lastname: Qureshi
authors.affiliation: Division of Renal Medicine, Department of Clinical Science , Intervention and Technology at Karolinska Institute , Stockholm , Sweden.
authors.forename: Marie
authors.initials: M
authors.lastname: Evans
authors.affiliation: Department of Internal Medicine , Ryhov Hospital , Jönköping , Sweden.
authors.forename: Maria
authors.initials: M
authors.lastname: Stendahl
authors.affiliation: Department of Internal Medicine , Helsingborg Hospital , Helsingborg , Sweden.
authors.forename: Karl-Göran
authors.initials: KG
authors.lastname: Prütz
authors.affiliation: Division of Renal Medicine, Department of Clinical Science , Intervention and Technology at Karolinska Institute , Stockholm , Sweden ; Evidence Based Medicine Unit , Stockholm County Council , Stockholm , Sweden.
authors.forename: Carl-Gustaf
authors.initials: CG
authors.lastname: Elinder
keywords: dialysis; geography; kidney disease; survival