title: Trends in dialysis modality choice and related patient survival in the ERA-EDTA Registry over a 20-year period.
abstract: BACKGROUND
  Although previous studies suggest similar patient survival for peritoneal dialysis (PD) and haemodialysis (HD), PD use has decreased worldwide. We aimed to study trends in the choice of first dialysis modality and relate these to variation in patient and technique survival and kidney transplant rates in Europe over the last 20 years.
  
  
  METHODS
  We used data from 196 076 patients within the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) Registry who started renal replacement therapy (RRT) between 1993 and 2012. Trends in the incidence rate and prevalence on Day 91 after commencing RRT were quantified with Joinpoint regression. Crude and adjusted hazard ratios (HRs) for 5-year dialysis patient and technique survival were calculated using Cox regression. Analyses were repeated using propensity score matching to control for confounding by indication.
  
  
  RESULTS
  PD prevalence dropped since 2007 and HD prevalence stabilized since 2009. Incidence rates of PD and HD decreased from 2000 and 2009, respectively, while the incidence of kidney transplantation increased from 1993 onwards. Similar 5-year patient survival for PD versus HD patients was found in 1993-97 [adjusted HR: 1.02, 95% confidence interval (95% CI): 0.98-1.06], while survival was higher for PD patients in 2003-07 (HR: 0.91, 95% CI: 0.88-0.95). Both PD (HR: 0.95, 95% CI: 0.91-1.00) and HD technique survival (HR: 0.93, 95% CI: 0.87-0.99) improved in 2003-07 compared with 1993-97.
  
  
  CONCLUSIONS
  Although initiating RRT on PD was associated with favourable patient survival when compared with starting on HD treatment, PD was often not selected as initial dialysis modality. Over time, we observed a significant decline in PD use and a stabilization in HD use. These observations were explained by the lower incidence rate of PD and HD and the increase in pre-emptive transplantation.
authors: ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors: Moniek W M
authors: MW
authors: van de Luijtgaarden
authors: ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors: Kitty J
authors: KJ
authors: Jager
authors: Department of Nephrology, Linköping University, Linköping, Sweden Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors: Mårten
authors: M
authors: Segelmark
authors: Department of Nephrology, Hospital del Mar, Barcelona, Spain.
authors: Julio
authors: J
authors: Pascual
authors: French-Speaking Belgium ESRD Registry, Bruxelles, Belgium.
authors: Frederic
authors: F
authors: Collart
authors: Nefrovisie/RENINE, Leiden, The Netherlands.
authors: Aline C
authors: AC
authors: Hemke
authors: SICATA (The Information System of the Andalusian Transplant Autonomic Coordination Registry), Andalusia, Spain.
authors: César
authors: C
authors: Remón
authors: Scottish Renal Registry, Glasgow, UK.
authors: Wendy
authors: W
authors: Metcalfe
authors: Department of Nephrology, University Clinic Hospital, Valencia, Spain.
authors: Alfonso
authors: A
authors: Miguel
authors: OEDTR, Austrian Dialysis and Transplant Registry, Linz, Austria.
authors: Reinhard
authors: R
authors: Kramar
authors: Department of Nephrology, St Olavs Hospital HF, Trondheim, Norway.
authors: Knut
authors: K
authors: Aasarød
authors: Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors: Ameen
authors: A
authors: Abu Hanna
authors: Division of Nephrology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors: Raymond T
authors: RT
authors: Krediet
authors: Diaverum Renal Services Group, Lund, Sweden.
authors: Staffan
authors: S
authors: Schön
authors: Department of Medicine and Community Health Science, University of Calgary, Calgary, Alberta, Canada.
authors: Pietro
authors: P
authors: Ravani
authors: UK Renal Registry, Southmead Hospital, Bristol BS105NB, UK.
authors: Fergus J
authors: FJ
authors: Caskey
authors: REIN Registry, Biomedicine Agency, La Plaine-Saint Denis, France.
authors: Cecile
authors: C
authors: Couchoud
authors: Division of Nephrology, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland.
authors: Runolfur
authors: R
authors: Palsson
authors: ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands Division of Nephrology, University Hospital Würzburg, Würzburg, Germany.
authors: Christoph
authors: C
authors: Wanner
authors: Finnish Registry for Kidney Diseases, Helsinki, Finland.
authors: Patrik
authors: P
authors: Finne
authors: ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors: Marlies
authors: M
authors: Noordzij
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000066491:Clinical Decision-Making; D005060:Europe; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy*; D016030:Kidney Transplantation / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000706:statistics & numerical data / Q000639:trends*; D015995:Prevalence; D057216:Propensity Score; D016016:Proportional Hazards Models; D012042:Registries; D006435:Renal Dialysis / Q000706:statistics & numerical data / Q000639:trends*
keywords: end-stage renal disease; haemodialysis; peritoneal dialysis; survival analysis; trends over time