title: The changing trends and outcomes in renal replacement therapy: data from the ERA-EDTA Registry.
abstract: This study examines the time trends in incidence, prevalence, patient and kidney allograft survival and causes of death (COD) in patients receiving renal replacement therapy (RRT) in Europe.
  
  
  
  Eighteen national or regional renal registries providing data to the European Renal Association-European Dialysis and Transplant Association Registry between 1998 and 2011 were included. Incidence and prevalence time trends between 2001 and 2011 were studied with Joinpoint and Poisson regression. Patient and kidney allograft survival and COD between 1998 and 2011 were analysed using Kaplan-Meier and competing risk methods and Cox regression.
  
  
  
  From 2001 to 2008, the adjusted incidence of RRT rose by 1.1% (95% CI: 0.6, 1.7) annually to 131 per million population (pmp). During 2008-2011, the adjusted incidence fell by 2.2% (95% CI: -4.2, -0.2) annually to 125 pmp. This decline occurred predominantly in patients aged 45-64 years, 65-74 years and in the primary renal diseases diabetes mellitus type 1 and 2, renovascular disease and glomerulonephritis. Between 2001 and 2011, the overall adjusted prevalence increased from 724 to 1032 pmp (+3.3% annually, 95% CI: 2.8, 3.8). The adjusted 5-year patient survival on RRT improved between 1998-2002 and 2003-2007 [adjusted hazard ratio (HRa) 0.85, 95% CI: 0.84, 0.86]. Comparing these time periods, the risk of cardiovascular deaths fell by 25% (HRa 0.75, 95% CI: 0.74, 0.77). However the risk of malignant death rose by 9% (HRa 1.09, 95% CI: 1.03, 1.16) in patients ≥65 years.
  
  
  
  This European study shows a declining RRT incidence, particularly in patients aged 45-64 years, 65-74 years and secondary to diabetic nephropathy. Encouragingly, the adjusted RRT patient survival continues to improve. The risk of cardiovascular death has decreased, though the risk of death from malignancy has increased in the older population.
authors.affiliation: Department of Medical Informatics, ERA-EDTA Registry, Academic Medical Center, Universiteit van Amsterdam, Amsterdam, The Netherlands.
authors.forename: Maria
authors.initials: M
authors.lastname: Pippias
authors.affiliation: Department of Medical Informatics, ERA-EDTA Registry, Academic Medical Center, Universiteit van Amsterdam, Amsterdam, The Netherlands.
authors.forename: Kitty J
authors.initials: KJ
authors.lastname: Jager
authors.affiliation: Department of Medical Informatics, ERA-EDTA Registry, Academic Medical Center, Universiteit van Amsterdam, Amsterdam, The Netherlands.
authors.forename: Anneke
authors.initials: A
authors.lastname: Kramer
authors.affiliation: Norwegian Renal Registry, Department for Transplant Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
authors.forename: Torbjørn
authors.initials: T
authors.lastname: Leivestad
authors.affiliation: Department of Nephrology, Hospital Juan Ramon Jimenez, Huelva, Spain.
authors.forename: Manuel Benítez
authors.initials: MB
authors.lastname: Sánchez
authors.affiliation: UK Renal Registry, Southmead Hospital, Bristol, UK School of Social and Community Medicine, Canynge Hall, University of Bristol, Bristol, UK.
authors.forename: Fergus J
authors.initials: FJ
authors.lastname: Caskey
authors.affiliation: French-Belgian ESRD Registry, Brussels, Belgium.
authors.forename: Frederic
authors.initials: F
authors.lastname: Collart
authors.affiliation: REIN Registry, Agence de la Biomédecine, Saint Denis La Plaine, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Couchoud
authors.affiliation: Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Friedo W
authors.initials: FW
authors.lastname: Dekker
authors.affiliation: Department of Nephrology, Helsinki University Central Hospital, Helsinki, Finland Finnish Registry for Kidney Diseases, Helsinki, Finland.
authors.forename: Patrik
authors.initials: P
authors.lastname: Finne
authors.affiliation: Carmen Cens Department of Nephrology, Université de Lyon F-69622, CH Lyon Sud, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Fouque
authors.affiliation: Department of Medicine, Roskilde Hospital, University of Copenhagen, Copenhagen, Denmark.
authors.forename: James G
authors.initials: JG
authors.lastname: Heaf
authors.affiliation: Nefrovisie Renine, Leiden, The Netherlands.
authors.forename: Marc H
authors.initials: MH
authors.lastname: Hemmelder
authors.affiliation: Austrian Dialysis and Transplant Registry, Rohr, Austria.
authors.forename: Reinhard
authors.initials: R
authors.lastname: Kramar
authors.affiliation: Department of Nephrology & Dialysis & Hypertension, Dutch-speaking Belgian Renal Registry (NBVN), Sint-Niklaas, Belgium.
authors.forename: Johan
authors.initials: J
authors.lastname: De Meester
authors.affiliation: Department of Medical Informatics, ERA-EDTA Registry, Academic Medical Center, Universiteit van Amsterdam, Amsterdam, The Netherlands.
authors.forename: Marlies
authors.initials: M
authors.lastname: Noordzij
authors.affiliation: 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.forename: Runolfur
authors.initials: R
authors.lastname: Palsson
authors.affiliation: Department of Nephrology, Hospital del Mar, Barcelona, Spain.
authors.forename: Julio
authors.initials: J
authors.lastname: Pascual
authors.affiliation: Valencia Region Renal Registry, Direccion General de Salud Pública, Conselleria de Sanitat, Valencia, Spain CIBERESP (Biomedical Research Consortium on Epidemiology and Public Health), Madrid, Spain.
authors.forename: Oscar
authors.initials: O
authors.lastname: Zurriaga
authors.affiliation: Renal Division, University Hospital Würzburg, Würzburg, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Wanner
authors.affiliation: Department of Medical Informatics, ERA-EDTA Registry, Academic Medical Center, Universiteit van Amsterdam, Amsterdam, The Netherlands.
authors.forename: Vianda S
authors.initials: VS
authors.lastname: Stel
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012042:Registries; D017582:Renal Replacement Therapy / Q000401:mortality / Q000706:statistics & numerical data* / Q000639:trends*; D013997:Time Factors
keywords: Europe; end-stage renal disease; incidence; renal replacement therapy; survival