The ERA-EDTA Registry Annual Report 2018: a summary

ORIGINAL ARTICLE The ERA-EDTA Registry Annual Report 2018: a summary Anneke Kramer 1 , Rianne Boenink 1 , Vianda S. Stel 1 , Carmen Santiuste de Pablos 2,3 , Filip Tomovi c 4 , Eliezer Golan 5 , Julia Kerschbaum 6 , Nurhan Seyahi 7 , Kyriakos Ioanou 8,9 , Palma Beltra´n 10 , Oscar Zurriaga 11,12,13,14 ,A ´ngela Magaz 15 , Marı´a F. Slon Roblero 16 , Nikola Gjorgjievski 17,18 , Liliana Garneata 19 , Federico Arribas 20 , Ana A. Galv~ ao 21 , Samira Bell 22,23 , Mai Ots-Rosenberg 24 , Jose´M.Mu ~ noz-Terol 25 , Rebecca Winzeler 26 , Kristine Hommel 27 , Anders A ˚sberg 28 , Viera Spustova 29 , Marı´a A ´ngeles Palencia Garcı´a 30 , Evgueniy Vazelov 31 , Patrik Finne 32,33 , Marc A.G.J. ten Dam 34 , Franti sek Lopot 35 , Sara Trujillo-Alema´n 36 , Mathilde Lassalle 37 , Mykola O. Kolesnyk 38 , Shalini Santhakumaran 39 , Alma Idrizi 40 , Anton Andrusev 41,42 , Jordi Comas Farne´s 43 , Kirill Komissarov 44 , Halima Resi c 45 , Runolfur Palsson 46,47 , Viktorija Kuzema 48,49,50 , Maria Angeles Garcia Bazaga 51 , Edita Ziginskiene 52,53 , Maria Stendahl 54 , Marjolein Bonthuis 1,55 , Ziad A. Massy 56,57 and Kitty J. Jager 1 1 Department of Medical Informatics, ERA-EDTA Registry, UMC, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands, 2 Department of Epidemiology, Murcia Renal Registry, Murcia Regional Health Authority, IMIB-Arrixaca, Murcia, Spain, 3 CIBER Epidemiologı´a y Salud Pu´ blica (CIBERESP), Madrid, Spain, 4 Clinical Center of Montenegro, Clinic for Nephrology, Podgorica, Montenegro, 5 Israel Renal Registry, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel, 6 Department of Internal Medicine IV—Nephrology and Hypertension, Austrian Dialysis and Transplant Registry, Medical University Innsbruck, Innsbruck, Austria, 7 Department of Nephrology, Istanbul University- Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey, 8 Cyprus Renal Registry, Nicosia, Cyprus, 9 Department of Nephrology, American Medical Center, Nicosia, Cyprus, 10 RERCA, Public Health Directorate, Asturias, Spain, 11 Valencia Region Renal Registry, Direccio General de Salut Publica i Adiccions, Valencia, Spain, 12 Department of Preventive Medicine and Public Health, Universitat de Valencia, Valencia, Spain, 13 Rare Diseases Joint Research Unit Universitat de Valencia-Foundation for the Promotion of Health and Biomedical Research in the Valencian Region, FISABIO, Valencia, Spain, 14 Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain, 15 Unidad de Informacio´n de Pacientes Renales—UNIPAR, Basque Country, Spain, 16 Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain, Received: 7.12.2020; Editorial decision: 18.12.2020 V CThe Author(s) 2020. Published by Oxford University Press on behalf of ERA-EDTA. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/ licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact [email protected] 107 Clinical Kidney Journal, 2021, vol. 14, no. 1, 107–123 doi: 10.1093/ckj/sfaa271 Advance Access Publication Date: 24 December 2020 Original Article Clinical Kidney Journal Downloaded from https://academic.oup.com/ckj/article/14/1/107/6046935 by UNIVERSIDAD DE SEVILLA user on 23 November 2023 17 University Hospital of Nephrology, Skopje, N. Macedonia, 18 Faculty of Medicine, University Ss “Cyril and Methodius” Skopje, Skopje, N. Macedonia, 19 Department of Internal Medicine and Nephrology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania, 20 Department of Aragon Health, General Direction of Health Care, Zaragoza, Spain, 21 Portuguese Renal Registry, Coimbra, Portugal, 22 Scottish Renal Registry, Meridian Court, Information Services Division Scotland, Glasgow, UK, 23 Division of Population Health and Genomics, University of Dundee, Dundee, UK, 24 Department of Internal Medicine, University of Tartu, Tartu University Hospital, Tartu, Estonia, 25 Department of Nephrology, Hospital University Virgen del Rocio, Seville, Spain, 26 Institute of Nephrology, City Hospital Waid and Triemli, Zurich, Switzerland, 27 Department of Medicine, Holbaek Hospital, Holbaek, Denmark, 28 Department of Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway, 29 Department of experimental and clinical pharmacotherapy, Slovak Medical University, Bratislava, Slovakia, 30 Coordinacio´n Autono´mica de Trasplantes de Castilla y Leo´n, Direccio´n General de Planificacio´n y Asistencia Sanitaria, Regional de Salud, Valladolid, Spain, 31 Dialysis clinic, “Alexandrovska” University Hospital, Sofia Medical University, Sofia, Bulgaria, 32 Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland, 33 Finnish Registry for Kidney Diseases, Helsinki, Finland, 34 Dutch Registry RENINE, Nefrovsie, Utrecht, The Netherlands, 35 Department of Medicine, General University Hospital Prague, Strahov, Czech Republic, 36 Health Quality Assessment and Information System Service, Direccio´n General de Programas Asistenciales, Servicio Canario de la Salud, Canary Islands, Spain, 37 REIN Registry, Agence de la Biome´decine, Saint-Denis La Plaine, France, 38 State Institute of Nephrology, National Academy of Medical Sciences of Ukraine, Kiev, Ukraine, 39 UK Renal Registry, Bristol, UK, 40 Service of Nephrology, UHC Mother Teresa, Tirana, Albania, 41 Chronic Dialysis, Russia & CIS Medical Department, Company “Baxter” AO, Moscow, Russia, 42 Renal Replacement Registry, Russian Dialysis Society, Moscow, Russia, 43 Health Department, Catalan Renal Registry, Catalan Transplant Organization, Generalitat of Catalonia, Barcelona, Spain, 44 Minsk Scientific and Practical Center of Surgery, Transplantation and Hematology, Minsk, Belarus, 45 Clinic of Nephrology, Clinical Center, University of Sarajevo, Sarajevo, Bosnia-Herzegovina, 46 Division of Nephrology, Landspitali– The National University Hospital of Iceland, Reykjavik, Iceland, 47 Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland, 48 Department of Nephrology, Riga Stradins clinical University Hospital, Riga, Latvia, 49 Department of Internal Medicine, Riga Stradins University, Riga, Latvia, 50 Latvian Nephrology Association, Riga, Latvia, 51 Direccio´n General de Salud Pu´ blica, Servicio Extreme~ no de Salud, Consejerı´a de Sanidad y Polı´ticas Sociales, Junta de Extremadura, Me´rida, Spain, 52 Lithuanian Nephrology, Dialysis and Transplantation Association, Kaunas, Lithuania, 53 Department of Nephrology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania, 54 Department of Internal Medicine, Swedish Renal Registry, Jonkoping Regional Hospital, Jonkoping, Sweden, 55 Department of Medical Informatics, SPN/ERA-EDTA Registry, UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands, 56 Division of Nephrology, Ambroise Pare´ University Hospital, Boulogne-Billancourt, France and 57 Institut National de la Sante´ et de la Recherche Me´dicale (INSERM) Unit, 1018 Team 5, Research Centre in Epidemiology and Population Health (CESP), University of Paris Ouest-Versailles-St Quentin-en-Yveline, Villejuif, France Correspondence to: Anneke Kramer; E-mail: [email protected]; Twitter handle: @EraEdtaRegistry ABSTRACT Background. The European Renal Association – European Dialysis and Transplant Association (ERA-EDTA) Registry collects data on kidney replacement therapy (KRT) via national and regional renal registries in Europe and countries bordering the Mediterranean Sea. This article summarizes the 2018 ERA-EDTA Registry Annual Report, and describes the epidemiology of KRT for kidney failure in 34 countries. Methods. Individual patient data on patients undergoing KRT in 2018 were provided by 34 national or regional renal registries and aggregated data by 17 registries. The incidence and prevalence of KRT, the kidney transplantation activity and the survival probabilities of these patients were calculated. Results. In 2018, the ERA-EDTA Registry covered a general population of 636 million people. Overall, the incidence of KRT for kidney failure was 129 per million population (p.m.p.), 62% of patients were men, 51% were 65years of age and 20% had 108 | A. Kramer et al. Downloaded from https://academic.oup.com/ckj/article/14/1/107/6046935 by UNIVERSIDAD DE SEVILLA user on 23 November 2023 diabetes mellitus as cause of kidney failure. Treatment modality at the onset of KRT was haemodialysis (HD) for 84%, peritoneal dialysis (PD) for 11% and pre-emptive kidney transplantation for 5% of patients. On 31 December 2018, the prevalence of KRT was 897 p.m.p., with 57% of patients on HD, 5% on PD and 38% living with a kidney transplant. The transplant rate in 2018 was 35 p.m.p.: 68% received a kidney from a deceased donor, 30% from a living donor and for 2% the donor source was unknown. For patients commencing dialysis during 2009–13, the unadjusted 5-year survival probability was 42.6%. For patients receiving a kidney transplant within this period, the unadjusted 5-year survival probability was 86.6% for recipients of deceased donor grafts and 93.9% for recipients of living donor grafts. Keywords: dialysis, epidemiology, kidney failure, kidney transplantation, survival analysis INTRODUCTION This article summarizes the European Renal Association – European Dialysis and Transplant Association (ERA-EDTA) Registry’s 2018 Annual Report, providing the most recent data on the epidemiology of kidney replacement therapy (KRT) for kidney failure in Europe, and countries bordering the Mediterranean Sea [1]. In total, 51 national or regional renal registries from 34 countries provided data to the ERA-EDTA Registry, of which 34 renal registries from 18 countries provided individual patient data, and another 17 renal registries provided aggregated data from 17 countries (Supplementary Appendix S1). In total, these registries cover a general population of 636 million people, which is lower than the 694 million people covered in the 2017 Annual Report [2], as this year Croatia, Georgia, Poland and Sfax region (Tunisia) could not be included. When excluding Israel, the remaining countries cover a general population of 627 million people, representing 74.2% of the total 2018 European general population. On the other hand, compared with our 2017 Annual Report, Montenegro and the Valencian region (Spain) are now included with individual patient data. This article presents the 2018 incidence and prevalence of KRT, kidney transplantation activity and both patient and graft survival in Europe. More information on the methods used to analyse the data, as well as the complete results, can be found in the ERA-EDTA Registry 2018 Annual Report [1]. RESULTS Incidence of KRT In 2018, 81714 individuals out of a population of 636 million people started KRT for kidney failure, resulting in an overall unadjusted incidence of 129 per million population (p.m.p.; Table 1). The unadjusted incidence ranged from 37, 73 and 74 p.m.p. in Ukraine, Estonia and Montenegro, respectively, to 256 p.m.p. in Portugal and Cyprus and 264 p.m.p. in Greece (Table 1 and Figures 1 and 2). Of the patients starting KRT, 62% were men, 51% were aged 65years and 20% had diabetes mellitus (DM) as cause of kidney failure (Figure 3). The median age of the patients starting KRT was 66.5years, and differed by almost 20years between Ukraine (55.0years) and the Dutch-speaking part of Belgium (74.4 years; Table 1). The majority (84%) of patients started KRT with haemodialysis (HD), another 11% started with peritoneal dialysis (PD) and 5% of patients received a pre-emptive kidney transplant (Figure 4). While the distribution of initial treatment modalities was similar for men and women, there were considerable differences between age groups, with decreasing proportions of patients receiving either PD or a pre-emptive transplant with increasing age (Figure 4). In addition, compared with patients without DM as cause of kidney failure, those with DM as cause of kidney failure more often started KRT on HD (85% versus 80%), and less frequently received a pre-emptive kidney transplant (2% versus 6%). Among the incident patients receiving KRT at Day 91 after the onset of treatment, 82% were receiving HD, 13% were receiving PD and 5% were living with a functioning kidney transplant (Figure 5). When compared with Day 1, the percentage of patients receiving HD decreased, a finding that was particularly evident in the younger age groups. Prevalence of KRT On 31 December 2018, 569 678 patients were receiving KRT for kidney failure, corresponding to an overall unadjusted prevalence of 897 p.m.p. (Table 2). Among the individual countries or regions the unadjusted prevalence ranged from 229, 313 and 411 p.m.p. in Ukraine, Montenegro and Russia, respectively, to 1469, 1547 and 2011 p.m.p. in Catalonia (Spain), Valencian region (Spain) and Portugal, respectively (Table 2 and Figures 6 and 7). Of the prevalent patients, 60% were men, 43% were aged 65 years and 15% had DM as cause of kidney failure (Figure 8). The median age of prevalent patients receiving KRT was 63.0 years, ranging from 52.0 years in Albania and Ukraine to 68.6 years in Israel (Table 2). Of the prevalent patients, 57% were receiving HD and 5% were receiving PD, while 38% were living with a kidney transplant (Figure 9). Compared with prevalent patients with a cause of kidney failure other than DM, those with DM as cause of kidney failure were less likely to be living with a functioning kidney transplant (51% versus 29%). Kidney transplantation In 2018, a total of 22260 kidney transplantations were performed, corresponding to an overall unadjusted transplant rate of 35 p.m.p. (Figure 10). In the individual countries or regions, the unadjusted kidney transplant rates ranged from 3 p.m.p. in Ukraine and 4 p.m.p. in Bulgaria and Serbia, to 76, 77 and 102 p.m.p. in Asturias (Spain), Cantabria (Spain) and Catalonia (Spain), respectively. Overall, the unadjusted deceased donor kidney transplant rate was more than twice that of living donor transplants (24 p.m.p. versus 10 p.m.p.; 68% versus 30%; Figures 11 and 12). The highest unadjusted rates of deceased donor kidney transplants were observed in several Spanish regions (>70 p.m.p.; Figure 12), whereas the highest unadjusted rates of living donor transplants were observed in Northern Ireland (27 p.m.p.), the Netherlands (28 p.m.p.) and Turkey (37 p.m.p.; Figure 12). Survival of patients receiving KRT For patients commencing KRT in the period 2009–13, the 5-year unadjusted patient survival probability was 51.1% [95% confidence interval (95% CI) 51.0–51.2; Table 3]. For patients starting ERA-EDTA Registry Annual Report 2018 |109 Downloaded from https://academic.oup.com/ckj/article/14/1/107/6046935 by UNIVERSIDAD DE SEVILLA user on 23 November 2023 Table 1. Incidence of KRT (as count and p.m.p.) in 2018, at Day 1, by country or region, unadjusted and the mean and median age at the start of KRT, and the incidence of KRT for patients with DM as cause of kidney failure (as count and p.m.p.) Country/region General population covered by the registry in thousands Incidence of KRT in 2018 at Day 1 All (n) All (p.m.p.) Mean age (years) Median age (years) DM (n) DM (p.m.p.) Albania 2841 398 140 59.8 61.0 78 27 Austria 8822 1057 120 64.4 67.1 243 28 Belarus 9475 782 83 176 19 Belgium, Dutch-speaking a 6578 1186 180 71.1 74.4 241 37 Belgium, French-speaking a 4849 983 203 68.6 70.0 187 39 Bosnia and Herzegovina 3531 440 125 62.0 64.0 127 36 Bulgaria 7000 1091 156 317 45 Cyprus 876 224 256 69.0 73.0 86 98 Czech Republic b 9983 2265 227 Denmark 5850 679 116 63.2 66.8 174 30 Estonia 1322 96 73 57.3 58.5 20 15 Finland 5516 509 92 61.1 64.1 161 29 France 66 966 11 296 169 67.6 70.5 2503 37 Greece 10 733 2833 264 70.9 73.5 682 64 Iceland 353 28 79 59.7 59.6 5 14 Israel 8883 1723 194 65.4 68.1 780 88 Italy (7 of 20 regions) 21 427 3355 157 68.6 71.6 559 26 Kosovo 1688 295 175 62.0 65.0 112 66 Latvia 1312 141 107 62.3 66.0 28 21 Lithuania 2809 316 112 59.9 60.4 46 16 Montenegro a 622 46 74 56.5 60.1 10 16 North Macedonia 2022 339 168 62.9 64.0 104 51 Norway 5312 546 103 63.8 67.9 92 17 Portugal 10 309 2634 256 811 79 Romania 19 064 3487 183 62.5 64.5 424 22 Russia b 133 570 11 070 83 56.3 61.0 1838 14 Serbia 6284 552 88 61.0 63.6 124 20 Slovakia b 5444 898 165 64.5 66.0 325 60 Spain (All) 46 723 6918 148 64.8 68.2 1702 36 Spain, Andalusia 8419 1221 145 62.5 65.5 319 38 Spain, Aragon 1317 141 107 66.8 69.8 33 25 Spain, Asturias 1028 172 167 67.2 68.5 53 52 Spain, Basque country 2174 251 115 65.2 68.4 61 28 Spain, Canary Islands 2192 382 174 64.3 66.4 136 62 Spain, Cantabria a 581 88 151 69.4 72.1 12 21 Spain, Castile and Leo´n a 2409 345 143 66.3 69.4 81 34 Spain, Castile-La Mancha a 2034 243 119 66.7 69.5 67 33 Spain, Catalonia 7600 1392 183 65.8 69.6 275 36 Spain, Community of Madrid 6578 915 139 65.6 69.2 241 37 Spain, Extremadura 1073 158 147 64.5 66.4 41 38 Spain, Galicia 2702 397 147 65.3 67.9 103 38 Spain, Murcia 1479 221 149 62.1 65.4 54 37 Spain, Navarre a 647 71 110 67.4 70.4 16 25 Spain, Valencian region 4964 783 158 66.2 70.0 166 33 Sweden 10 175 1095 108 64.2 68.1 280 28 Switzerland 8514 875 103 65.5 69.3 192 23 The Netherlands 16 025 1975 123 63.9 67.2 380 24 Turkey c 82 004 12 232 149 954 54 Ukraine 42 216 1563 37 52.8 55.0 370 9 UK, England a,d 55 977 6530 117 62.0 64.0 1761 31 UK, Northern Ireland a 1882 228 121 64.3 67.2 48 26 UK, Scotland 5438 613 113 60.2 62.1 180 33 UK, Wales a 3139 416 133 63.4 65.9 125 40 All countries 635 534 81 714 129 63.5 66.5 16 245 29 When cells are left empty, the data are unavailable and could not be used for the calculation of the summary data. a Patients <20 years are not reported. The true incidence counts are therefore slightly higher than the counts reported here. b Data include dialysis patients only. c Data on incidence by cause of kidney failure (DM) is based on 2642 dialysis patients (21.6% of total). d The incidence is underestimated by 2% due to one centre not submitting data since 2014. 110 | A. Kramer et al. Downloaded from https://academic.oup.com/ckj/article/14/1/107/6046935 by UNIVERSIDAD DE SEVILLA user on 23 November 2023 KRT with dialysis in this period, the unadjusted 5-year patient survival probability was 42.6% (95% CI 42.5–42.7). Adjusted analyses for patient survival on HD and PD revealed higher survival probabilities in the first 3 years for those receiving PD (Figure 13). For patients receiving a kidney transplant in the period 2009–13, living donor transplant recipients experienced a higher adjusted 5-year patient survival than recipients of deceased donor transplants: 94.7% (95% CI 94.3–95.2) versus 92.0% FIGURE 1: Incidence of KRT (p.m.p.) in 2018, at Day 1, by country or region, unadjusted. The incidence for Czech Republic, Russia and Slovakia only includes patients receiving dialysis. For England (UK), the incidence is underestimated by 2% (Table 1). ERA-EDTA Registry Annual Report 2018 |111 Downloaded from https://academic.oup.com/ckj/article/14/1/107/6046935 by UNIVERSIDAD DE SEVILLA user on 23 November 2023 (95% CI 91.7–92.3; Figure 13), as well as a higher adjusted 5-year graft survival: 87.1% (95% CI 86.4–87.8) versus 81.1% (95% CI 80.6–81.5; Table 3). A description of the adjustments made and the countries and regions included in these analyses can be found in Table 3. Expected remaining lifetime Patients receiving dialysis between 2014 and 2018 are expected to live only half of the estimated expected remaining lifetime of patients living with a functioning kidney transplant in the same period (Figure 14). When compared with the general population, FIGURE 2: Unadjusted (left panel) and adjusted (right panel) incidence of KRT p.m.p. in 2018, at Day 1, by country or region. Registries providing individual patient data are shown as dark bars, and registries providing aggregated data as light bars. Adjustment of incidence was performed by standardizing to the age and sex distribution of the EU27 population. The incidence for Czech Republic, Russia and Slovakia only includes patients receiving dialysis. For England (UK), the incidence is underestimated by 2% (Table 1). 112 | A. Kramer et al. Downloaded from https://academic.oup.com/ckj/article/14/1/107/6046935 by UNIVERSIDAD DE SEVILLA user on 23 November 2023 the life expectancy of patients on dialysis was 70% shorter, while for kidney transplant recipients it was 40% shorter. AFFILIATED REGISTRIES Albanian Renal Registry (A. Idrizi, M. Rroji and E. Likaj); Austrian Dialysis and Transplant Registry (OEDTR) (F. Engler, J. Kerschbaum, R. Kramar, G. Mayer and the Austrian Society of Nephrology); Belarus Renal Registry (K.S. Komissarov, K.S. Kamisarau and A.V. Kalachyk); Dutch speaking Belgian Society of Nephrology (NBVN) (M. Couttenye, F. Schroven and J. De Meester); French speaking Belgian Society of Nephrology (GNFB) (J.M. des Grottes and F. Collart); Renal Registry Bosnia and Herzegovina (H. Resi c, B Jakovljevic and Z. Kelava); Bulgaria FIGURE 3: (A) Sex, (B) age and (C) cause of kidney failure distribution by type of data provided for incident patients accepted for KRT in 2018, at Day 1. See Supplementary Appendix A1 for a list of countries and regions providing individual patient data or aggregated data. ERA-EDTA Registry Annual Report 2018 |113 Downloaded from https://academic.oup.com/ckj/article/14/1/107/6046935 by UNIVERSIDAD DE SEVILLA user on 23 November 2023 FIGURE 4: Treatment modality distribution, at Day 1, by (A) type of data provided, (B) age, (C) sex and (D) cause of kidney failure (DM and non-DM) for incident patients accepted for KRT in 2018. Parts (B), (C) and (D) are only based on the data from registries providing individual patient data. See Supplementary Appendix A1 for a list of countries and regions providing individual patient data or aggregated data. Tx, kidney transplant FIGURE 5: Treatment modality distribution, at Day 91, by (A) type of data provided, (B) age, (C) sex and (D) cause of kidney failure (DM and non-DM) for incident patients accepted for KRT in 2018. Parts (B), (C) and (D) are only based on the data from registries providing individual patient data. See Supplementary Appendix A1 for a list of countries and regions providing individual patient data or aggregated data. Tx, kidney transplant 114 | A. Kramer et al. Downloaded from https://academic.oup.com/ckj/article/14/1/107/6046935 by UNIVERSIDAD DE SEVILLA user on 23 November 2023 Table 2. Prevalence of KRT (as count and p.m.p.) on 31 December 2018, by country or region, unadjusted and the mean and median age on 31 December 2018 and the prevalence of KRT for patients DM as cause of kidney failure (as count and p.m.p.) Country/region General population covered by the registry in thousands Prevalent patients on KRT in 2018 All (n) All (p.m.p.) Mean age (years) Median age (years) DM (n) DM (p.m.p.) Albania 2841 1602 564 51.3 52.0 322 113 Austria 8822 9577 1086 62.0 63.4 1756 199 Belarus 9475 4096 432 541 57 Belgium, Dutch-speaking a 6578 8466 1287 66.4 68.4 1435 218 Belgium, French-speaking a 4849 6559 1353 65.2 66.9 1164 240 Bosnia and Herzegovina 3531 2699 764 59.9 61.6 539 153 Bulgaria 7000 4464 638 Cyprus 876 Czech Republic 9983 12 194 1221 Denmark 5850 5541 947 59.1 60.7 938 160 Estonia 1322 983 744 58.3 59.0 176 133 Finland 5516 5106 926 59.6 62.1 1286 233 France 66 966 90 358 1349 63.2 65.3 14 881 222 Greece 10 733 14 665 1366 65.4 67.5 2757 257 Iceland 353 266 754 56.3 57.5 30 85 Israel b 8883 6747 760 66.6 68.6 3121 351 Italy (7 of 20 regions) 21 427 26 131 1220 62.8 65.0 2916 136 Kosovo 1688 805 477 62.9 66.0 240 142 Latvia 1312 1020 778 55.5 57.0 103 79 Lithuania 2809 2342 834 Montenegro a 622 195 313 57.0 59.5 28 45 North Macedonia 2022 1756 868 58.8 60.0 304 150 Norway 5312 5256 989 60.0 62.2 724 136 Portugal 10 309 20 730 2011 68.0 68.5 3670 356 Romania 19 064 21 738 1140 62.6 64.3 2220 116 Russia 133 570 54 953 411 56.8 59.0 7913 59 Serbia 6284 4589 730 60.0 62.4 808 129 Slovakia b 5444 3589 659 64.1 66.0 1202 221 Spain (All) 46 723 61 773 1322 59.9 63.1 10 014 214 Spain, Andalusia 8419 10 577 1256 60.9 62.2 1675 199 Spain, Aragon 1317 1710 1299 63.8 65.2 307 233 Spain, Asturias 1028 1409 1371 63.9 65.1 252 245 Spain, Basque country 2174 2723 1252 62.2 64.4 328 151 Spain, Canary Islands 2192 3200 1460 61.8 63.1 886 404 Spain, Cantabria a 581 689 1185 63.4 64.7 97 167 Spain, Castile and Leo´n a 2409 3126 1298 65.4 66.5 552 229 Spain, Castile-La Mancha a 2034 2485 1222 63.3 64.1 405 199 Spain, Catalonia 7600 11 162 1469 63.3 65.0 1609 212 Spain, Community of Madrid 6578 7816 1188 62.3 63.8 1406 214 Spain, Extremadura 1073 1326 1236 62.4 62.8 207 193 Spain, Galicia 2702 3816 1412 63.1 64.5 649 240 Spain, Murcia 1479 2043 1382 62.4 63.3 299 202 Spain, Navarre a 647 865 1337 63.2 65.0 128 198 Spain, Valencian region 4964 7679 1547 63.5 65.5 1095 221 Sweden 10 175 10 206 1003 60.3 62.4 1836 180 Switzerland 8514 8077 949 62.5 64.5 1220 143 The Netherlands 16 542 17 493 1057 60.8 62.8 2336 141 Turkey c 82 004 81 055 988 3043 338 Ukraine 42 216 9659 229 50.7 52.0 1511 36 UK, England a,d 55 977 54 520 974 59.0 59.6 9645 172 UK, Northern Ireland a 1882 1909 1015 59.3 59.5 283 150 UK, Scotland 5438 5324 979 57.1 58.5 901 166 UK, Wales a 3139 3235 1031 59.6 60.7 561 179 All countries 636 051 569 678 897 61.1 63.0 80 424 148 When cells are left empty, the data are unavailable and could not be used for the calculation of the summary data. a Patients <20 years are not reported. The true prevalent counts are therefore slightly higher than the counts reported here. b Data on prevalence include dialysis patients only. c Data on the prevalence by cause of kidney failure (DM) is based on 8904 dialysis patients (11.0% of total). d The prevalence is underestimated by 1% due to one centre not submitting data since 2014. ERA-EDTA Registry Annual Report 2018 |115 Downloaded from https://academic.oup.com/ckj/article/14/1/107/6046935 by UNIVERSIDAD DE SEVILLA user on 23 November 2023 Table 3. The survival probabilities at 1, 2 and 5 years by treatment modality and cohort, from Day 1 of the start of KRT, dialysis or from the day of kidney transplantation Survival probabilities as percentage (95% CIs) Cohort: 2009–13 Cohort: 2012–16 Survival type 1 year 2 years 5 years 1 year 2 years Patient survival on KRT Unadjusted 84.3 (84.2–84.5) 74.3 (74.2–74.5) 51.1 (51.0–51.2) 85.1 (85.0–85.3) 75.1 (75.0–75.3) Adjusted a 87.0 (86.9–87.2) 77.9 (77.6–78.1) 53.1 (52.8–53.4) 87.5 (87.4–87.7) 78.3 (78.1–78.5) Patient survival on dialysis Unadjusted 83.3 (83.1–83.4) 71.8 (71.7–72.0) 42.6 (42.5–42.7) 84.1 (83.9–84.2) 72.6 (72.4–72.7) Adjusted a 85.5 (85.3–85.6) 75.1 (74.9–75.3) 46.4 (46.1–46.8) 86.3 (86.1–86.5) 76.0 (75.8–76.3) Patient survival after first kidney transplantation (deceased donor) Unadjusted 96.1 (95.9–96.3) 94.0 (93.8–94.2) 86.6 (86.3–86.9) 96.3 (96.1–96.4) 94.1 (93.9–94.3) Adjusted b 97.8 (97.7–97.9) 96.5 (96.4–96.7) 92.0 (91.7–92.3) 98.0 (97.8–98.1) 96.8 (96.6–96.9) Graft survival after first kidney transplantation (deceased donor) Unadjusted 90.7 (90.5–91.0) 87.6 (87.3–87.9) 77.5 (77.2–77.9) 91.2 (90.9–91.4) 88.0 (87.7–88.3) Adjusted b 92.4 (92.1–92.6) 89.7 (89.4–90.0) 81.1 (80.6–81.5) 93.0 (92.7–93.2) 90.4 (90.1–90.7) Patient survival after first kidney transplantation (living donor) Unadjusted 98.9 (98.7–99.1) 97.9 (97.6–98.2) 93.9 (93.5–94.3) 98.9 (98.7–99.1) 98.0 (97.8–98.3) Adjusted b 99.1 (98.9–99.2) 98.2 (98.0–98.5) 94.7 (94.3–95.2) 99.1 (98.9–99.2) 98.3 (98.1–98.5) Graft survival after first kidney transplantation (living donor) Unadjusted 96.5 (96.2–96.8) 94.7 (94.3–95.1) 87.8 (87.2–88.3) 96.7 (96.4–97.0) 95.1 (94.8–95.5) Adjusted b 96.3 (95.9–96.6) 94.4 (94.0–94.9) 87.1 (86.4–87.8) 96.5 (96.2–96.8) 94.8 (94.4–95.2) The findings are based on data from the following renal registries providing individual patient data: Austria, Belgium (Dutch-speaking), Belgium (French-speaking), Bosnia and Herzegovina, Denmark, Finland, France, Greece, Iceland, Norway, Spain (Andalusia), Spain (Aragon), Spain (Asturias), Spain (Basque country), Spain (Cantabria), Spain (Castile and Leo´n), Spain (Castile-La Mancha), Spain (Catalonia), Spain (Community of Madrid), Spain (Extremadura), Spain (Galicia), Spain (Valencian region), Sweden, the Netherlands, UK (England/Northern Ireland/Wales) and UK (Scotland). Unadjusted survival probabilities were calculated using the Kaplan–Meier method, and adjusted survival probabilities using the Cox regression model. a Analyses were adjusted using fixed values: age (67 years), sex (63% men) and cause of kidney failure (24% DM, 19% hypertension/renal vascular disease, 11% glomerulonephritis and 46% other causes). b Analyses were adjusted using fixed values: age (50 years), sex (63% men) and cause of kidney failure (14% DM, 10% hypertension/renal vascular disease, 23% glomerulonephritis and 53% other causes). FIGURE 13: Survival of patients starting HD and PD between 2009 and 2013 from Day 91 (A) and patients receiving a first kidney transplant from a living or deceased do- nor between 2009 and 2013 (B). Survival on dialysis was censored for kidney transplantation, and adjusted using fixed values for age (67 years), sex (63% men) and cause of kidney failure (24% DM, 19% hypertension/renal vascular disease, 11% glomerulonephritis and 46% other causes). Survival after kidney transplantation was adjusted using fixed values for age (50 years), sex (63% men) and cause of kidney failure (14% DM, 10% hypertension/renal vascular disease, 23% glomerulonephritis and 53% other causes). These figures are based on the data from the following registries providing individual patient data: Austria, Belgium (Dutch-speaking), Belgium (Frenchspeaking), Bosnia and Herzegovina, Denmark, Finland, France, Greece, Iceland, Norway, Spain (Andalusia), Spain (Aragon), Spain (Asturias), Spain (Basque country), Spain (Cantabria), Spain (Castile and Leo´n), Spain (Castile-La Mancha), Spain (Catalonia), Spain (Extremadura), Spain (Galicia), Spain (Community of Madrid), Spain (Valencian region), Sweden, the Netherlands, UK (England/Northern Ireland/Wales) and UK (Scotland). 122 | A. Kramer et al. Downloaded from https://academic.oup.com/ckj/article/14/1/107/6046935 by UNIVERSIDAD DE SEVILLA user on 23 November 2023 REFERENCES 1. ERA-EDTA Registry. ERA-EDTA registry annual report 2018. Amsterdam UMC, Department of Medical Informatics, Amsterdam, the Netherlands: Amsterdam UMC, 2020 2. Kramer A, Boenink R, Noordzij M et al. The ERA-EDTA registry annual report 2017: a summary. Clin Kidney J 2020; 13: 693–709 FIGURE 14: Expected remaining lifetimes of prevalent dialysis and kidney transplant patients (Cohort 2013–17) and the general population (Cohort 2013–17), by age. This figure is based on data from the following registries providing individual patient data: Austria, Belgium (Dutch-speaking), Belgium (French-speaking), Bosnia and Herzegovina, Denmark, Finland, France, Greece, Iceland, Norway, Spain (Andalusia), Spain (Aragon), Spain (Asturias), Spain (Basque Country), Spain (Cantabria), Spain (Castile and Leo´n), Spain (Castile-La Mancha), Spain (Catalonia), Spain (Extremadura), Spain (Galicia), Spain (Community of Madrid), Spain (Valencian region), Sweden, the Netherlands and the UK (all countries). ERA-EDTA Registry Annual Report 2018 |123 Downloaded from https://academic.oup.com/ckj/article/14/1/107/6046935 by UNIVERSIDAD DE SEVILLA user on 23 November 2023