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The changing trends and outcomes in renal replacement therapy: data from the ERA-EDTA Registry

Pippias M, Jager KJ, Kramer A, Leivestad T, Sánchez MB, Caskey FJ, Collart F Couchoud C, Dekker FW, Finne P, Fouque D, Heaf JG,Hemmelder MH, Kramar R, De Meester J, Noordzij M, Palsson R, Pascual J, Zurriaga O, Wanner C, Stel VS

This study examines the changes of such indicators as the incidence of new cases, prevalence, patients and renal allograft survival and the causes of death of patients receiving renal replacement therapy in Europe.

Methods

18 national and regional renal registries that providing data to the ERA-EDTA registry for the period from 1998 to 2011 were included in this study. The incidence and prevalence trends were examined using the Jointpoint and the Poisson regression between 2001 and 2011 years. Patients and renal allografts survival and causes of death were analyzed using Kaplan-Meier method and competing risks as well as the Cox regression between 1998-2011 years.

Results

The adjusted incidence rateof RRT increased by 1.1% (95% confidence interval 0.6, 1.7) per year to 131 per million population (pmp) from 2001 to 2008 years. The adjust incidence of RRT decreased by 2.2% (95% CI -4.2, -0.2) annually to 125 pmp during 2008-2011. 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. 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 0.85, 95% CI 0.84, 0.86). Comparing these time periods, the risk of cardiovascular death decreased by 25% (hra 0.75, 95% CI 0.74, 0.77). But the risk of malignant death rose by 9% (HRA 1.09, 95% CI 1.03, 1.16) in patients 65 year and above.

Conclusion

The European study found a reduction in the incidence of new cases of RRT, particularly in patients aged 45-64 years, 65-74 years and with diabetic nephropathy. It is encouraging that the adjusted RRT patient survival continues to improve. But the risk of death from malignancy has increased (in elderly patients)

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