NDT Plus Advance Access published online on September 11, 2009
NDT Plus, doi:10.1093/ndtplus/sfp126
© The Author [2009].
Published by Oxford University Press [on behalf of the 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/2.0/uk/) which permits unrestricted non-commercial use distribution, and reproduction in any medium, provided the original work is properly cited.
The 2007 ERA-EDTA Registry Annual Report—a Précis
Vianda S. Stel1,
Anneke Kramer1,
Carmine Zoccali2 and
Kitty J. Jager1
1 ERA–EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
2 CNR–IBIM Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Renal and Transplantation Unit Ospedali Riuniti, Reggio Cal., Italy
Correspondence: Kitty J. Jager; E-mail: k.j.jager{at}amc.uva.nl
Key Words: incidence • prevalence • renal replacement therapy • survival
Received for publication July 17, 2009. Accepted for publication August 17, 2009.
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Introduction
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This summary of the 2007 ERA-EDTA Registry Report includes data
on renal replacement therapy (RRT) from 49 national and regional
registries in 28 countries in Europe and bordering the Mediterranean
Sea (Figure
1). Data sets with individual patient data for analysis
were received from 34 registries, whereas 17 registries contributed
data only in aggregated form. For both types of registries,
we present incidence and prevalence data as well as transplant
rates. Survival analysis used the data from countries and regions
that provided individual patient records. More detailed data
than those presented in this paper can be found in the 2007
ERA-EDTA Registry Report [
1] that is also available on www.era-edta-reg.org.
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The incidence of RRT for ESRD across Europe
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In 2007, the overall incidence rate of RRT for end-stage renal
disease (ESRD) among all registries reporting to the ERA-EDTA
Registry was 116 per million population (pmp). Figure
2 shows
that the highest incidence rates at Day 1 were reported by Turkey
(231 pmp), Portugal (227 pmp) and Israel (193 pmp), whereas
incidence rates below 100 pmp were reported by Ukraine (20 pmp),
Russia (31 pmp), Montenegro (32 pmp), Iceland (81 pmp), Latvia
(86 pmp), Romania (90 pmp), Finland (92 pmp) and FYR of Macedonia
(92 pmp). The mean age at the start of RRT ranged from 43 years
(Ukraine) to 69 years (Belgium) (Figure
2). Table
1 shows the
incidence rate of RRT over the period 2003–2007 for countries
and regions providing individual patient data, adjusted for
age and gender distribution.
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Fig. 2 Incidence of RRT per million population (pmp) and mean age (years) at Day 1 in 2007, unadjusted. Figures include data from renal registries providing individual patient data (left figure) and aggregated data (right figure). Data of Estonia and Tunisia are based on Day 91 of RRT.
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Table 1 Incidence of RRT over the period 2003–2007 per million population (pmp) at Day 1, adjusted for age and gender distribution
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For the age group 0–19 years at the start of RRT, data
were available for a limited number of registries including
those of Austria, Denmark, Finland, Greece, Iceland, Norway,
Romania, Spain (Andalusia), Spain (Aragon), Spain (Basque country),
Spain (Catalonia), Spain (Valencian region), Sweden, The Netherlands,
and United Kingdom (Scotland). As numbers of children starting
RRT were low, we present averages for 2006–2007 (Table
2). In 2007, the ERA-EDTA Registry started a close collaboration
with the ESPN/ERA-EDTA Registry that initiated data collection
from paediatric registries across Europe [
2]. For an overview
of paediatric RRT data collected from those registries, please
visit www.espn-reg.org.
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Table 2 Incidence of RRT over the period 2006–2007 per million age-related population (pmarp) per year at Day 1, by age group, unadjusted
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Table
3 shows the incidence rate of RRT by age group, for countries
and regions providing individual patient data. For the highest
age groups, the highest incidence rates were reported from Belgium
and Greece, whereas Finland and Romania belong to the countries
reporting the lowest incidence rates.
The incidence rates of RRT for ESRD due to diabetes mellitus
were highest in Israel (81 pmp), Turkey (64 pmp), and Slovakia
(60 pmp), whereas the highest incidence rates of RRT for ESRD
due to hypertension/renal vascular disease were reported from
Turkey (58 pmp), and Belgium (52 pmp) (Table
4).
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The prevalence of RRT for ESRD across Europe
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The overall prevalence among all registries reporting to the
ERA-EDTA Registry was 662 pmp. Figure
3 shows that the prevalence
of RRT pmp at 31 December 2007 was highest in Portugal (1372
pmp), Belgium (French-speaking) (1109 pmp) and Spain (Catalonia)
(1100 pmp). The lowest prevalence was reported by Ukraine (85
pmp) and Russia (146 pmp). The mean age at 31 December 2007
ranged from 44 years (Russia and Ukraine) to 64 years (Belgium,
Dutch speaking) for registries providing data both on dialysis
and transplant patients (Figure
3). Table
5 shows the overall
prevalence of RRT, adjusted for age and gender distribution.
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Fig. 3 Prevalence of RRT per million population (pmp) and mean age (years) on 31 December 2007, unadjusted. Figures include data from renal registries providing individual patient data (left figure) and aggregated data (right figure). Data from Czech Republic, Israel, Italy (14 of 20 regions), Slovakia and Tunisia include dialysis patients only, and in Italy (12 of 20 regions) the percentage of missing prevalent RRT patients is estimated at 11%, due to an estimated 25–30% underreporting of patients living on a functioning graft.
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Table 5 Prevalence of RRT on 31 December over the period 2003–2007 per million population (pmp), adjusted for age and gender distribution
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Only a limited number of registries provided complete data for
prevalent patients in the age group 0–19 years in 2007,
including those of Austria, Denmark, Finland, Greece, Iceland,
Norway, Romania, Spain (Andalusia), Spain (Aragon), Spain (Basque
country), Spain (Catalonia), Spain (Valencian region), Sweden,
The Netherlands and United Kingdom (Scotland). The prevalence
for age group 0–19 years is presented in Table
6.
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Table 6 Prevalence of RRT per million age-related population (pmarp) on 31 December 2007, by age group, unadjusted
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Table
7 shows that for the highest age groups, the highest prevalence
was reported by Belgium, Greece, Italy, and several Spanish
registries.
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Table 7 Prevalence of RRT per million age related population (pmarp) on 31 December 2007, by age group, unadjusted
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Renal transplants
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Figure
4 shows that the highest transplant rates were reported
from Spain (Cantabria) (71 pmp), Spain (Catalonia) (65 pmp)
and Norway (55 pmp). Countries with the highest transplant rates
with living donor kidneys included Iceland (23 pmp), The Netherlands
(23 pmp) and Norway (18 pmp).
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Fig. 4 Renal transplants performed per million population (pmp) in 2007, by donor type, unadjusted. Figures include data from renal registries providing individual patient data (left figure) and aggregated data (right figure).
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Patient and graft survival
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Survival analysis used the data from 20 registries in 12 countries
that provided individual patient records for the periods 1998–2002
and 2001–2005. Data are presented for all countries and
regions together (Table 8 and Figures 5–7). Comparisons
of survival by treatment modality were all adjusted for fixed
values of age, gender and distribution of PRD. Similar adjustments
have been applied to survival comparisons by PRD (please, consult
appendix for fixed values and further methodology).
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Appendix: statistical methods
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To Table 8
Data presented include the survival of incident patients on
RRT and of patients receiving a first transplant between 1998–2002
or between 2001–2005 with their 95% confidence intervals.
The patients were followed until 31 December 2007. Statistical
analysis of unadjusted survival was performed by the Kaplan–Meier
method.
For the analysis of patient survival on RRT, the day at the start of RRT was taken as the starting point and the event studied was death. Censored observations were recovery of renal function, loss to follow-up and end of follow-up time.
For the analysis of patient survival on dialysis, the first day on dialysis was the starting point, the event was death and reasons for censoring were recovery of renal function, loss to follow-up, end of follow-up time and renal transplantation.
For the analysis of patient and graft survival after transplantation, the date of the first renal transplantation was defined as the first day of follow-up.
For the patient survival after transplantation, the event studied was death and for the graft survival the events were graft failure and death. Reasons for censoring were loss to follow-up and end of follow-up time.
To Figure 5
For the analyses of patient survival on dialysis the starting point was Day 91 on dialysis. Analyses were adjusted for the fixed values of age (60 years), gender (60% men) and primary renal disease (20% diabetes mellitus, 17% hypertension/renal vascular disease, 15% glomerulonephritis and 48% other cause).
For the analyses of patient survival after transplantation, the starting point was the time of the first transplant. The analyses were adjusted for the fixed values of age (45 years), gender (60% men) and primary renal disease (10% diabetes mellitus, 8% hypertension/renal vascular disease, 28% glomerulonephritis and 54% other cause).
To Figures 6 and 7
For the analyses presented in each figure, the starting point was Day 91 on dialysis. The analyses were adjusted for the fixed values of age (60 years) and gender (60% men).
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Acknowledgements
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The ERA-EDTA Registry is funded by the European Renal Association-European
Dialysis and Transplant Association (ERA-EDTA). The ERA-EDTA
Registry would like to thank the patients and staff of all the
dialysis and transplant units who have contributed data via
their national and regional renal registries. In addition, we
would like to thank the following persons and organizations
for their contribution to the work of the ERA-EDTA Registry.
Affiliated registries—Austria: R Kramar and R Oberbauer;
Belgium, Dutch-speaking: H Augustijn, B De Moor and J De Meester;
Belgium, French-speaking: JM des Grottes and F Collart; Bosnia-Herzegovina:
H Resi
, E Me
i
and A Hukeljic; Czech Republic: I Rychlík,
J Potucek and F Lopot; Denmark: J Heaf; Estonia: Ü Pechter,
M Luman and M Rosenberg; Finland: P Finne and C Grönhagen-Riska;
France (18 of 24 regions): M Lassalle and C Couchoud; FYR of
Macedonia: O Stojceva-Taneva and A Sikole; Greece: GA Ioannidis;
Iceland: R Palsson; Israel: The Israeli Society for Nephrology
and Hypertension and The Israel Center for Disease Control;
Italy (7 of 20 regions): P Riegler, F Antonucci, G Cappelli,
M Bonomini, F Casino, M Postorino and AM Pinna; Italy (14 of
20 regions): A Limido, A Rustici and M Nichelatti; Latvia: H
Cernevskis and V Kuzema; Montenegro: M Ratkovic and S Ivanovic;
Norway: T Leivestad; Poland: B Rutkowski, G Korejwo and P Jagodzinski;
Portugal: F Macário, E Rocha and J Vinhas; Romania: G
Mircescu, L Garneata and E Podgoreanu; Russia: NA Tomilina and
BT Bikbov; Slovakia: J Fekete, M Deme
and M Hassan; Spain, Andalusia:
P Castro de la Nuez and JM Munoz Terol; Spain, Aragon: Registro
de Insuficiencia Renal Crónica en Tratamiento Sustitutivo
de Aragón; Spain, Asturias: R Alonso de la Torre, Á
Roces and E Sánchez; Spain, Basque country: Á
Magaz, J Aranzabal, I Lampreabe and J Arrieta; Spain, Cantabria:
J González Cotorruelo and O García Ruíz;
Spain, Castile and Leon: AM Olmos and R González; Spain,
Castile-La Mancha: G Gutierrez and I Moreno; Spain, Catalonia:
E Arcos, J Comas, R Deulofeu and J Twose; Spain, Valencian
region: O Zurriaga and M Ferrer; Spain (17 of 19 regions): Spanish
RRT National Registry, Spanish Regional Registries and Spanish
Society of Nephrology; Sweden: S Schön, KG Prütz,
A Seeberger, L Bäckman and B Rippe; The Netherlands: A
Hoitsma and A Hemke; Tunisia: C Mahjoubi, H Trimech and F Jarraya;
Turkey: K Serdengeçti and G Süleymanlar; Ukraine:
M Kolesnyk, G Vladzijevskaya and J Samuseva; United Kingdom,
England/Northern Ireland/Wales: D Ansell and C Tomson; United
Kingdom, Scotland: W Metcalfe and K Simpson. ERA-EDTA registry
Committee Members—GM London, France (ERA-EDTA President);
C Wanner, Germany (Newsletter Editor); D Ansell, United Kingdom;
C Combe, France; F García López, Spain; R Kramar,
Austria; T Leivestad, Norway; A MacLeod, United Kingdom; J Tizard,
United Kingdom; and E Verrina, Italy. Other ERA-EDTA Registry
Office Staff—AM van den Broek, R Cornet, FW Dekker, MWM
van de Luijtgaarden, M Noordzij and KJ van Stralen.
Conflict of interest statement. None declared.
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References
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- ERA-EDTA Registry. ERA-EDTA Registry Annual Report 2007. Academic Medical Center, Department of Medical Informatics, Amsterdam, The Netherlands, 2009.
- Tizard EJ, Verrina E, van Stralen KJ, et al. Progress with the European Society for Paediatric Nephrology (ESPN)/ERA-EDTA Registry for children with established renal failure (ERF). Nephrol Dial Transplant (2009) 24:2615–2617.[Free Full Text]
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Introduction
The incidence of RRT...
