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Nephrol Dial Transplant. 2016 Jan;31(1):120-8. doi: 10.1093/ndt/gfv295. Epub 2015 Aug 26.

Trends in dialysis modality choice and related patient survival in the ERA-EDTA Registry over a 20-year period.

Author information

1
ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
2
Department of Nephrology, Linköping University, Linköping, Sweden Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
3
Department of Nephrology, Hospital del Mar, Barcelona, Spain.
4
French-Speaking Belgium ESRD Registry, Bruxelles, Belgium.
5
Nefrovisie/RENINE, Leiden, The Netherlands.
6
SICATA (The Information System of the Andalusian Transplant Autonomic Coordination Registry), Andalusia, Spain.
7
Scottish Renal Registry, Glasgow, UK.
8
Department of Nephrology, University Clinic Hospital, Valencia, Spain.
9
OEDTR, Austrian Dialysis and Transplant Registry, Linz, Austria.
10
Department of Nephrology, St Olavs Hospital HF, Trondheim, Norway.
11
Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
12
Division of Nephrology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
13
Diaverum Renal Services Group, Lund, Sweden.
14
Department of Medicine and Community Health Science, University of Calgary, Calgary, Alberta, Canada.
15
UK Renal Registry, Southmead Hospital, Bristol BS105NB, UK.
16
REIN Registry, Biomedicine Agency, La Plaine-Saint Denis, France.
17
Division of Nephrology, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland.
18
ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands Division of Nephrology, University Hospital Würzburg, Würzburg, Germany.
19
Finnish Registry for Kidney Diseases, Helsinki, Finland.

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.

KEYWORDS:

end-stage renal disease; haemodialysis; peritoneal dialysis; survival analysis; trends over time

PMID:
26311215
DOI:
10.1093/ndt/gfv295
[Indexed for MEDLINE]

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