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

Moniek W M van de Luijtgaarden; Kitty J Jager; Mårten Segelmark; Julio Pascual; Frederic Collart; Aline C Hemke; César Remón; Wendy Metcalfe; Alfonso Miguel; Reinhard Kramar; Knut Aasarød; Ameen Abu Hanna; Raymond T Krediet; Staffan Schön; Pietro Ravani; Fergus J Caskey; Cecile Couchoud; Runolfur Palsson; Christoph Wanner; Patrik Finne; Marlies Noordzij

doi:10.1093/ndt/gfv295

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

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

Authors

Moniek W M van de Luijtgaarden¹, Kitty J Jager¹, Mårten Segelmark², Julio Pascual³, Frederic Collart⁴, Aline C Hemke⁵, César Remón⁶, Wendy Metcalfe⁷, Alfonso Miguel⁸, Reinhard Kramar⁹, Knut Aasarød¹⁰, Ameen Abu Hanna¹¹, Raymond T Krediet¹², Staffan Schön¹³, Pietro Ravani¹⁴, Fergus J Caskey¹⁵, Cecile Couchoud¹⁶, Runolfur Palsson¹⁷, Christoph Wanner¹⁸, Patrik Finne¹⁹, Marlies Noordzij¹

Affiliations

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.

PMID: 26311215
DOI: 10.1093/ndt/gfv295

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.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Aged, 80 and over
Clinical Decision-Making
Europe
Female
Humans
Kaplan-Meier Estimate
Kidney Failure, Chronic / mortality
Kidney Failure, Chronic / therapy*
Kidney Transplantation / statistics & numerical data
Male
Middle Aged
Peritoneal Dialysis / statistics & numerical data
Peritoneal Dialysis / trends*
Prevalence
Propensity Score
Proportional Hazards Models
Registries
Renal Dialysis / statistics & numerical data
Renal Dialysis / trends*