The 2008 ERA-EDTA Registry Annual Report-a précis.

Background. This study provides a summary of the 2008 ERA-EDTA Registry Report (this report is available at www.era-edta-reg.org).Methods. The data on renal replacement therapy (RRT) were available from 55 national and regional registries in 30 countries in Europe and bordering the Mediterranean Sea. Datasets with individual patient data were received from 36 registries, whereas 19 registries contributed data in aggregated form. We presented incidence and prevalence of RRT, and transplant rates. Survival analysis was solely based on individual patient records.Results. In 2008, the overall incidence rate of RRT for end-stage renal disease (ESRD) among all registries reporting to the ERA-EDTA Registry was 122 per million population (pmp), and the prevalence was 644 pmp. Incidence rates varied from 264 pmp in Turkey to 15 pmp in Ukraine. The mean age of patients starting RRT in 2008 ranged from 69 years in Dutch-speaking Belgium to 44 years in Ukraine. The highest prevalence of RRT for ESRD was reported by Portugal (1408 pmp) and the lowest by Ukraine (89 pmp). The prevalence of haemodialysis on 31 December 2008 ranged from 66 pmp (Ukraine) to 875 pmp (Portugal) and the prevalence of peritoneal dialysis from 8 pmp (Montenegro) to 115 pmp (Denmark). In Norway, 70% of the patients on RRT on 31 December 2008 were living with a functioning graft (572 pmp). In 2008, the number of transplants performed pmp was highest in Spain (Catalonia) (64 pmp), whereas the highest transplant rates with living-donor kidneys were reported from the Netherlands (25 pmp) and Norway (21 pmp). In the cohort 1999-2003, the unadjusted 1-, 2- and 5-year survival of patients on RRT was 80.8% (95% CI: 80.6-81.0), 69.1% (95% CI: 68.9-69.3) and 46.1% (95% CI: 45.9-46.3), respectively.

Introduction

This summary of the 2008 ERA–EDTA Registry Report includes the data on renal replacement therapy (RRT) from 55 national and regional registries in 30 countries in Europe and bordering the Mediterranean Sea (Figure 1). The renal registries provided datasets with individual patient data (36 registries) or in aggregated form (19 registries). The data from all registries were used to present incidence and prevalence of RRT data as well as transplant rates. Survival analyses 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 2008 ERA–EDTA Registry Report [1] which is available at www.era-edta-reg.org.

Fig. 1

Incidence of RRT per million population (pmp) at Day 1, 2008 B&H, Bosnia–Herzegovina; FYROM, Former Yugoslav Republic of Macedonia.

Incidence of RRT for ESRD across Europe

Incidence is the number of new cases of a condition during a specific period of time which, in this annual report, is a year (2008). In 2008, the overall incidence rate of RRT for end-stage renal disease (ESRD) among all registries reporting to the ERA–EDTA Registry was 122 per million population (pmp). Figure 2 shows that the highest incidence rates at Day 1 were reported by Turkey (264 pmp), Portugal (232 pmp) and Greece (199 pmp), whereas incidence rates below 100 pmp where reported by Ukraine (15 pmp), Montenegro (30 pmp), Russia (37 pmp), Estonia (66 pmp), Iceland (73 pmp), Latvia (95 pmp), Finland (95 pmp), Romania (96 pmp) and Spain (Castile-La Mancha) (98 pmp). The incidence rate of RRT for diabetic ESRD was highest in Turkey (80 pmp), Israel (77 pmp) and Slovakia (71 pmp), while the registries of Iceland, Romania, Ukraine, Montenegro, Russia, Estonia and Latvia reported incidence rates for ESRD due to diabetes mellitus below 20 pmp (Figure 2). Table 1 shows the incidence rate of RRT over the period 2004–08 for countries and regions providing individual patient data, adjusted for age and gender distribution.

Fig. 2

Incidence of RRT per million population (pmp) at Day 1 in 2008, for all patients and for patients with diabetes mellitus as primary renal disease, unadjusted. Figures include data from renal registries providing individual patient data (left figure) and aggregated data (right figure). Data of Tunisia are based on Day 91 of RRT.

Table 1

Incidence of RRT over the period 2004–08 per million population (pmp) at Day 1, adjusted for age and gender distribution

Country/regions providing individual patient data	2004	2005	2006	2007	2008
	pmp	pmp	pmp	pmp	pmp
Austria	164	155	161	155	149
Belgium
Dutch-speaking	172	172	178	174	173
French-speaking	191	181	191	190	194
Denmark	138	126	124	149	127
Finland	98	96	86	90	92
Greece	186	181	182	174	180
Iceland	90	85	84	94	89
Italy, Calabria	147	136	132	144	150
Norway	107	106	107	120	119
Spain
Andalusia	144	147	145	132	136
Asturias	137	104	109	109	107
Basque country	121	112	101	105	97
Cantabria	142	151	118	100	106
Catalonia	140	149	134	142	135
Castile and Leon	105	98	104	103	102
Castile-La Mancha	109	121	107	99	98
Valencian region	166	147	153	145	136
Sweden	119	116	124	123	116
The Netherlands	115	115	120	122	125
UK
England	91	111	115	110	110
Scotland	117	126	116	114	106
Wales	118	128	131	136	106
All countries	126	131	132	130	128

For the age group 0–19 years at the start of RRT, the data were available for 14 registries of 11 countries including those of Austria, Denmark, Finland, Greece, Iceland, Norway, Romania, Spain (Andalusia), Spain (Basque country), Spain (Catalonia), Spain (Valencian region), Sweden, the Netherlands and the UK (Scotland). As numbers of children starting RRT were low we present averages for 2007-2008 (Table 2). For an overview of paediatric RRT data collected by the ESPN/ERA–EDTA Registry, please visit www.espn-reg.org.

Table 2

Incidence of RRT over the period 2007-08 per million age-related population (pmarp) per year at Day 1, by age group, unadjusted

Cohort	0–19	0–4	5–9	10–14	15–19
	pmarp	pmarp	pmarp	pmarp	pmarp
2007–08	9.3	7.1	4.1	9.2	15.7

Figure 3 shows that the mean age of patients starting RRT in 2008 ranged from 44 years in Ukraine to 69 years in Dutch-speaking Belgium.

Fig. 3

Mean age (years) of patients starting RRT in 2008. Figures include data from renal registries providing individual patient data (left figure) and aggregated data (right figure). Data of Tunisia are based on Day 91 of RRT.

The incidence of the different treatment modalities was measured as number of patients pmp on treatment modality at Day 91 of RRT (Table 3). Whereas incidence rates of haemodialysis were highest in Greece (160 pmp), Israel (157 pmp), and in Dutch- and French-speaking Belgium (150 pmp and 153 pmp respectively), the highest incidence rates for peritoneal dialysis were reported from Sweden (37 pmp), Denmark (34 pmp) and Finland and Iceland (both 28 pmp). The highest incidence rates of patients living on a functioning graft at Day 91 of RRT were seen in Norway (15 pmp) and the Netherlands (11 pmp).

Table 3

Incidence of RRT per million population (pmp) at Day 91 in 2008, by treatment modality, unadjusted

Country/regions providing individual patient data	All	HD	PD	Tx	Unkn/missing	Country/regions providing aggregated data	All	HD	PD	Tx	Unkn/missing
	pmp	pmp	pmp	pmp	pmp		pmp	pmp	pmp	pmp	pmp
Austria	134	115	14	5	0	Bosnia-Herzegovina	102	92	5	0	5
Belgium						Croatia	134	121	13	1	0
Dutch-speaking	172	150	20	2	0	Czech Republic	150	141	9		0
French-speaking	172	153	14	4	1	Estonia	63	39	21	3	0
Denmark	117	79	34	4	0	France (20 of 26 regions)	130	109	15	5	2
Finland	94	65	28	1	0	FYR of Macedonia	108	102	3	3	0
France (16 of 26 regions)	123	102	16	6	0	Israel	174	157	14	3	0
Greece	177	160	17	1	0	Italy (16 of 20 regions)	145	127	18		0
Iceland	69	38	28	3	0	Latvia	87	72	15	1	0
Italy (13 of 20 regions)	142	115	22	5	0	Montenegro	29	22	0	6	0
Norway	106	72	19	15	0	Poland
Romania	90	72	16	2	0	Portugal
Spain						Russia	34	29	5	0	0
Andalusia	120	102	14	3	0	Slovakia	157	147	11		0
Asturias	124	98	20	5	1	Slovenia	112	110	2	0	0
Basque country	98	76	20	1	0	Spain (18 of 19 regions)
Cantabria	111	89	17	5	0	Tunisia	135	128	8		0
Castile and Leon	122	99	23	0	0	Turkey
Castile-La Mancha	101	87	12	2	0	Ukraine	15	12	3	0	0
Catalonia	129	107	15	7	0
Extremadura	121	99	22	0	1
Valencian region	129	118	10	2	0
Sweden	106	64	37	5	0
The Netherlands	109	74	24	11	0
UK
All countries	100	73	20	6	1
England	100	72	20	7	1
Northern Ireland	100	81	18	2	0
Scotland	98	75	18	5	0
Wales	102	78	21	3	0

Categories may not add up because of rounding off. When cells are left empty, (complete) data are unavailable.

HD, haemodialysis; PD, peritoneal dialysis; Tx, transplantation; Unkn, unknown.

Prevalence of RRT for ESRD across Europe

Prevalence is the number of people in a given population with a particular disease at a given time, in this annual report at December 31, 2008. The overall prevalence among all registries reporting to the ERA–EDTA Registry was 644 pmp. Figure 4 shows that the prevalence of RRT pmp at 31 December 2008 was highest in Portugal (1408 pmp), Belgium (French-speaking) (1153 pmp) and Spain (Catalonia) (1124 pmp). The lowest prevalence was reported by Ukraine (89 pmp) and Russia (165 pmp). Table 4 shows the overall prevalence of RRT, adjusted for age and gender distribution.

Fig. 4

Prevalence of RRT per million population (pmp) on 31 December 2008, for all patients and for patients with diabetes mellitus as primary renal disease, unadjusted. Figures include data from renal registries providing individual patient data (left figure) and aggregated data (right figure). Data from Czech Republic, Israel, Italy (16 of 20 regions) Slovakia, and Tunisia include dialysis patients only. In Italy (13 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.

Table 4

Prevalence of RRT on December 31 over the period 2004-08 per million population (pmp), adjusted for age and gender distribution

Country/regions providing individual patient data	2004	2005	2006	2007	2008
	pmp	pmp	pmp	pmp	pmp
Austria	860	887	910	929	976
Belgium
Dutch-speaking	916	950	983	1009	1042
French-speaking	1021	1054	1101	1136	1179
Denmark	777	786	794	831	848
Finland	682	704	711	723	740
Greece	886	910	923	939	953
Iceland	546	537	538	575	585
Italy, Calabria	946	948	953	968	969
Norway	751	771	791	820	852
Spain
Andalusia	1002	1034	1031	1015	1034
Asturias	838	854	867	873	888
Basque country	890	926	937	953	965
Catalonia	1085	1076	1077	1113	1135
Cantabria	796	796	791	780	794
Castile-La Mancha	874	907	913	912	914
Castile and Leon	806	820	827	821	840
Valencian region	1103	1085	1091	1094	1084
Sweden	793	804	827	841	847
The Netherlands	734	760	794	818	854
UK
England	557	708	734	769	797
Scotland	739	765	784	808	817
Wales	692	715	740	814	813
All countries	760	826	846	867	889

Only a limited number of registries provided complete data for prevalent patients in the age group 0-19 years in 2008, including those of Austria, Denmark, Finland, Greece, Iceland, Norway, Romania, Spain (Andalusia), Spain (Basque country), Spain (Catalonia), Spain (Valencian region), Sweden, the Netherlands and the UK (Scotland). The prevalence for age group 0–19 years is presented in Table 5.

Table 5

Prevalence of RRT per million age-related population (pmarp) on 31 December 2008, by age group, unadjusted

Year	0–19	0–4	5–9	10–14	15–19
	pmarp	pmarp	pmarp	pmarp	pmarp
2008	56	17	36	58	107

The mean age of patients on RRT on 31 December 2008 ranged from 44 years (Ukraine) to 64 years (Dutch-speaking Belgium and Italy) for registries providing data on both dialysis and transplant patients (Figure 5).

Fig. 5

Mean age (years) of prevalent patients on RRT on 31 December 2008. Figures include data from renal registries providing individual patient data (left figure) and aggregated data (right figure). Data from Czech Republic, Israel, Italy (16 of 20 regions), Slovakia and Tunisia include dialysis patients only.

The prevalence of haemodialysis on 31 December 2008 was highest in Portugal (875 pmp), Greece (753 pmp) and Italy (16 of 20 regions) (739 pmp), and the lowest in Ukraine (66 pmp), Russia (118 pmp) and Iceland (154 pmp) (Table 6). The prevalence of peritoneal dialysis was highest in Denmark (115 pmp), the UK, Wales (102 pmp) and Sweden (92 pmp), whereas the lowest prevalence of this treatment was reported in Montenegro (8 pmp), Ukraine (11 pmp) and Russia (12 pmp). In Norway, 70% of the patients on RRT were living with a functioning graft (572 pmp).

Table 6

Prevalence of RRT per million population (pmp) on 31 December 2008, by treatment modality, unadjusted

Country/regions providing individual patient data	All	HD	PD	Tx	Unkn/missing	Country/regions providing aggregated data	All	HD	PD	Tx	Unkn/missing
	pmp	pmp	pmp	pmp	pmp		pmp	pmp	pmp	pmp	pmp
Austria	951	443	43	465	0	Bosnia-Herzegovina	696	615	31	43	7
Belgium						Croatia	904	618	55	230	0
Dutch-speaking	1115	590	66	460	0	Czech Republic	538	494	44		0
French-speaking	1153	633	54	465	1	Estonia	467	156	52	259	0
Denmark	852	380	115	352	4	France (20 of 26 regions)	1059	530	43	484	2
Finland	768	250	69	450	0	FYR of Macedonia	706	621	14	71	0
France (16 of 26 regions)	980	501	40	439	1	Israel	689	645	44		0
Greece	1033	753	68	212	0	Italy (16 of 20 regions)	839	739	78		22
Iceland	520	154	44	321	0	Latvia	403	156	50	198	0
Italy (13 of 20 regions)	1028	687	88	253	0	Montenegro	332	290	8	34	0
Norway	816	203	40	572	0	Poland	690	407	29	254	0
Romania	422	325	68	29	0	Portugal	1408	875	48	485	0
Spain						Russia	165	118	12	35	0
Andalusia	971	475	39	456	0	Slovakia	569	532	37		0
Asturias	1039	363	53	556	67	Slovenia	968	661	52	255	0
Basque country	1050	353	89	608	0	Spain (18 of 19 regions)	994	468	49	477	0
Cantabria	844	331	58	454	0	Tunisia	750	734	16		0
Castile and Leon	969	432	56	476	5	Turkey	761	569	82	111	0
Castile-La Mancha	896	395	36	466	0	Ukraine	89	66	11	12	0
Catalonia	1124	518	41	565	0
Extremadura	910	455	55	400	1
Valencian region	1081	608	41	430	3
Sweden	873	296	92	484	0
The Netherlands	845	293	74	478	0
UK
All countries	786	357	75	329	25
England	781	355	75	324	27
Northern Ireland	810	412	58	339	1
Scotland	821	354	65	401	1
Wales	832	373	102	317	41

Categories may not add up because of rounding off. When cells are left empty, (complete) data are unavailable.

HD, haemodialysis; PD, peritoneal dialysis; Tx, transplantation; Unkn, unknown.

Renal transplants performed in 2008

Table 7 shows that the highest transplant rates were reported from Spain (Catalonia) (64 pmp), Norway (58 pmp) and Spain (Basque country) (55 pmp). Countries with the highest transplant rates with living-donor kidneys included the Netherlands (25 pmp), Norway (21 pmp) and Montenegro (19 pmp).

Table 7

Renal transplants performed per million population (pmp) in 2008, by donor type, unadjusted

Country/regions providing individual patient data	All	Living donor	Deceased donor	Unknown type donor	Country/regions providing aggregated data	All	Living donor	Deceased donor	Unknown type donor
	pmp	pmp	pmp	pmp		pmp	pmp	pmp	pmp
Austria	40	7	33	0	Bosnia-Herzegovina	7	5	3	0
Belgium					Croatia	35	4	26	6
Dutch-speaking	38	2	35	1	Czech Republic	32	3	29	0
French-speaking	33	2	29	2	Estonia	43	2	40	0
Denmark	36	14	23	0	France (20 of 26 regions)	45	4	42	0
Finland	28	2	26	0	FYR of Macedonia	4	4	0	0
France (16 of 26 regions)	44	2	38	3	Israel	33	8	13	12
Greece	24	6	17	0	Italy (16 of 20 regions)	35	3	32	0
Iceland	16	16	0	0	Latvia	22	0	21	0
Italy (13 of 20 regions)	20	1	3	16	Montenegro	26	19	6	0
Norway	58	21	38	0	Poland	22	1	22	0
Romania	7			7	Portugal	49	5	45	0
Spain					Russia	6	1	5	0
Andalusia	45			45	Slovakia
Asturias	37	0	37	0	Slovenia	26	0	26	0
Basque country	55	0	55	0	Spain (18 of 19 regions)	48	3	45	0
Cantabria	50	3	46	0	Tunisia	12	10	3	0
Castile and Leon	37	0	37	0	Turkey	19	13	5	0
Castile-La Mancha	50	1	46	2	Ukraine	2	1	0	0
Catalonia	64	11	53	0
Extremadura	36	0	31	5
Valencian region	40	0	38	1
Sweden	46	15	31	0
The Netherlands	47	25	22	1
UK
All countries	41	15	25	0
England	42	16	26	0
Northern Ireland	23	5	18	0
Scotland	41	13	28	0
Wales	33	10	24	0

Categories may not add up because of rounding off. When cells are left empty, (complete) data are unavailable.

Patient and graft survival

For survival analysis data was used from 19 registries in 12 countries that provided individual patient records for the period 1999–2003 [i.e. Austria, Belgium (Dutch-speaking), Belgium (French-speaking), Denmark, Finland, Greece, Iceland, Italy (Calabria), Norway, Spain (Andalusia), Spain (Asturias), Spain (Basque country), Spain (Cantabria), Spain (Catalonia), Spain (Valencian region), Sweden, the Netherlands, the UK (England/Wales) and the UK (Scotland)]. Three Spanish regions [i.e. Spain (Castile and Leon), Spain (Castile-La Mancha) and Spain (Extremadura)] were also included in the analyses based on cohort 2002–06 because for these registries, complete data were available from 2002. The data are presented for all countries and regions together (Table 8 and Figures 6, 7 and 8). 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 (for fixed values and further methodology, consult the Appendix section).

Table 8

One-, 2- and 5-years survival probabilities, unadjusted

	Cohort 1999–2003			Cohort 2002–06
	1-year	2-year	5-year	1-year	2-year
Patient survival on RRT	80.8 (80.6–81.0)	69.1 (68.9–69.3)	46.1 (45.9–46.3)	81.5 (81.3–81.7)	70.3 (70.1–70.5)
Patient survival on dialysis	80.3 (80.0–80.5)	67.2 (67.0–67.5)	38.3 (38.1–38.4)	80.8 (80.6–81.0)	68.4 (68.2–68.6)
Patient survival after first transplant (deceased donor)	95.5 (95.1–95.8)	93.6 (93.1–94.0)	86.6 (86.1–87.1)	95.6 (95.3–95.9)	93.7 (93.3–94.1)
Patient survival after first transplant (living donor)	97.6 (97.0–98.1)	96.8 (96.1–97.3)	94.1 (93.2–94.8)	97.9 (97.4–98.3)	97.1 (96.5–97.6)
Graft survival after first transplant (deceased donor)	90.0 (89.5–90.5)	87.0 (86.5–87.6)	77.6 (77.0–78.1)	90.0 (89.5–90.4)	87.2 (86.7–87.7)
Graft survival after first transplant (living donor)	94.4 (93.5–95.1)	92.6 (91.7–93.4)	86.2 (85.1–87.2)	94.5 (93.7–95.1)	92.8 (92.0–93.5)

For analysis methods, see the Appendix section.

Survival of incident dialysis patients and of patients receiving a first transplant between 1999 and 2003, by treatment modality, adjusted for age, gender and primary renal disease.

Survival of incident haemodialysis patients in 1999–2003, from Day 91, by primary renal disease, adjusted for age and gender.

Survival of incident peritoneal dialysis patients in 1999–2003, from Day 91, by primary renal disease, adjusted for age and gender.

European Renal Registry Investigators

Austria: R Kramar; Belgium, Dutch-speaking: H Augustijn, B De Moor, and J De Meester; Belgium, French-speaking: JM des Grottes and F Collart; Bosnia-Herzegovina: H Resić, B Jakovljević, and E Mešić; Croatia: Croatian National Renal Registry, Croatian Regional Renal Registries, and Croatian Society of Nephrology; Czech Republic: I Rychlík, J Potucek, and F Lopot; Denmark: J Heaf; Estonia: M Luman, M Rosenberg, and Ü Pechter; Finland: P Finne and C Grönhagen-Riska; France: M Lassalle, C Couchoud, GM London, and C Combe; FYR of Macedonia: O Stojceva-Taneva, G Selim, and A Sikole; Germany: F Schaefer; Greece: GA Ioannidis; Iceland: R Palsson: Israel: E Golan and M Shreibman; Italy: A Rustici, M Nichelatti, A Limido, A Molino, M Salomone, G Cappelli, E Arosio, F Antonucci, A Santoro, E Mancini, A Rosati, GM Frascà, G Gaffi, M Standoli, M Bonomini, L DiLiberato, S DiGiulio, A DiNapoli, D Torres, F Casino, C Zoccali, M Postorino, AM Pinna, P Ravani, and E Verrina; 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, R Filipe, and F Nolasco; Romania: G Mircescu, L Garneata, and E Podgoreanu; Russia: NA Tomilina and BT Bikbov; Slovakia: V Spustová and J Fekete; Slovenia: J Buturović-Ponikvar, J Gubensek, and A Kandus; Spain, Andalusia: P Castro de la Nuez and MA Pérez Valdivia; 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 Gutiérrez Ávila and I Moreno; Spain, Catalonia: E Arcos, J Comas, R Deulofeu, and J Twose; Spain, Extremadura: JM Ramos Aceitero and MA García Bazaga; Spain, Valencian region: O Zurriaga Llorens and M Ferrer Alamar; Spain: R Saracho; Sweden: KG Prütz, L Bäckman, S Schön, A Seebergen, and B Rippe; the Netherlands: A Hoitsma, A Hemke, AM van den Broek, R Cornet, FW Dekker, A Kramer, M Noordzij and KJ van Stralen; Tunisia: C Mahjoubi, H Trimech, and F Jarraya; Turkey: K Serdengeçti and G Süleymanlar; Ukraine: M Kolesnyk, G Vladzijevskaya, and J Samuseva; the UK, England/Northern Ireland/Wales: D Ansell and C Tomson; the UK, Scotland: W Metcalfe and K Simpson.