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

Van De Luijtgaarden, Moniek W.M. ; Jager, Kitty J. ; Segelmark, Mårten LU ; Pascual, Julio ; Collart, Frederic ; Hemke, Aline C. ; Remón, César ; Metcalfe, Wendy ; Miguel, Alfonso and Kramar, Reinhard , et al. (2016) In Nephrology Dialysis Transplantation 31(1). p.120-128
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... (More)

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.

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publishing date
type
Contribution to journal
publication status
published
keywords
end-stage renal disease, haemodialysis, peritoneal dialysis, survival analysis, trends over time
in
Nephrology Dialysis Transplantation
volume
31
issue
1
pages
120 - 128
publisher
Oxford University Press
external identifiers
  • scopus:84960099088
  • pmid:26311215
ISSN
0931-0509
DOI
10.1093/ndt/gfv295
language
English
LU publication?
no
id
f1c1c531-ec3b-4585-98c8-ea7abe2857c0
date added to LUP
2020-06-17 16:35:28
date last changed
2024-06-26 17:47:35
@article{f1c1c531-ec3b-4585-98c8-ea7abe2857c0,
  abstract     = {{<p>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.</p>}},
  author       = {{Van De Luijtgaarden, Moniek W.M. and Jager, Kitty J. and Segelmark, Mårten and Pascual, Julio and Collart, Frederic and Hemke, Aline C. and Remón, César and Metcalfe, Wendy and Miguel, Alfonso and Kramar, Reinhard and Aasarød, Knut and Abu Hanna, Ameen and Krediet, Raymond T. and Schön, Staffan and Ravani, Pietro and Caskey, Fergus J. and Couchoud, Cecile and Palsson, Runolfur and Wanner, Christoph and Finne, Patrik and Noordzij, Marlies}},
  issn         = {{0931-0509}},
  keywords     = {{end-stage renal disease; haemodialysis; peritoneal dialysis; survival analysis; trends over time}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{120--128}},
  publisher    = {{Oxford University Press}},
  series       = {{Nephrology Dialysis Transplantation}},
  title        = {{Trends in dialysis modality choice and related patient survival in the ERA-EDTA Registry over a 20-year period}},
  url          = {{http://dx.doi.org/10.1093/ndt/gfv295}},
  doi          = {{10.1093/ndt/gfv295}},
  volume       = {{31}},
  year         = {{2016}},
}