Background

This article provides a summary of the 2013 European Renal Association–European Dialysis and Transplant Association (ERA-EDTA) Registry Annual Report (available at http://www.era-edta-reg.org), with a focus on patients with diabetes mellitus (DM) as the cause of end-stage renal disease (ESRD).

Methods

In 2015, the ERA-EDTA Registry received data on renal replacement therapy (RRT) for ESRD from 49 national or regional renal registries in 34 countries in Europe and bordering the Mediterranean Sea. Individual patient data were provided by 31 registries, while 18 registries provided aggregated data. The total population covered by the participating registries comprised 650 million people.

Results

In total, 72 933 patients started RRT for ESRD within the countries and regions reporting to the ERA-EDTA Registry, resulting in an overall incidence of 112 per million population (pmp). The overall prevalence on 31 December 2013 was 738 pmp (n = 478 990). Patients with DM as the cause of ESRD comprised 24% of the incident RRT patients (26 pmp) and 17% of the prevalent RRT patients (122 pmp). When compared with the USA, the incidence of patients starting RRT pmp secondary to DM in Europe was five times lower and the incidence of RRT due to other causes of ESRD was two times lower. Overall, 19 426 kidney transplants were performed (30 pmp). The 5-year adjusted survival for all RRT patients was 60.9% [95% confidence interval (CI) 60.5–61.3] and 50.6% (95% CI 49.9–51.2) for patients with DM as the cause of ESRD.

Introduction

The European Renal Association–European Dialysis and Transplant Association (ERA-EDTA) Registry collects data on renal replacement therapy (RRT) for end-stage renal disease (ESRD) via national and regional renal registries in Europe and from countries bordering the Mediterranean Sea. Each year an annual report is produced, presenting an overview of the incidence and prevalence of RRT, kidney transplant activity and the survival of patients on RRT in Europe. With this article, we aim to provide a summary of the 2013 Annual Report of the ERA-EDTA Registry [1]. Both the Annual Report and slides summarizing the Annual Report are available at http://www.era-edta-reg.org. This article specifically focuses on the most common cause of ESRD in the Western world: diabetes mellitus (DM).

Methods

In 2015, the ERA-EDTA Registry received 2013 data from 49 national and regional renal registries in 34 countries in Europe and those bordering the Mediterranean Sea. The majority of renal registries (31 of 49) contributed individual patient data, whereas the other 18 renal registries contributed aggregated data (Figure 1).

Fig. 1.

Renal registries from countries and regions in Europe and bordering the Mediterranean Sea that contributed individual patient data or aggregated data to the ERA-EDTA Registry for 2013.

Fig. 1.

Renal registries from countries and regions in Europe and bordering the Mediterranean Sea that contributed individual patient data or aggregated data to the ERA-EDTA Registry for 2013.

While a standard Microsoft Excel template was used for the collection of aggregated data, the individual patient data were received in different formats, including SPSS, Microsoft Excel and SAS. Extensive data checking was performed and the data were converted to a standard format in order to be stored in a relational database. After data analysis, the results were checked by the participating renal registries. All registry-specific results in the ERA-EDTA Registry Annual Report were approved by the registries before publication.

Mid-year population data for the contributing countries/regions were received from Eurostat (http://ec.europa.eu/eurostat), the national bureau of statistics or the renal registry.

The incidence of RRT was defined as the number of patients starting RRT in one year (2013) and the prevalence of RRT as the number of patients alive and receiving RRT on 31 December 2013. Incidence and prevalence per million population (pmp) were calculated by dividing the observed count by the mid-year population. Time trends of the incidence rates were analysed using Joinpoint regression, with the trends presented as annual percentage change (APC) [2, 3].

Patient survival on RRT, on dialysis and following kidney transplantation was analysed using data from renal registries providing individual patient data for the period 2004–13. A detailed description of the survival methods is given in the Appendix.

Patients were included in the DM subgroup if they were registered as having DM type 1 or type 2 as the cause of ESRD (ERA-EDTA primary renal disease 1995 codes 80 or 81 or ERA-EDTA primary renal disease 2012 codes 2316, 2328, 2337 or 2344 [1]). As information on DM as comorbidity is not routinely collected by the ERA-EDTA Registry, this article only focuses on DM as the cause of ESRD.

Statistical methods

Within this article, patient survival on RRT and following kidney transplantation was analysed using the Kaplan–Meier method and Cox proportional hazards regression. For dialysis patients, kidney transplantation is an event that competes with death. Therefore, we used the cumulative incidence competing risk method for the estimation of the unadjusted cause-specific death probabilities, and the Fine and Gray method for the adjusted cause-specific death probabilities [7]. For the calculation of patient survival on RRT and on dialysis, the date of RRT initiation was the starting point and death was the event studied. Censored observations were recovery of renal function, loss to follow-up and end of the follow-up period (31 December 2013). For analysis of patient survival following kidney transplantation, the date of the first kidney transplant was defined as the first day of follow-up and death was the event studied. Reasons for censoring were loss to follow-up and end of the follow-up period. RRT and dialysis survival probabilities were adjusted for fixed values for age (60 years), gender (60% men) and the cause of ESRD distribution (20% DM, 17% hypertension/renal vascular disease, 15% glomerulonephritis and 48% other causes of ESRD). Transplantation survival probabilities were adjusted for the following values: age 45 years, 60% men, 10% DM, 8% hypertension/renal vascular disease, 28% glomerulonephritis and 54% other causes of ESRD. For the adjusted survival probabilities of the DM subgroup, the corresponding fixed values were used with the exception of the cause of ESRD distribution.

Results

For the majority of renal registries contributing data to the ERA-EDTA Registry, the coverage of the population was 100%, with the exception of Croatia (80%), Latvia (80%), Serbia (94%), Switzerland (94%), Spain (95%), Poland (95%), Georgia (96%), Bulgaria (97%), Czech Republic (98%) and Romania (99%). The total population covered by the participating registries comprised 650 million people. The proportion of the European population covered by the ERA-EDTA Registry in 2013 was 73.6%. A list of the European countries with available data and those without is provided in the Appendix.

Incidence of RRT in 2013

In 2013, a total of 72 933 patients started RRT for ESRD in all the registries reporting to the ERA-EDTA Registry, resulting in an overall incidence of 112 pmp (Figure 2). For countries/regions providing individual patient data (left panel), the overall incidence at Day 1 was 135 pmp, while it was 98 pmp for countries providing aggregated data (right panel). The lowest incidence rates were found in Montenegro (27 pmp), Ukraine (30 pmp) and Russia (50 pmp), whereas the highest rates were observed in Greece (216 pmp) and both parts of Belgium (Dutch-speaking part: 187 pmp, French-speaking part: 183 pmp). Figure 2 also shows the contribution of DM as the cause of ESRD to the incidence of RRT. Overall, patients who had DM as the cause of ESRD comprised 24% of the incident patients (26 pmp). For 48% of those patients, the type of DM was unknown (12 pmp), while 12% (3 pmp) had DM type 1 and 40% (10 pmp) had DM type 2. Among countries/regions whose registries provide individual patient data, the incidence of RRT for ESRD secondary to DM ranged between 12 pmp in Iceland and 58 pmp in Greece. However, in countries with a high proportion of patients with an unknown or missing cause of ESRD, the proportion of patients with DM as the cause of ESRD may be underestimated, as DM may be the cause of ESRD in some of these patients. For this reason, we also report the incidence of RRT for ESRD due to unknown or missing causes of ESRD, which varied widely between 0 pmp in Estonia and 73 pmp in Greece. Countries providing aggregated data showed a greater difference in the incidence of RRT secondary to DM, ranging from 5 pmp in Ukraine to 83 pmp in Israel. In general, countries/regions with a high overall incidence of RRT also had a high incidence of RRT for ESRD secondary to DM.

Fig. 2.

Unadjusted incidence of RRT pmp at Day 1 in 2013 by cause of ESRD. Data are from renal registries providing individual patient data (left panel) and from renal registries providing aggregated data (right panel). Data for Bulgaria, the Czech Republic, Lithuania, Slovakia and Switzerland only include dialysis patients. Registries from Dutch- and French-speaking Belgium, the Spanish regions of Cantabria, Castile and León and Castile-La Mancha and the UK (England, Northern Ireland and Wales) do not report on patients <20 years of age.

Fig. 2.

Unadjusted incidence of RRT pmp at Day 1 in 2013 by cause of ESRD. Data are from renal registries providing individual patient data (left panel) and from renal registries providing aggregated data (right panel). Data for Bulgaria, the Czech Republic, Lithuania, Slovakia and Switzerland only include dialysis patients. Registries from Dutch- and French-speaking Belgium, the Spanish regions of Cantabria, Castile and León and Castile-La Mancha and the UK (England, Northern Ireland and Wales) do not report on patients <20 years of age.

Table 1 shows the unadjusted incidence of RRT pmp on Day 91 after the onset of RRT by established treatment modality (haemodialysis, peritoneal dialysis and kidney transplantation). Overall, most patients were treated with haemodialysis (99 pmp in renal registries providing individual patient data and 137 pmp in those providing aggregated data), whereas the incidence of peritoneal dialysis was much lower (19 and 10 pmp, respectively). The incidence of kidney transplantation on Day 91 was highest in The Netherlands (17 pmp) and Norway (15 pmp), whereas it was lowest in Bosnia and Herzegovina and the Spanish region of Extremadura (0 pmp in both cases). Table 2 presents the percentages of established treatment modalities on Day 91 after the start of RRT for all patients, for patients with DM, for patients with other causes of ESRD and for patients with an unknown cause of ESRD. Patients with DM were more often treated with any type of dialysis on Day 91 after the start of RRT than patients with other causes of ESRD (98 versus 93%), while they were less often transplanted (2 versus 7%).

Table 1.

Unadjusted incidence of RRT pmp for ESRD at Day 91 by established modality in 2013 for countries/regions providing individual patient data and for countries providing aggregated data

 All (pmp) HD (pmp) PD (pmp) Tx (pmp) Other (pmp) 
Countries/regions providing individual patient data 
 Austriaa 132.1 113.0 13.5 5.6 
 Belgium 
  Dutch-speakingb 168.4 146.2 18.4 3.8 
  French-speakingb 164.9 140.2 19.5 5.3 
 Bosnia and Herzegovina 110.0 106.3 3.7 
 Denmark 109.7 66.1 34.4 8.8 0.4 
 Estonia 59.9 44.0 12.1 3.8 
 Finland 85.7 57.5 27.4 0.7 
 France 145.9 121.3 17.5 6.5 0.6 
 Greece 194.4 179.9 13.9 0.5 
 Iceland 74.1 30.9 34.0 9.3 
 Norway 96.1 59.5 22.0 14.6 
 Romania 130.5 122.0 6.9 1.5 
 Serbia 136.9 117.0 17.2 2.7 
 Slovenia 114.6 101.5 11.2 1.9 
 Spain 
  Andalusia 122.2 95.7 21.1 5.4 
  Aragon 125.1 95.9 26.2 3.0 
  Asturiasa 149.2 100.5 45.6 3.1 
  Basque country 114.6 71.8 32.2 10.6 
  Cantabriab 83.2 54.3 22.1 6.8 
  Castile and Leónb 106.5 85.0 18.3 3.2 
  Castile-La Manchab 103.6 76.7 23.5 3.4 
  Cataloniaa 139.3 106.6 20.0 12.8 
  Community of Madrid 117.3 92.4 17.4 7.5 
  Extremaduraa 119.6 102.1 17.5 0.0 
  Galicia 139.8 99.8 31.6 8.3 
  Region of Murcia 103.9 78.8 23.8 1.4 
  Valencia Region 130.0 99.9 28.6 1.6 
 Sweden 104.2 57.5 37.7 9.0 
 The Netherlands 108.4 73.8 17.7 16.8 
 UK 
  Englanda,b 103.3 71.1 21.1 11.1 
  Northern Irelanda,b 86.4 59.9 16.6 9.8 
  Scotland 91.2 69.3 14.3 7.7 
  Walesa,b 103.7 75.6 19.2 8.9 
All countries 125.8 99.1 19.1 7.3 0.2 
Countries providing aggregated patient data 
 Albania 59.2 53.6 4.8 0.7 
 Bulgariac 132.3 128.9 3.4  
 Croatia 133.3 123.1 9.0 1.2 
 Cyprus 175.4 145.0 24.6 5.8 
 Czech Republicc 139.3 130.5 8.8  
 Georgia 148.6 139.3 5.8 0.2 3.3 
 Israel 171.7 146.9 16.3 8.6 
 Latvia 70.6 61.2 8.7 0.6 
 Lithuaniac 106.3 99.6 6.7  
 Montenegro 22.6 14.5 0.0 8.1 
 Portugald 218.9 198.8 19.3 0.9 
 Slovakiac 132.4 128.6 3.9  
All countries 148.7 136.6 10.2 1.7 0.2 
 All (pmp) HD (pmp) PD (pmp) Tx (pmp) Other (pmp) 
Countries/regions providing individual patient data 
 Austriaa 132.1 113.0 13.5 5.6 
 Belgium 
  Dutch-speakingb 168.4 146.2 18.4 3.8 
  French-speakingb 164.9 140.2 19.5 5.3 
 Bosnia and Herzegovina 110.0 106.3 3.7 
 Denmark 109.7 66.1 34.4 8.8 0.4 
 Estonia 59.9 44.0 12.1 3.8 
 Finland 85.7 57.5 27.4 0.7 
 France 145.9 121.3 17.5 6.5 0.6 
 Greece 194.4 179.9 13.9 0.5 
 Iceland 74.1 30.9 34.0 9.3 
 Norway 96.1 59.5 22.0 14.6 
 Romania 130.5 122.0 6.9 1.5 
 Serbia 136.9 117.0 17.2 2.7 
 Slovenia 114.6 101.5 11.2 1.9 
 Spain 
  Andalusia 122.2 95.7 21.1 5.4 
  Aragon 125.1 95.9 26.2 3.0 
  Asturiasa 149.2 100.5 45.6 3.1 
  Basque country 114.6 71.8 32.2 10.6 
  Cantabriab 83.2 54.3 22.1 6.8 
  Castile and Leónb 106.5 85.0 18.3 3.2 
  Castile-La Manchab 103.6 76.7 23.5 3.4 
  Cataloniaa 139.3 106.6 20.0 12.8 
  Community of Madrid 117.3 92.4 17.4 7.5 
  Extremaduraa 119.6 102.1 17.5 0.0 
  Galicia 139.8 99.8 31.6 8.3 
  Region of Murcia 103.9 78.8 23.8 1.4 
  Valencia Region 130.0 99.9 28.6 1.6 
 Sweden 104.2 57.5 37.7 9.0 
 The Netherlands 108.4 73.8 17.7 16.8 
 UK 
  Englanda,b 103.3 71.1 21.1 11.1 
  Northern Irelanda,b 86.4 59.9 16.6 9.8 
  Scotland 91.2 69.3 14.3 7.7 
  Walesa,b 103.7 75.6 19.2 8.9 
All countries 125.8 99.1 19.1 7.3 0.2 
Countries providing aggregated patient data 
 Albania 59.2 53.6 4.8 0.7 
 Bulgariac 132.3 128.9 3.4  
 Croatia 133.3 123.1 9.0 1.2 
 Cyprus 175.4 145.0 24.6 5.8 
 Czech Republicc 139.3 130.5 8.8  
 Georgia 148.6 139.3 5.8 0.2 3.3 
 Israel 171.7 146.9 16.3 8.6 
 Latvia 70.6 61.2 8.7 0.6 
 Lithuaniac 106.3 99.6 6.7  
 Montenegro 22.6 14.5 0.0 8.1 
 Portugald 218.9 198.8 19.3 0.9 
 Slovakiac 132.4 128.6 3.9  
All countries 148.7 136.6 10.2 1.7 0.2 

The category HD also includes haemofiltration and haemodiafiltration. When cells are left empty, the data are unavailable.

HD: haemodialysis, PD: peritoneal dialysis, Tx: kidney transplant.

aThe incidence at Day 91 is based on patients who started RRT in the first 9 months of 2013.

bPatients <20 years of age are not reported.

cData include dialysis patients only.

dOnly pre-emptive transplantations (at Day 1) are included.

Table 2.

Percentages of established RRT modalities at Day 91, unadjusted, by DM as the cause of ESRD, for countries/regions providing individual patient data

 All
 
DM
 
Other causes of ESRD
 
Unknown/missing cause of ESRD
 
HD PD Tx Other HD PD Tx Other HD PD Tx Other HD PD Tx Other 
Austriaa 86 10 89 84 11 88 
Belgium 
 Dutch-speakingb 87 11 92 85 13 93 
 French-speakingb 85 12 90 10 83 12 87 
Bosnia and Herzegovina 97 97 96 97 
Denmark 60 31 67 30 60 28 12 55 41 
Estonia 73 20 56 38 78 16 
Finland 67 32 66 34 66 33 75 25 
France 83 12 88 10 82 12 82 14 
Greece 93 91 93 93 
Iceland 42 46 13 50 25 25 44 44 11 100 
Norway 62 23 15 69 17 14 60 24 16 79 21 
Romania 94 94 93 94 
Serbia 85 13 78 20 89 82 17 
Slovenia 89 10 89 11 85 12 98 
Spain                 
 Andalusia 78 17 83 15 74 21 84 12 
 Aragon 77 21 81 17 71 26 87 13 
 Asturiasa 67 31 45 55 71 28 90 10 
 Basque country 63 28 72 26 65 25 10 44 42 14 
 Cantabriab 65 27 77 15 61 33 
 Castile and Leónb 80 17 88 11 76 21 80 16 
 Castile-La Manchab 74 23 81 16 70 26 78 22 
 Cataloniaa 76 14 82 16 73 14 13 78 14 
 Community of Madrid 79 15 83 15 74 16 86 10 
 Extremaduraa 85 15 82 18 85 15 90 
 Galicia 71 23 78 22 63 27 10 82 14 
 Region of Murciaa 76 23 85 15 72 26 76 24 
 Valencia Region 77 22 82 17 73 25 82 18 
Sweden 55 36 60 36 53 37 10 57 34 
The Netherlands 68 16 16 82 15 75 20 49 11 40 
UK 
 Englanda,b 69 20 11 76 20 65 21 14 71 20 
 Northern Irelanda,b 69 19 11 74 23 69 16 15 64 28 
 Scotland 76 16 86 11 72 17 11 78 17 
 Walesa,b 73 19 76 18 69 20 11 80 15 
All countries 77 16 82 15 76 17 77 15 
 All
 
DM
 
Other causes of ESRD
 
Unknown/missing cause of ESRD
 
HD PD Tx Other HD PD Tx Other HD PD Tx Other HD PD Tx Other 
Austriaa 86 10 89 84 11 88 
Belgium 
 Dutch-speakingb 87 11 92 85 13 93 
 French-speakingb 85 12 90 10 83 12 87 
Bosnia and Herzegovina 97 97 96 97 
Denmark 60 31 67 30 60 28 12 55 41 
Estonia 73 20 56 38 78 16 
Finland 67 32 66 34 66 33 75 25 
France 83 12 88 10 82 12 82 14 
Greece 93 91 93 93 
Iceland 42 46 13 50 25 25 44 44 11 100 
Norway 62 23 15 69 17 14 60 24 16 79 21 
Romania 94 94 93 94 
Serbia 85 13 78 20 89 82 17 
Slovenia 89 10 89 11 85 12 98 
Spain                 
 Andalusia 78 17 83 15 74 21 84 12 
 Aragon 77 21 81 17 71 26 87 13 
 Asturiasa 67 31 45 55 71 28 90 10 
 Basque country 63 28 72 26 65 25 10 44 42 14 
 Cantabriab 65 27 77 15 61 33 
 Castile and Leónb 80 17 88 11 76 21 80 16 
 Castile-La Manchab 74 23 81 16 70 26 78 22 
 Cataloniaa 76 14 82 16 73 14 13 78 14 
 Community of Madrid 79 15 83 15 74 16 86 10 
 Extremaduraa 85 15 82 18 85 15 90 
 Galicia 71 23 78 22 63 27 10 82 14 
 Region of Murciaa 76 23 85 15 72 26 76 24 
 Valencia Region 77 22 82 17 73 25 82 18 
Sweden 55 36 60 36 53 37 10 57 34 
The Netherlands 68 16 16 82 15 75 20 49 11 40 
UK 
 Englanda,b 69 20 11 76 20 65 21 14 71 20 
 Northern Irelanda,b 69 19 11 74 23 69 16 15 64 28 
 Scotland 76 16 86 11 72 17 11 78 17 
 Walesa,b 73 19 76 18 69 20 11 80 15 
All countries 77 16 82 15 76 17 77 15 

The category HD also includes haemofiltration and haemodiafiltration. Categories may not add up because of missing values or rounding off. Percentages are row percentages. When cells are left empty, the data are unavailable.

HD: haemodialysis, PD: peritoneal dialysis, Tx: kidney transplant.

aThe incidence at Day 91 is based on patients who started RRT in the first 9 months of 2013.

bPatients <20 years of age are not reported.

Trends in the incidence of RRT over time in the USA and Europe

Figure 3 shows the trend in the incidence of RRT over the last 10 years, by cause of ESRD, in both Europe and the USA [data extracted from the US Renal Data System (USRDS) Annual Report [4]]. When compared with the USA, the incidence of patients starting RRT for ESRD secondary to DM is almost five times lower in Europe and the incidence of RRT for ESRD due to other causes of ESRD is at least two times lower. Joinpoint regression analyses revealed that in Europe, the incidence of patients starting RRT for ESRD secondary to DM decreased from 2007, although this was not statistically significant {2004–7: APC 1.9 [95% confidence interval (CI) −1.1–+5.1], 2007–13: APC −0.9 [95% CI −1.9–0.2]}. In the USA, the reported incidence of RRT for ESRD secondary to DM remained stable during the last decade [APC 0.2 (95% CI −0.2–0.5)].

Fig. 3.

Unadjusted incidence of RRT pmp at Day 1 by cause of ESRD for the USA [4] and Europe. Data for Europe were based on those renal registries that had individual patient data available from 2004, including Austria, Belgium (Dutch-speaking and French-speaking), Denmark, Finland, Greece, Iceland, Norway, Spain (Andalusia, Aragon, Asturias, Basque country, Cantabria, Castile and León, Castile-La Mancha, Catalonia and Valencia Region), Sweden, The Netherlands and UK (all countries).

Fig. 3.

Unadjusted incidence of RRT pmp at Day 1 by cause of ESRD for the USA [4] and Europe. Data for Europe were based on those renal registries that had individual patient data available from 2004, including Austria, Belgium (Dutch-speaking and French-speaking), Denmark, Finland, Greece, Iceland, Norway, Spain (Andalusia, Aragon, Asturias, Basque country, Cantabria, Castile and León, Castile-La Mancha, Catalonia and Valencia Region), Sweden, The Netherlands and UK (all countries).

Prevalence of RRT on 31 December 2013

Figure 4 shows the unadjusted prevalence of RRT pmp on 31 December 2013, by cause of ESRD. Overall, 477 186 patients were receiving RRT on 31 December 2013, resulting in an overall prevalence of 738 pmp The prevalence was highest in Portugal (1749 pmp), French-speaking Belgium (1270 pmp) and the Spanish region of Catalonia (1262 pmp), whereas it was lowest in Ukraine (159 pmp), Russia (241 pmp) and Montenegro (305 pmp). Patients with DM as the cause of ESRD comprised 17% of the prevalent patients (122 pmp). For 54% of these patients, the type of DM was unknown (66 pmp), while 14% (18 pmp) had DM type 1 and 31% (38 pmp) had DM type 2. In countries/regions with registries providing individual patient data, the overall prevalence of RRT for ESRD secondary to DM was 159 pmp, ranging between 74 pmp in Iceland and 219 pmp in Greece. Tables 3 and 4 present the prevalence by treatment modality (haemodialysis, peritoneal dialysis and kidney transplantation) on 31 December 2013 (pmp and as percentage). In countries/regions with registries providing individual patient data, most prevalent patients were receiving haemodialysis, closely followed by those with a functioning graft. In countries with registries providing aggregated data, the great majority of the patients were receiving haemodialysis. Table 4 shows that in case of patients with DM as the cause of ESRD, only four registries reported ≥50% of patients living with a functioning graft. In contrast, for other causes of ESRD, the vast majority of the registries reported that more than half of the patients had a functioning graft.

Table 3.

Unadjusted prevalence of RRT pmp for ESRD on 31 December 2013 by treatment modality for countries/regions providing individual patient data and for countries providing aggregated data

 All (pmp) HD (pmp) PD (pmp) Tx (pmp) Other (pmp) 
Countries/regions providing individual patient data 
 Austria 1053.7 471.3 49.8 532.4 0.2 
 Belgium 
  Dutch-speakinga 1223.1 648.7 56.8 517.6 
  French-speakinga 1269.9 677.6 57.5 530.6 4.2 
 Bosnia and Herzegovina 746.9 666.5 24.2 56.2 
 Denmark 876.9 354.1 95.0 424.6 3.2 
 Estonia 572.1 192.7 33.4 346.0 
 Finland 825.9 269.2 65.8 490.9 
 France 1175.1 601.1 44.4 522.1 7.5 
 Greece 1172.1 871.8 61.3 239.0 
 Iceland 685.7 148.3 77.2 460.2 
 Norway 900.5 212.8 39.0 648.7 
 Romaniab 816.9 676.7 75.8 64.1 0.3 
 Serbia 839.1 648.2 69.9 120.4 0.6 
 Slovenia 1008.3 654.9 25.2 328.2 
 Spain 
  Andalusia 1107.7 493.5 46.4 567.9 
  Aragon 1131.2 416.5 53.2 661.5 
  Asturias 1131.3 402.7 105.8 622.8 
  Basque country 1175.4 373.8 90.2 711.3 
  Cantabriaa 998.5 336.2 59.4 602.9 
  Castile and Leóna 1123.6 484.2 73.8 565.6 
  Castile-La Manchaa 1025.5 390.0 59.0 575.6 1.0 
  Catalonia 1262.2 532.2 53.4 676.6 
  Community of Madrid 999.3 388.7 54.3 556.2 
  Extremadura 1081.5 531.7 66.1 482.8 0.9 
  Galicia 1220.9 537.6 101.3 581.9 
  Region of Murcia 1200.4 609.4 63.9 527.2 
  Valencia Region 1232.5 651.4 77.4 502.0 1.8 
 Sweden 939.5 313.2 86.8 539.5 0.1 
 The Netherlands 945.4 332.0 55.2 558.2 
 UK 
  Englanda 890.4 372.9 59.0 458.5 
  Northern Irelanda 846.0 354.2 44.3 447.6 
  Scotland 866.0 350.4 43.4 471.9 0.4 
  Walesa 886.0 348.1 57.4 480.5 
All countries 1019.8 501.0 57.5 459.3 2.0 
Countries providing aggregated patient data 
 Albania 340.5 257.1 18.0 65.4 
 Bulgaria 540.9 449.4 22.3 69.3 
 Croatia 799.5 583.3 37.1 159.9 19.3 
 Czech Republic 1033.5 562.3 50.3 420.9 
 Georgia 385.2 324.1 20.8 38.5 1.9 
 Israelc 734.7 692.1 42.4  0.1 
 Latvia 600.3 221.8 53.7 324.8 
 Lithuania 719.0 475.4 15.8 227.8 
 Montenegro 304.8 133.9 4.8 166.1 
 Poland 822.4 513.4 27.9 281.1 
 Portugal 1749.3 1046.7 69.8 632.8 
 Russia 241.4 179.8 13.8 47.8 
 Slovakiac 609.0 592.9 16.1   
 Spain (18 of 19 regions) 1125.8 482.1 62.1 579.9 1.8 
 Switzerlandc 381.6 349.5 32.0  0.1 
 Turkey 870.2 687.1 59.2 123.9 
 Ukraine 159.0 117.6 21.3 20.1 
All countries 589.6 392.4 33.4 163.3 0.4 
 All (pmp) HD (pmp) PD (pmp) Tx (pmp) Other (pmp) 
Countries/regions providing individual patient data 
 Austria 1053.7 471.3 49.8 532.4 0.2 
 Belgium 
  Dutch-speakinga 1223.1 648.7 56.8 517.6 
  French-speakinga 1269.9 677.6 57.5 530.6 4.2 
 Bosnia and Herzegovina 746.9 666.5 24.2 56.2 
 Denmark 876.9 354.1 95.0 424.6 3.2 
 Estonia 572.1 192.7 33.4 346.0 
 Finland 825.9 269.2 65.8 490.9 
 France 1175.1 601.1 44.4 522.1 7.5 
 Greece 1172.1 871.8 61.3 239.0 
 Iceland 685.7 148.3 77.2 460.2 
 Norway 900.5 212.8 39.0 648.7 
 Romaniab 816.9 676.7 75.8 64.1 0.3 
 Serbia 839.1 648.2 69.9 120.4 0.6 
 Slovenia 1008.3 654.9 25.2 328.2 
 Spain 
  Andalusia 1107.7 493.5 46.4 567.9 
  Aragon 1131.2 416.5 53.2 661.5 
  Asturias 1131.3 402.7 105.8 622.8 
  Basque country 1175.4 373.8 90.2 711.3 
  Cantabriaa 998.5 336.2 59.4 602.9 
  Castile and Leóna 1123.6 484.2 73.8 565.6 
  Castile-La Manchaa 1025.5 390.0 59.0 575.6 1.0 
  Catalonia 1262.2 532.2 53.4 676.6 
  Community of Madrid 999.3 388.7 54.3 556.2 
  Extremadura 1081.5 531.7 66.1 482.8 0.9 
  Galicia 1220.9 537.6 101.3 581.9 
  Region of Murcia 1200.4 609.4 63.9 527.2 
  Valencia Region 1232.5 651.4 77.4 502.0 1.8 
 Sweden 939.5 313.2 86.8 539.5 0.1 
 The Netherlands 945.4 332.0 55.2 558.2 
 UK 
  Englanda 890.4 372.9 59.0 458.5 
  Northern Irelanda 846.0 354.2 44.3 447.6 
  Scotland 866.0 350.4 43.4 471.9 0.4 
  Walesa 886.0 348.1 57.4 480.5 
All countries 1019.8 501.0 57.5 459.3 2.0 
Countries providing aggregated patient data 
 Albania 340.5 257.1 18.0 65.4 
 Bulgaria 540.9 449.4 22.3 69.3 
 Croatia 799.5 583.3 37.1 159.9 19.3 
 Czech Republic 1033.5 562.3 50.3 420.9 
 Georgia 385.2 324.1 20.8 38.5 1.9 
 Israelc 734.7 692.1 42.4  0.1 
 Latvia 600.3 221.8 53.7 324.8 
 Lithuania 719.0 475.4 15.8 227.8 
 Montenegro 304.8 133.9 4.8 166.1 
 Poland 822.4 513.4 27.9 281.1 
 Portugal 1749.3 1046.7 69.8 632.8 
 Russia 241.4 179.8 13.8 47.8 
 Slovakiac 609.0 592.9 16.1   
 Spain (18 of 19 regions) 1125.8 482.1 62.1 579.9 1.8 
 Switzerlandc 381.6 349.5 32.0  0.1 
 Turkey 870.2 687.1 59.2 123.9 
 Ukraine 159.0 117.6 21.3 20.1 
All countries 589.6 392.4 33.4 163.3 0.4 

The category HD also includes haemofiltration and haemodiafiltration. When cells are left empty, the data are unavailable.

HD: haemodialysis, PD: peritoneal dialysis, Tx: kidney transplant.

aPatients <20 years of age are not reported.

bThe overall prevalence of RRT is underestimated by ∼3% due to an estimated 30% underreporting of patients living with a functioning graft.

cData include dialysis patients only.

Table 4.

Percentages of RRT modalities among prevalent patients on 31 December 2013, unadjusted, by DM as the cause of ESRD for countries/regions providing individual patient data

 All
 
DM
 
Other causes of ESRD
 
Unknown/missing cause of ESRD
 
HD PD Tx Other HD PD Tx Other HD PD Tx Other HD PD Tx Other 
Austria 45 51 60 36 40 55 45 50 
Belgium 
 Dutch-speakinga 53 42 71 25 48 47 57 41 
 French-speakinga 53 42 71 23 50 45 44 51 
Bosnia and Herzegovina 89 92 89 87 11 
Denmark 40 11 48 54 13 33 36 55 44 15 41 
Estonia 34 60 26 10 64 36 60 
Finland 33 59 40 10 50 26 67 56 12 32 
France 51 44 73 22 47 49 51 43 
Greece 74 20 89 68 27 77 19 
Iceland 22 11 67 29 13 58 20 10 70 29 29 43 
Norway 24 72 34 63 22 74 42 54 
Romaniab 83 86 11 81 84 
Serbia 77 14 77 16 78 15 73 17 
Slovenia 65 33 86 11 59 39 70 27 
Spain 
 Andalusia 45 51 63 31 39 57 50 47 
 Aragon 37 58 57 37 36 60 24 72 
 Asturias 36 55 46 18 36 32 60 39 55 
 Basque country 32 61 56 12 32 27 67 38 11 52 
 Cantabriaa 34 60 50 44 31 63 36 64 
 Castile and Leóna 43 50 60 32 45 47 29 68 
 Castile-La Manchaa 38 56 57 35 33 61 39 57 
 Catalonia 42 54 63 31 34 62 51 43 
 Community of Madrid 39 56 57 36 33 61 43 54 
 Extremadura 49 45 76 17 43 50 46 50 
 Galicia 44 48 63 11 26 37 56 49 42 
 Region of Murcia 51 44 71 23 46 48 52 44 
 Valencia Region 53 41 71 22 47 46 59 35 
Sweden 33 57 45 12 43 29 63 43 12 45 
The Netherlands 35 59 55 38 33 62 32 63 
UK 
 Englanda 42 51 59 32 37 58 45 47 
 Northern Irelanda 42 53 66 28 36 59 46 45 
 Scotland 40 54 59 35 35 60 48 47 
 Walesa 39 54 55 39 34 60 46 49 
All countries 49 45 66 27 45 50 51 41 
 All
 
DM
 
Other causes of ESRD
 
Unknown/missing cause of ESRD
 
HD PD Tx Other HD PD Tx Other HD PD Tx Other HD PD Tx Other 
Austria 45 51 60 36 40 55 45 50 
Belgium 
 Dutch-speakinga 53 42 71 25 48 47 57 41 
 French-speakinga 53 42 71 23 50 45 44 51 
Bosnia and Herzegovina 89 92 89 87 11 
Denmark 40 11 48 54 13 33 36 55 44 15 41 
Estonia 34 60 26 10 64 36 60 
Finland 33 59 40 10 50 26 67 56 12 32 
France 51 44 73 22 47 49 51 43 
Greece 74 20 89 68 27 77 19 
Iceland 22 11 67 29 13 58 20 10 70 29 29 43 
Norway 24 72 34 63 22 74 42 54 
Romaniab 83 86 11 81 84 
Serbia 77 14 77 16 78 15 73 17 
Slovenia 65 33 86 11 59 39 70 27 
Spain 
 Andalusia 45 51 63 31 39 57 50 47 
 Aragon 37 58 57 37 36 60 24 72 
 Asturias 36 55 46 18 36 32 60 39 55 
 Basque country 32 61 56 12 32 27 67 38 11 52 
 Cantabriaa 34 60 50 44 31 63 36 64 
 Castile and Leóna 43 50 60 32 45 47 29 68 
 Castile-La Manchaa 38 56 57 35 33 61 39 57 
 Catalonia 42 54 63 31 34 62 51 43 
 Community of Madrid 39 56 57 36 33 61 43 54 
 Extremadura 49 45 76 17 43 50 46 50 
 Galicia 44 48 63 11 26 37 56 49 42 
 Region of Murcia 51 44 71 23 46 48 52 44 
 Valencia Region 53 41 71 22 47 46 59 35 
Sweden 33 57 45 12 43 29 63 43 12 45 
The Netherlands 35 59 55 38 33 62 32 63 
UK 
 Englanda 42 51 59 32 37 58 45 47 
 Northern Irelanda 42 53 66 28 36 59 46 45 
 Scotland 40 54 59 35 35 60 48 47 
 Walesa 39 54 55 39 34 60 46 49 
All countries 49 45 66 27 45 50 51 41 

The category HD also includes haemofiltration and haemodiafiltration. When cells are left empty, the data are unavailable.

HD: haemodialysis, PD: peritoneal dialysis, Tx: kidney transplant.

aPatients <20 years of age are not reported.

bThe overall prevalence of RRT is underestimated by ∼3% due to an estimated 30% underreporting of patients living with a functioning graft.

Fig. 4.

Unadjusted prevalence of RRT pmp on 31 December 2013 by cause of ESRD. Data are from renal registries providing individual patient data (left panel) and from renal registries providing aggregated data (right panel). Data for Israel, Slovakia and Switzerland only include dialysis patients. For Romania, the overall prevalence of RRT is underestimated by ∼3% due to an estimated 30% underreporting of patients living on a functioning graft. Registries from Dutch- and French-speaking Belgium, the Spanish regions of Cantabria, Castile and León and Castile-La Mancha and the UK (England, Northern Ireland and Wales) do not report on patients <20 years of age.

Fig. 4.

Unadjusted prevalence of RRT pmp on 31 December 2013 by cause of ESRD. Data are from renal registries providing individual patient data (left panel) and from renal registries providing aggregated data (right panel). Data for Israel, Slovakia and Switzerland only include dialysis patients. For Romania, the overall prevalence of RRT is underestimated by ∼3% due to an estimated 30% underreporting of patients living on a functioning graft. Registries from Dutch- and French-speaking Belgium, the Spanish regions of Cantabria, Castile and León and Castile-La Mancha and the UK (England, Northern Ireland and Wales) do not report on patients <20 years of age.

Kidney transplants performed in 2013

Figure 5 shows the kidney transplant rate in 2013 for countries/regions whose registries provide individual patient data and for countries whose registries provide aggregated patient data, by donor type. Overall, 19 426 kidney transplantations were performed (30 pmp), of which 6002 (9 pmp) transplants came from living donors, 13 207 (20 pmp) from deceased donors and 217 (0.3 pmp) from an unknown donor source. The three Spanish regions—Cantabria (104 pmp), Basque country (75 pmp) and Catalonia (71 pmp)—had the highest kidney transplant rates, while Ukraine (3 pmp), Albania (3 pmp) and Russia (7 pmp) showed the lowest rates. The highest living donor kidney transplant rates were found in The Netherlands (31 pmp), Turkey (31 pmp) and Cyprus (27 pmp).

Fig. 5.

Kidney transplants pmp performed in 2013, unadjusted. Data are from renal registries providing individual patient data (left panel) and aggregated data (right panel). For Slovakia, data were obtained from the Slovak Centre of Organ Transplantation, and for Spain (18 of 19 regions), from the Organización Nacional de Transplantes. For Romania, the kidney transplantation activity reflects 70% of the total kidney transplantation activity in the country due to an underreporting of pre-emptive kidney transplantations. Registries from Dutch- and French-speaking Belgium, the Spanish regions of Cantabria, Castile and León and Castile-La Mancha and the UK (England, Northern Ireland and Wales) do not report on patients <20 years of age.

Fig. 5.

Kidney transplants pmp performed in 2013, unadjusted. Data are from renal registries providing individual patient data (left panel) and aggregated data (right panel). For Slovakia, data were obtained from the Slovak Centre of Organ Transplantation, and for Spain (18 of 19 regions), from the Organización Nacional de Transplantes. For Romania, the kidney transplantation activity reflects 70% of the total kidney transplantation activity in the country due to an underreporting of pre-emptive kidney transplantations. Registries from Dutch- and French-speaking Belgium, the Spanish regions of Cantabria, Castile and León and Castile-La Mancha and the UK (England, Northern Ireland and Wales) do not report on patients <20 years of age.

Patient survival

Survival analyses included data from 22 registries in 11 countries, which provided individual patient data for the period of 2004–11. Table 5 shows the unadjusted and adjusted survival probabilities for patients starting RRT or dialysis or receiving their first kidney transplant between 2004 and 2008. In order to present more recent survival data, 1- and 2-year survival probabilities are also presented, for patients starting RRT/dialysis or receiving their first kidney transplant between 2007 and 2011. The survival of patients with DM as the cause of ESRD was worse when compared with the total group of patients starting RRT, dialysis or receiving a kidney transplant. Two-year survival probabilities were higher for patients starting RRT, dialysis or receiving a kidney transplant between 2007 and 2011 than between 2004 and 2008.

Table 5.

One-, 2- and 5-year unadjusted and adjusted patient survival probabilities (in %) with 95% confidence interval for all patients and for patients with DM as the cause of ESRD

 2004–8 period
 
2007–11 period
 
1 year 2 year 5 year 1 year 2 year 
Patient survival on RRT 
 Unadjusted 
  All 82.1 (81.9–82.3) 71.2 (71.0–71.4) 48.3 (48.2–48.5) 83.5 (83.3–83.7) 73.1 (72.9–73.3) 
  DM 82.3 (81.8–82.7) 68.8 (68.4–69.2) 40.2 (39.9–40.4) 83.9 (83.5–84.3) 71.1 (70.7–71.5) 
 Adjusteda 
  All 89.2 (89.0–89.3) 81.4 (81.1–81.7) 60.9 (60.5–61.3) 90.0 (89.8–90.2) 82.7 (82.5–83.0) 
  DM 87.8 (87.4–88.1) 77.3 (76.8–77.8) 50.6 (49.9–51.2) 89.0 (88.7–89.4) 79.4 (78.9–79.9) 
Patient survival on dialysis (with kidney transplantation as competing event) 
 Unadjusted 
  All 81.6 (81.4–81.8) 70.5 (70.3–70.8) 48.1 (47.9–48.4) 82.8 (82.6–83.0) 72.1 (71.9–72.3) 
  DM 82.0 (81.6–82.4) 68.6 (68.2–69.0) 40.6 (40.1–41.1) 83.5 (83.2–83.9) 70.6 (70.1–71.1) 
 Adjusteda 
  All 89.4 (89.3–89.6) 81.9 (81.7–82.1) 62.4 (62.2–62.8) 89.9 (90.0–89.8) 82.6 (82.8–82.4) 
  DM 87.3 (87.1–87.5) 78.5 (78.2–78.8) 56.6 (56.2–57.0) 88.5 (88.6–88.3) 80.2 (80.5–80.0) 
Patient survival after first kidney transplantation (deceased donor) 
 Unadjusted 
  All 95.7 (95.4–96.0) 93.7 (93.4–94.1) 87.1 (86.7–87.5) 96.0 (95.7–96.2) 94.0 (93.6–94.3) 
  DM 93.9 (93.0–94.7) 91.3 (90.3–92.2) 81.6 (80.3–82.7) 94.8 (94.0–95.4) 92.2 (91.3–93.0) 
 Adjusteda 
  All 97.4 (97.2–97.6) 96.1 (95.9–96.4) 91.8 (91.4–92.2) 97.6 (97.4–97.8) 96.4 (96.1–96.6) 
  DM 95.8 (95.1–96.4) 93.8 (93.1–94.6) 86.5 (85.4–87.7) 96.5 (95.9–97.0) 94.7 (94.0–95.4) 
Patient survival after first kidney transplantation (living donor) 
 Unadjusted 
  All 98.3 (98.0–98.6) 97.4 (97.0–97.8) 94.3 (93.7–94.8) 98.6 (98.3–98.8) 97.6 (97.3–97.9) 
  DM 96.3 (94.2–97.6) 93.4 (90.9–95.2) 85.3 (82.3–87.8) 96.8 (95.3–97.9) 94.9 (93.0–96.2) 
 Adjusteda 
  All 98.7 (98.4–99.0) 98.1 (97.7–98.4) 95.6 (95.0–96.1) 99.1 (98.9–99.3) 98.4 (98.2–98.7) 
  DM 97.5 (96.4–98.7) 95.6 (94.0–97.2) 89.8 (87.5–92.3) 98.1 (97.3–98.9) 96.9 (95.8–98.0) 
 2004–8 period
 
2007–11 period
 
1 year 2 year 5 year 1 year 2 year 
Patient survival on RRT 
 Unadjusted 
  All 82.1 (81.9–82.3) 71.2 (71.0–71.4) 48.3 (48.2–48.5) 83.5 (83.3–83.7) 73.1 (72.9–73.3) 
  DM 82.3 (81.8–82.7) 68.8 (68.4–69.2) 40.2 (39.9–40.4) 83.9 (83.5–84.3) 71.1 (70.7–71.5) 
 Adjusteda 
  All 89.2 (89.0–89.3) 81.4 (81.1–81.7) 60.9 (60.5–61.3) 90.0 (89.8–90.2) 82.7 (82.5–83.0) 
  DM 87.8 (87.4–88.1) 77.3 (76.8–77.8) 50.6 (49.9–51.2) 89.0 (88.7–89.4) 79.4 (78.9–79.9) 
Patient survival on dialysis (with kidney transplantation as competing event) 
 Unadjusted 
  All 81.6 (81.4–81.8) 70.5 (70.3–70.8) 48.1 (47.9–48.4) 82.8 (82.6–83.0) 72.1 (71.9–72.3) 
  DM 82.0 (81.6–82.4) 68.6 (68.2–69.0) 40.6 (40.1–41.1) 83.5 (83.2–83.9) 70.6 (70.1–71.1) 
 Adjusteda 
  All 89.4 (89.3–89.6) 81.9 (81.7–82.1) 62.4 (62.2–62.8) 89.9 (90.0–89.8) 82.6 (82.8–82.4) 
  DM 87.3 (87.1–87.5) 78.5 (78.2–78.8) 56.6 (56.2–57.0) 88.5 (88.6–88.3) 80.2 (80.5–80.0) 
Patient survival after first kidney transplantation (deceased donor) 
 Unadjusted 
  All 95.7 (95.4–96.0) 93.7 (93.4–94.1) 87.1 (86.7–87.5) 96.0 (95.7–96.2) 94.0 (93.6–94.3) 
  DM 93.9 (93.0–94.7) 91.3 (90.3–92.2) 81.6 (80.3–82.7) 94.8 (94.0–95.4) 92.2 (91.3–93.0) 
 Adjusteda 
  All 97.4 (97.2–97.6) 96.1 (95.9–96.4) 91.8 (91.4–92.2) 97.6 (97.4–97.8) 96.4 (96.1–96.6) 
  DM 95.8 (95.1–96.4) 93.8 (93.1–94.6) 86.5 (85.4–87.7) 96.5 (95.9–97.0) 94.7 (94.0–95.4) 
Patient survival after first kidney transplantation (living donor) 
 Unadjusted 
  All 98.3 (98.0–98.6) 97.4 (97.0–97.8) 94.3 (93.7–94.8) 98.6 (98.3–98.8) 97.6 (97.3–97.9) 
  DM 96.3 (94.2–97.6) 93.4 (90.9–95.2) 85.3 (82.3–87.8) 96.8 (95.3–97.9) 94.9 (93.0–96.2) 
 Adjusteda 
  All 98.7 (98.4–99.0) 98.1 (97.7–98.4) 95.6 (95.0–96.1) 99.1 (98.9–99.3) 98.4 (98.2–98.7) 
  DM 97.5 (96.4–98.7) 95.6 (94.0–97.2) 89.8 (87.5–92.3) 98.1 (97.3–98.9) 96.9 (95.8–98.0) 

Based on data from Austria, Belgium (Dutch-speaking and French-speaking), Denmark, Finland, Greece, Iceland, Norway, Spain (Andalusia, Aragon, Asturias, Basque country, Cantabria, Castile and León, Castile-La Mancha, Catalonia, Extremadura and Valencia Region), Sweden, The Netherlands and UK (all countries).

aAdjusted survival probabilities were adjusted for age, gender and cause of ESRD. For the adjusted survival probabilities of the DM subgroup, only age and gender were taken into account.

Paediatric patients

For children, we performed a separate analysis of the incidence and prevalence by age group using data from 25 national or regional renal registries from 16 countries that provided individual paediatric data. In 2012–13, 686 children [7.5 per million age-related population (pmarp)] started RRT. Of these children, 135 (6.0 pmarp) were <5 years of age at the onset of RRT, 96 (4.2 pmarp) were ages 5–9 years, 175 (7.7 pmarp) were ages 10–14 years and 280 (12.1 pmarp) were ages 15–19 years. On 31 December 2013, 2529 (55.3 pmarp) children were receiving RRT, of whom 203 (18.0 pmarp) were <5 years of age, 423 (36.6 pmarp) were ages 5–9 years, 686 (60.2 pmarp) were ages 10–14 years and 1217 (105.9 pmarp) were ages 15–19 years.

A more detailed overview of the paediatric RRT data in Europe can be found at the ESPN/ERA-EDTA Registry website (http://www.espn-reg.org).

Discussion

This summary of the 2013 ERA-EDTA Registry Annual Report includes data from 49 national and regional renal registries in 34 countries in Europe and bordering the Mediterranean Sea, with a special focus on patients receiving RRT for ESRD secondary to DM.

Both the overall incidence of RRT for ESRD and the incidence of RRT for ESRD secondary to DM were substantially lower in Europe than in the USA [4]. However, even in Europe and among countries bordering the Mediterranean Sea, there were notable differences in the incidence of RRT for ESRD secondary to DM. This variation may be explained in part by differences in the prevalence of DM within the general population [5], differences in preventive measures, such as lifestyle advice and the use of renoprotective medication, and differences in macroeconomic factors and nephrology services [6]. It should be noted that this variation may also be influenced by discrepancies in the proportion of patients coded with a missing or unknown cause of ESRD. Nevertheless, in view of the ongoing epidemic of DM in Western societies [5], it is remarkable that both in Europe and in the USA, the rise in the incidence of RRT for ESRD secondary to DM appears to have subsided.

Although patients receiving RRT for ESRD secondary to DM were less likely to receive a kidney transplant and had worse survival compared with the overall group, their survival seems to be improving with time.

In conclusion, we have shown encouraging results for patients receiving RRT for ESRD secondary to DM. This suggests that advances in health care have been effective with regard to the prevention and management of ESRD secondary to DM.

Affiliated registries

Albania: N. Thereska, A. Strakosha and N. Pasko; Austria: R. Kramar; Belgium, Dutch-speaking: B. De Moor, F. Schroven and J. De Meester; Belgium, French-speaking: J.M. des Grottes and F. Collart; Bosnia-Herzegovina: H. Resić, B. Prnjavorac and N. Petković; Bulgaria: E. Vazelov and V. Mushekov; Croatia: I. Bubić, S. Rački and N. Janković; Cyprus: K. Ioannou and all of the renal units providing data; Czech Republic: I. Rychlík, J. Potucek and F. Lopot; Denmark: J.G. Heaf; Estonia: Ü. Pechter, M. Rosenberg and K. Lilienthal; Finland: P. Finne and C. Grönhagen-Riska; France: M. Lassalle and C. Couchoud; Georgia: N. Kantaria and Dialysis Nephrology and Transplantation Union of Georgia; Greece: N. Afentakis; Iceland: R. Palsson; Israel: R. Dichtiar, T. Shohat and E. Golan; Latvia: H. Cernevskis and V. Kuzema; Lithuania: V. Kuzminskis, I.A. Bumblytė and E. Žiginskienė; Montenegro: M. Ratkovic, D Radunovic and S. Ivanovic; Norway: T. Leivestad; Poland: B. Rutkowski, G. Korejwo and P. Jagodziński; Portugal: F. Macário, F. Nolasco and R. Filipe; Romania: G. Mircescu, L. Garneata and E. Podgoreanu; Russia: B. Bikbov and N. Tomilina; Serbia: working group of the Serbian RRT Registry and all of the Serbian renal units; Slovakia: V. Spustová, I. Lajdova and M. Karolyova; Slovenia: J. Buturovic-Ponikvar, J. Gubenšek and M. Arnol; Spain, Andalusia: P. Castro de la Nuez; Spain, Aragon: J.I. Sanchez Miret and J.M. Abad Diez; Spain, Asturias: R. Alonso de la Torre, J.R. Quirós and the RERCA Working Group; Spain, Basque country: Á. Magaz, J. Aranzabal, M. Rodrigo and I. Moina; Spain, Cantabria: M. Arias Rodríquez and O. García Ruiz; Spain, Castile and León: R. González and C. Fernández-Renedo; Spain, Castile-La Mancha: G. Gutiérrez Ávila and I. Moreno Alía; Spain, Catalonia: E. Arcos, J. Comas and J. Tort; Spain, Community of Madrid: M.I. Aparicio Madre and C. Chamorro Jambrina; Extremadura: J.M. Ramos Aceitero and M.A. García Bazaga; Spain, Galicia: E. Bouzas-Caamaño and J. Sánchez-Ibáñez; Region of Murcia: C. Santiuste de Pablos and I. Marín Sánchez; Spain, Valencia Region: O. Zurriaga Llorens, M. Ferrer Alamar and N. Fuster Camarena; Spain: Spanish RRT National Registry at ONT, Spanish Regional Registries and Spanish Society of Nephrology (SEN); Sweden: K.G. Prütz, M. Stendahl, M. Evans, S. Schön, L. Bäckman and M. Segelmark; Switzerland: P. Ambühl and R. Winzeler; The Netherlands: M. Hemmelder and A. Hemke; Turkey: G. Süleymanlar, N. Seyahi and M.R. Maltiparmak; Ukraine: M. Kolesnyk and S. Nikolaenko; UK, England/Northern Ireland/Wales: all the staff of the UK Renal Registry and of the renal units submitting data; UK, Scotland: all of the Scottish renal units.

ERA-EDTA registry committee members

A. Więcek (ERA-EDTA President); C. Wanner, Germany (Chairman); F.J. Caskey, UK; F. Collart, Belgium; C. Couchoud, France; D. Fouque, France; J.W. Groothoff, The Netherlands; J.G. Heaf, Denmark; P. Ravani, Italy; I. Rychlik, Czech Republic; F. Schaefer, Germany; S. Schön, Sweden.

ERA-EDTA registry office staff

K.J. Jager (Managing Director), M. Bonthuis (for paediatric section), R. Cornet, F.W. Dekker, G. Guggenheim, A. Kramer, M. Noordzij, M. Pippias, V.S. Stel and A.J. Weerstra.

Conflict of interest statement

None declared. (See related article by van den Brand et al. Diabetes mellitus as a cause of end-stage renal disease in Europe: signs of improvement. Clin Kidney J (2016) 9: 454–456.)

Acknowledgements

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 persons and organizations listed in the ‘Affiliated registries’ for their contribution to the work of the ERA-EDTA Registry. The ERA-EDTA Registry is funded by the ERA-EDTA. This article was written by Anneke Kramer et al. on behalf of the ERA-EDTA Registry, which is an official body of the ERA-EDTA, and it was approved by all co-authors.

Appendix

Coverage of the European population by the ERA-EDTA registry

European countries supplying data to the ERA-EDTA Registry in 2013: Albania, Austria, Belgium, Bosnia and Herzegovina, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Georgia, Greece, Iceland, Latvia, Lithuania, Montenegro, the Netherlands, Norway, Poland, Portugal, Romania, Russia, Serbia, Slovakia, Slovenia, Spain, Sweden, Switzerland, Turkey, Ukraine and the UK.

European countries not supplying data to the ERA-EDTA Registry in 2013: Andorra, Armenia, Azerbaijan, Belarus, former Yugoslav Republic of Macedonia, Germany, Hungary, Ireland, Italy, Kosovo (under United Nations Security Council Resolution 1244/99), Liechtenstein, Luxembourg, Malta, Moldova, Monaco and San Marino.

The coverage of the European population by the ERA-EDTA Registry in 2013 was 73.6%. For this calculation, only the proportions of the population residing in the European part of Russia and Turkey were considered.

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