Nephrol Dial Transplant (2003) 18: 1824-1833
© 2003 European Renal Association-European Dialysis and Transplant Association
Trends in the incidence of renal replacement therapy for end-stage renal disease in Europe, 1990–1999
1 Institut National de la Santé et de la Recherche Médicale, INSERM Unité 258, Villejuif, France, 2 ERA–EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, 3 Department of Clinical Epidemiology, Leiden University Medical Center, The Netherlands and 4 Scottish Renal Registry, Glasgow Royal Infirmary, Glasgow, UK
Correspondence and offprint requests to: Dr Bénédicte Stengel, INSERM Unité 258, 16 avenue P. Vaillant Couturier, 94807 Villejuif cedex, France. Email: stengel{at}vjf.inserm.fr
Background. The epidemiology of renal replacement therapy (RRT) for end-stage renal disease (ESRD) varies considerably worldwide, but we have lacked reliable quantitative estimates of trends in the incidence by age, sex and cause in Europe over the last decade.
Methods. We analysed data from nine countries participating in the ERA–EDTA registry: Austria, Belgium, Denmark, Finland, Greece, The Netherlands, Norway, Spain and UK (Scotland). Adjusted incidence rates for age and sex were studied for 2 year periods between 1990 and 1999. Average annual changes (%) were estimated by Poisson regression.
Results. The adjusted incidence rate of RRT increased from 79.4 per million population (pmp) (range: 58.4–101.0) in 1990–1991 to 117.1 pmp (91.6–144.8) in 1998–1999, i.e. 4.8% (3.1–6.4%) each year. This increase did not flatten out at the end of the decade, except in The Netherlands, and was greater in men than women, 5.2 vs 4.0%/year. In most countries, the incidence rate remained stable for those younger than 45 years; it rose by 2.2%/year on average in the 45–64 year age group and by 7.0% among those 65–74 years; it tripled over the decade in those 75 years or older, and by 1998–1999 it ranged from 140.9 to 540.4 pmp between countries. The incidence of ESRD due to diabetes, hypertension and renal vascular disease nearly doubled over 10 years; in 1998–1999, it varied between countries from 10.2 to 39.3 pmp for diabetes, from 5.8 to 21.0 for hypertension, and from 1.0 to 15.5 for renal vascular disease.
Conclusion. RRT incidence continues to rise but at various rates in the European countries studied, tending to widen the gap between them. This mainly results from enlarging differences in incidence in the elderly and, to a lesser extent, in that due to diabetes, hypertension and renal vascular disease.
Keywords: age; diabetic nephropathy; end-stage renal disease; incidence; renal replacement therapy; renal vascular disease
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