NDT Advance Access originally published online on September 27, 2005
Nephrology Dialysis Transplantation 2005 20(12):2803-2811; doi:10.1093/ndt/gfi099
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Prevalence of co-morbidity in different European RRT populations and its effect on access to renal transplantation
1 ERA–EDTA Registry, Academic Medical Center, University of Amsterdam, Department of Medical Informatics, Amsterdam, 2 Leiden University Medical Centre, Department of Clinical Epidemiology, Leiden, The Netherlands, 3 The UK Renal Registry, Southmead Hospital, Bristol, UK, 4 Registro Lombardo Dialisi e Trapianto, "Ospedale UBOLDO", Cernusco S/N, Milano, Italy, 5 Austrian Dialysis and Transplant Registry (OEDTR), General Hospital of Wels, Wels, Austria, 6 Norwegian Renal Registry, Institute of Immunology, Rikshospitalet University Hospital, Oslo, Norway and 7 Catalan Renal Registry (RMRC), Catalan Transplant Organisation, Catalan Health Service, Autonomous Government of Catalonia, Barcelona
Correspondence and offprint requests to: Vianda S. Stel, PhD, ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, J1b 113.1, PO Box 22700, 1100 DE Amsterdam, The Netherlands. Email: v.s.stel{at}amc.uva.nl
Background. This study compared the prevalence of co-morbidity in patients starting renal replacement therapy (RRT) between European countries and further examined how co-morbidity affects access to transplantation.
Methods. In this ERA-EDTA registry special study, 17907 patients from Austria, Catalonia (Spain), Lombardy (Italy), Norway, and the UK (England/Wales) were included (1994–2001). Co-morbidity was recorded at the start of RRT.
Results. The prevalence of co-morbidity was: diabetes mellitus (DM) (primary renal disease and co-morbidity) 28%, ischaemic heart disease (IHD) 23%, peripheral vascular disease (PVD) 24%, cerebrovascular disease (CVD) 14% and malignancy 11%. With exception of malignancy, the prevalence of co-morbidity was highest in Austria, but differences were small among other countries. With exception of DM, males suffered more often from co-morbidity than females. In general, the percentage of haemodialysis was higher in patients with co-morbidity, but treatment modality differed substantially between countries. Using a Cox regression with adjustment for demographics, country, year of start and other co-morbidities, the presence of each of the co-morbid conditions made it less likely [RR; 95%CI] to receive a transplant within 4 years: DM [0.79; 0.70–0.88], IHD [0.59; 0.50–0.70], PVD [0.57; 0.49–0.67], CVD [0.49; 0.39–0.61], and malignancy [0.32; 0.24–0.42]. The age, gender and year of start adjusted relative risk [95%CI] to receive a renal transplant within 4 years ranged from 0.23 [0.19–0.27] for Lombardy (Italy) to 3.86 [3.36–4.45] for Norway (Austria = reference). These international differences existed for patients with and without co-morbidity.
Conclusions. The prevalence of co-morbidity was highest in Austria but differences were small among other countries. The access to a renal graft was most affected by the presence of malignancy and least affected by the presence of DM. International differences in access to transplantation were only partly due to co-morbid variability.
Keywords: co-morbidity; dialysis; epidemiology; registries; renal replacement therapy; renal transplantation
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