Improved survival in renal replacement therapy in Europe between 1975 and 1992 - An ERA-EDTA Registry study

Background. The prevalence of Renal Replacement Therapy (RRT) is rising ste adily, worldwide and in Europe. One reason for this is an increasing number of patients starting RRT, but improving survival on RRT may also be contri buting. Material and Methods. In an ERA-EDTA Registry study we have examined surviv al of patients with Standard Primary Renal Disease, or Diabetes, aged 20 to 75 years, who started RRT with haemodialysis (HD) or peritoneal dialysis ( PD) between 1975 and 1992. Altogether close to a quarter of a million patie nts were included in the analysis which included conventional survival anal ysis of comparable subgroups of the whole cohort as well as Cox regression. Results. After accounting for age, mode of initial treatment, and diagnosis , an improvement in survival of RRT patients was evident. From Cox regressi on it was calculated the risk for death decreased by about 5% annually duri ng the time period 1975-1992. Patients who started RRT using PD experienced a higher mortality than those starting with HD. According to Cox regressio n the relative risk ratio for death was 1.25 for the whole period. The diff erence in survival between patients starting with PD or HD diminished durin g the observation period (1975-1992). Discussion. The survival prospects of a patient presenting with end stage r enal disease were considerably better in the early 1990s compared to the mi d 1970s. This is reassuring despite the fact that mortality on RRT remains high. The higher mortality of RRT patients who started with PD is probably an 'historical' observation as the techniques of this treatment modality ha ve improved considerably since the 1980s which was the time period from whi ch came most of the data for the analysis.