Background Data on renal replacement therapy (RRT) for end-stage renal disease (ESRD) was collected by the European Renal Association (ERA) Registry via national and regional renal registries in Europe and countries bordering the Mediterranean Sea. This paper provides a summary of the 2019 ERA Registry Annual Report, including data from 34 countries and additional age comparisons. Methods Individual patient data for 2019 was provided by 35 registries and aggregated data by 17 registries. Using this data, the incidence and prevalence of RRT, the kidney transplantation activity and the survival probabilities were calculated. Results In 2019, a general population of 680.8 million people was covered by the ERA Registry. Overall, the incidence of RRT was 132 per million population (p.m.p.). Of these patients, 62% were men, 54% were ≥ 65 years of age, 21% had diabetes mellitus as primary renal disease, and 84% had haemodialysis (HD), 11% had peritoneal dialysis (PD) and 5% had pre-emptive kidney transplantation as initial treatment modality. The overall prevalence of RRT on 31 December 2019 was 893 p.m.p., with 58% of patients on HD, 5% on PD, and 37% living with a kidney transplant. The overall kidney transplant rate was 35 p.m.p. and 29% of the kidney grafts were from a living donor. The unadjusted 5-year survival probability was 42.3% for patients commencing dialysis, 86.6% for recipients of deceased donor grafts and 94.4% for recipients of living donor grafts in the period 2010–2014. When comparing age categories, there were substantial differences in the distribution of primary renal disease, treatment modality, kidney donor type, and in the survival probabilities.

Oxidative stress and inflammation are highly intertwined pathophysiological processes. We analyzed the markers of these processes and high-sensitive troponin I (hsTnI) for mortality prediction in patients on haemodialysis. This study enrolled a total of 62 patients on regular haemodialysis. The patients were monitored for two years, and the observed outcomes were all-cause and cardiovascular mortality. Blood samples were taken before one dialysis session for analysis of the baseline concentrations of prooxidant–antioxidant balance (PAB), total antioxidant status (TAS), total oxidative status (TOS), hsTnI, hsCRP and resistin. The overall all-cause mortality was 37.1% and CVD mortality 16.1%. By univariate and multivariate logistic regression, our findings suggest that good predictors of all-cause mortality include hsCRP and PAB (p < .05) and of CVD mortality hsCRP (p < .05) and hsTnI (p < .001). To evaluate the relationship between the combined parameter measurements and all-cause/CVD mortality risk, patients were divided into three groups according to their PAB, hsCRP and hsTnI concentrations. The cutoffs for hsCRP and hsTnI and the median for PAB were used. Kaplan–Meier survival curves pointed out that the highest mortality risk of all-cause mortality was in the group with hsCRP levels above the cutoff and PAB levels above the median (p < .001). The highest risk of CVD mortality was found in the group with hsCRP and hsTnI levels above the cutoff levels (p = .001). Our data suggest that hsCRP and PAB are very good predictors of all-cause mortality. For CVD complications and mortality prediction in HD patients, the most sensitive parameters appear to be hsTnI and hsCRP.

Dear Editor, Acute pancreatitis is a relatively rare but highly lethal complication in patients with end-stage renal disease (1). Etiology of acute pancreatitis after renal transplantation is unclear and includes immunosuppressive drugs, alcohol consumption, hyperlipidemia, bile duct stones, hyperparathyroidism and viral infections (2,3). Sirolimus is an mTOR inhibitor commonly used for post-transplant immunosuppression, with numerous adverse effects, most commonly proteinuria, hypertrigliceridemia and leukopenia (4). We present the first reported case of a renal transplant recipient with acute pancreatitis caused by sirolimus.A 24-year-old man underwent preemptive renal transplantation from a living-related donor for treatment of end-stage renal disease of unknown etiology. He received thymoglobulin induction followed by mycophenolate mofetil, tacrolimus and steroids. Development of renal artery thrombosis on the first post-transplant day required thrombectomy, which was successfully performed with adequate kidney reperfusion. In order to decrease further allograft injury on the second post-transplant day tacrolimus was replaced with rapamycin in a loading dose of 6 mg on the first day, followed by daily dose of 2 mg. Twenty days later he presented with sterile diarrhea. He was afebrile and hemodynamically stable. Abdomen was not painful on palpation. Laboratory results showed normal liver enzymes, lipase 904.9 U/L (normal, 8-78 U/L) and amylase 568 U/L (normal, 25-125 U/L). His cholesterol level was 5.93 mmol/L (normal, 3.8-5.17) with triglycerides 1.7 mmol/L (<1.69), blood glucose was 8.8 mmol/L (normal, 3.9-6.0). calcium 2.09 mmol/L (normal, 2.1-2.55), and phosphorus 1.53 mmol/L (normal, 0.74-1.52). Serum creatinine was 445 μmol/L (normal, 50-98), with creatinine clearance 17 mL/min. Mumps and coxackie virus serology were negative. Cytomegalovirus DNA, varicella-zoster virus DNA and Epstein-Barr virus DNA were all negative, as well as hepatitis C RNA, hepatitis B DNA and HIV RNA. Sirolimus concentration was 12.8 μg/L. A CT scan of the abdomen showed mild diffuse parenchymal pancreatic enlargement, indistinct pancreatic margins and peripancreatic fat stranding with stomach dilatation. There were no stones in the gallbladder or bile ducts. He was diagnosed with acute pancreatitis. Sirolimus was immediately discontinued, and he continued with steroids and mycophenolate mofetil. With parenteral fluid replacement and bowel rest, his stools normalized. Laboratory results reached normal values after 14 days. His graft function remained stable but poor with serum creatinine 450 μmol/L at the last visit.To the authors' knowledge, this is the first reported case of sirolimus-induced acute pancreatitis. Use of sirolimus is limited by numerous adverse effects that are often difficult to manage. Hypertrigliceridemia is a frequent side-effect of sirolimus treatment, which occurs in more than 50% of patients (4). Hypertrigliceridemia is also a frequent cause of acute pancreatitis. However, in our patient, serum triglyceride...

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