This European study shows a declining RRT incidence, particularly in patients aged 45-64 years, 65-74 years and secondary to diabetic nephropathy. Encouragingly, the adjusted RRT patient survival continues to improve. The risk of cardiovascular death has decreased, though the risk of death from malignancy has increased in the older population.

In Europe, there is a decreasing trend in the use of AVFs and an increasing trend in the use of CVCs at the start and after the start of HD. We cannot explain all between-country variations we found, and more research is needed to clarify how healthcare around vascular access is organized in Europe.

Survival of patients with scleroderma who receive dialysis for more than 90 days was worse than for those with other causes of ESRD. Patient survival after transplantation was similar to that observed among patients with ESRD due to other conditions. Patients with scleroderma had a higher rate of recovery from RRT dependence than controls.

Background Literature on recovery of kidney function (RKF) in patients with end-stage kidney disease treated with maintenance dialysis (i.e. over 90 days) is limited. We assessed the incidence of RKF and its associated characteristics in a European cohort of dialysis patients. Methods We included adult patients from the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) Registry who started maintenance dialysis in 1997-2016. Sustained RKF was defined as permanent discontinuation of dialysis. Temporary discontinuation of ≥ 30 days (non-sustained RKF) was also evaluated. Factors associated with RKF adjusted for potential confounders were studied using Cox-regression analyses. Results RKF occurred in 7,657 (1.8%) of 440,996 patients of whom 71% experienced sustained RKF. Approximately 90% of all recoveries occurred within the first two years after day 91 of dialysis. Of patients with non-sustained RKF, 39% restarted kidney replacement therapy within one year. Sustained RKF was strongly associated with the following underlying kidney diseases (as registered by the treating physician): tubular necrosis (irreversible) or cortical necrosis (adjusted Hazard Ratio [aHR]: 20.4, 95%CI: 17.9-23.1), systemic sclerosis (aHR: 18.5, 95%CI: 13.8-24.7) and hemolytic uremic syndrome (aHR: 17.3, 95%CI: 13.9-21.6). Weaker associations were found for hemodialysis as first dialysis-modality (aHR: 1.5, 95%CI: 1.4-1.6) and dialysis initiation at an older age (aHR: 1.8, 95%CI: 1.6-2.0) or in a more recent time-period (aHR: 2.4, 95%CI: 2.1-2.7). Conclusions Definitive discontinuation of maintenance dialysis is a rare and not necessarily an early event. Certain clinical characteristics, but mostly the type of underlying kidney disease, are associated with a higher likelihood of RKF.

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