Incidence and outcomes of kidney replacement therapy for end-stage kidney disease due to primary glomerular disease in Europe: findings from the ERA Registry

Abstract

Background and hypothesis Primary glomerular disease (PGD) is a major cause of end-stage kidney disease (ESKD) leading to kidney replacement therapy (KRT). We aimed to describe incidence (trends) in individuals starting KRT for ESKD due to PGD and to examine their survival and causes of death. Methods We used data from the European Renal Association (ERA) Registry on 69 854 patients who started KRT for ESKD due to PGD between 2000 and 2019. ERA primary renal disease codes were used to define six PGD subgroups. We examined age and sex standardized incidence, trend of the incidence, and survival. Results The standardized incidence of KRT for ESKD due to PGD was 16.6 per million population (pmp), ranging from 8.6 pmp in Serbia to 20.0 pmp in France. IgA nephropathy (IgAN) and focal segmental glomerulosclerosis (FSGS) had the highest incidence of 4.6 pmp and 2.6 pmp, respectively. Histologically non-examined PGDs represented over 50% of cases in Serbia, Bosnia and Herzegovina, and Romania and were also common in Greece, Estonia, Belgium, and Sweden. The incidence declined from 18.6 pmp in 2000 to 14.5 pmp in 2013, after which it stabilized. All PGD subgroups had five-year survival probabilities above 50%, with crescentic glomerulonephritis having the highest risk of death (adjusted hazard ratio: 1.8 [95% confidence interval: 1.6–1.9]) compared with IgAN. Cardiovascular disease was the most common cause of death (33.9%). Conclusion The incidence of KRT for ESKD due to PGD showed large differences between countries and was highest and increasing for IgAN and FSGS. Lack of kidney biopsy facilities in some countries may have affected accurate assignment of the cause of ESKD. The recognition of the incidence and outcomes of KRT among different PGD subgroups may contribute to a more individualized patient care approach.

Sixty years of European Renal Association (ERA) Registry data on kidney disease: visualizing differences in clinical practice

“…Several other ERA Registry studies show disparities across countries and/or changes in trends over time on for example the incidence of KRT [ 6 ], kidney transplant rates [ 7 ], characteristics of first kidney transplant patients [ 8 ], and trends in KRT survival [ 6 ]. Other studies focused on patient subgroups [ 9 , 10 ]. For example, the standardized incidence of KRT for kidney failure due to primary glomerular diseases (PGD) was 2.3-fold different across European countries, while 7.5%–76.1% of PGDs were not supported by histology, raising questions about the cause of CKD [ 9 ].…”

“…Other studies focused on patient subgroups [ 9 , 10 ]. For example, the standardized incidence of KRT for kidney failure due to primary glomerular diseases (PGD) was 2.3-fold different across European countries, while 7.5%–76.1% of PGDs were not supported by histology, raising questions about the cause of CKD [ 9 ]. Patients on extended-hours (≥6 h/treatment) hemodialysis had a 27% lower risk of death compared with patients treated for 3.5–4 h/treatment [ 10 ].…”