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

Samar Abd ElHafeez (Lead / Corresponding author), Anneke Kramer, Mustafa Arici, Anders Åsberg, Samira Bell, Julie Belliere, Carmen Diaz-Corte, Gema Fernández Fresned, Marc H. Hemmelder, Line Heylen, Kristine Hommel, Julia Kerschbaum, Radomir Naumovic, Dorothea Nitsch, Rafael Santamaria Olmo, Patrik Finne, Runólfur Pálsson, Maria Pippias, Halima Resić, Mai RosenbergCarmen Santiuste de Pablos, Mårten Segelmark, Søren Schwartz Sørensen, Maria Jose Soler, Enrico Vidal, Kitty J. Jager, Alberto Ortiz, Vianda S. Stel

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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 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.
Original languageEnglish
Article numbergfae034
Number of pages12
JournalNephrology Dialysis Transplantation
Early online date7 Feb 2024
DOIs
Publication statusE-pub ahead of print - 7 Feb 2024

Keywords

  • Primary glomerular disease
  • epidemiology
  • Kidney Replacement Therapy
  • dialysis
  • kidney transplantation
  • outcome

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