The Spanish Renal Registry: 2013 report and evolution from 2007-2013

Abstract

The purpose of the study is to show the evolution of renal replacement therapy (RRT) in Spain from 2007 to 2013. Aggregated data and individual patient records were used from participating regional renal disease registries and that National Transplant Organisation registry. The reference population was the official population on January 1st of each year studied. Data on incidence and prevalence were based on aggregated data, while the survival analysis was calculated from individual patient records. The study period was 2007 to 2013 for prevalence, incidence and transplantation, and survival was analysed for 2004-2012. The population covered by the registry was a minimum of 95.3% to 100% of the Spanish population for aggregated data. The EU27 age and gender distributions of the European population for 2005 were used to adjust incidence and prevalence for age and gender. Survival probabilities were calculated for incident patients between the years 2004 and 2013 using the Kaplan-Meier method to calculate unadjusted patient survival probability. The log rank test was applied to compare survival curves according to some risk factors. Cox proportional hazards model was created to study the potential predictors of survival. In 2013, the total number of patients in Spain that started RRT was 5,705 for 95.3% of the total Spanish population, with an unadjusted rate of 127.1pmp. The evolution from 2007 to 2013 showed a gradual decline from 127.4pmp in 2007 to 120.4pmp in 2012, with a small upturn to 127.1 in 2013. The adjusted incidence rate for the year 2013 was 121.5pmp for the total population, 158.7pmp for males and 83.1pmp for females. The most frequent cause of primary renal disease in incident was diabetes mellitus: 20.4% in 2007, which increased to 24.6% in 2013. The percentage of transplant as first RRT increased from 1.7% in 2007 to 4.2% in 2013. The total number of patients in RRT for 95.3% of the population in 2013 was 50,567, with an unadjusted prevalent rate of 1,125.7pmp. The adjusted prevalence rate for 2013 was 1,087.5 pmp (1,360.7 pmp for males and 809.8pmp for females). The percentage of diabetes mellitus in prevalent patients evolved from 13.9% in 2007 to 14.9% (168 pmp) in 2013. The percentage of transplanted prevalent patients with functioning grafts evolved from 49.3% in 2007 to 51.5% in 2013. The number of transplantations performed each year increased from 2,211 (48.9 pmp) in 2007 (6.2% living donor transplants) to 2,552 (54.2pmp) in 2013 (15.0% living donor transplants). 40,394 patients from 12 regions of Spain who began RRT between 2004 and 2012 were included in the survival analysis (87% Spanish population coverage). Unadjusted patient survival probabilities after one, 2 and 5 years were 91, 81 and 57%, respectively. In the univariate analysis, better survival was found for non-diabetic patients, women, age below 45, peritoneal dialysis as first RRT and patients who had received at least one transplant.

Keywords: End-stage renal disease; Enfermedad renal crónica terminal; Incidence; Incidencia; Kidney transplantation; Prevalence; Prevalencia; Renal replacement therapy; Supervivencia; Survival; Trasplante renal; Tratamiento renal sustitutivo.