Trends in dialysis modality choice and related patient survival in the ERA-EDTA Registry over a 20-year period

Research output: Contribution to journalArticle


Background Although previous studies suggest similar patient survival for peritoneal dialysis (PD) and haemodialysis (HD), PD use has decreased worldwide. We aimed to study trends in the choice of first dialysis modality and relate these to variation in patient and technique survival and kidney transplant rates in Europe over the last 20 years. Methods We used data from 196 076 patients within the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) Registry who started renal replacement therapy (RRT) between 1993 and 2012. Trends in the incidence rate and prevalence on Day 91 after commencing RRT were quantified with Joinpoint regression. Crude and adjusted hazard ratios (HRs) for 5-year dialysis patient and technique survival were calculated using Cox regression. Analyses were repeated using propensity score matching to control for confounding by indication. Results PD prevalence dropped since 2007 and HD prevalence stabilized since 2009. Incidence rates of PD and HD decreased from 2000 and 2009, respectively, while the incidence of kidney transplantation increased from 1993 onwards. Similar 5-year patient survival for PD versus HD patients was found in 1993-97 [adjusted HR: 1.02, 95% confidence interval (95% CI): 0.98-1.06], while survival was higher for PD patients in 2003-07 (HR: 0.91, 95% CI: 0.88-0.95). Both PD (HR: 0.95, 95% CI: 0.91-1.00) and HD technique survival (HR: 0.93, 95% CI: 0.87-0.99) improved in 2003-07 compared with 1993-97. Conclusions Although initiating RRT on PD was associated with favourable patient survival when compared with starting on HD treatment, PD was often not selected as initial dialysis modality. Over time, we observed a significant decline in PD use and a stabilization in HD use. These observations were explained by the lower incidence rate of PD and HD and the increase in pre-emptive transplantation.


  • Moniek W.M. Van De Luijtgaarden
  • Kitty J. Jager
  • Julio Pascual
  • Frederic Collart
  • Aline C. Hemke
  • César Remón
  • Wendy Metcalfe
  • Alfonso Miguel
  • Reinhard Kramar
  • Knut Aasarød
  • Ameen Abu Hanna
  • Raymond T. Krediet
  • Staffan Schön
  • Pietro Ravani
  • Fergus J. Caskey
  • Cecile Couchoud
  • Runolfur Palsson
  • Christoph Wanner
  • Patrik Finne
  • Marlies Noordzij
External organisations
  • Academic Medical Center of University of Amsterdam (AMC)
  • Linköping University
  • Hospital del Mar Medical Research Institute
  • University and Polytechnic Hospital la Fe
  • St. Olav’s University Hospital
  • University of Calgary
  • National University Hospital of Iceland
  • University of Iceland
  • Wurzburg University Medical Center
Research areas and keywords


  • end-stage renal disease, haemodialysis, peritoneal dialysis, survival analysis, trends over time
Original languageEnglish
Pages (from-to)120-128
JournalNephrology Dialysis Transplantation
Issue number1
Publication statusPublished - 2016
Publication categoryResearch
Externally publishedYes