Is age an important factor in the changing incidence rate of renal replacement therapie in Westernized countries?

Activiteit: Talk or presentation at a conference


Introduction and Aims Introduction and aim From 1980 up to the early 2000 an ever greater number of patients started renal replacement therapy (RRT). However, over the last 10 years reports from national and international registries suggested a trend towards stabilization or even decrease in the number of incident patients. Here, we report the incidence trends of RRT in westernized countries (Europe, United States, Canada, Australia and New Zealand) over the last 10 years stratified by age categories. Methods Methods We collected data from the European Renal Association – European Transplant and Dialysis Association (ERA-EDTA; Austria, Belgium Dutch and French speaking part, Denmark, Finland, Greece, Norway, Sweden and The Netherlands), the United States Renal Data System (USRDS), the Canadian Organ Replacement Registry (CORR) and the Australia and New Zealand Dialysis And Transplant Registry (ANZDATA). We extracted the unadjusted total incidence rate as well as the incidence rate by age categories. Time trends in the incidence rate by country and age category were modeled from 2004 until 2013 using Poisson regression. Incidence rate ratios were calculated for the maximum fitted rate during follow up versus the fitted rate in 2013.The null hypothesis of no change in incidence rate was tested using paired Wilcoxon test. Results Results We observed two types of trends for the unadjusted incidence rate of RRT in these registries in the last 20 years. First, a growing incidence rate until approximately 2009 and then later a stabilization or even a decline in some countries (USA, Canada, Belgium, Australia and New Zealand, Greece and Austria). The second subgroup shows a lower incidence rate that has remained rather stable (the Scandinavian countries and The Netherlands). After stratification for age, all registries show a relatively stable incidence rate for the age categories 0-64 year old. Incidence rates in the age categories 65-74 year and > 75 year declined overall, with large differences between the high (USA, Canada, Belgium, Greece and Austria) and the low incidence countries (the Scandinavian countries and The Netherlands). In the 65-74 year and the > 75 year age group, the percentage decline in incidence rate being the most important in the low incidence countries, despite the lower absolute incidence rate at the start of the follow up period. Furthermore in the low incidence countries the rate ratios of the > 75 year vs 20-44 year categories is much lower than in high incidence countries. Thus the higher the proportion of older patients entering RRT, the higher the total incidence rate. Conclusions Conclusion The incidence rate of RRT in westernized countries is declining over the last decade. In spite of similar socio-economic background we observed large differences in the incidence rate between countries. In low incidence countries the proportion of patients starting RRT in the older age categories (64-75 year and > 75 year) is lower and is declining more rapidly than in the high incidences countries. Thus the decision to start dialysis therapy in the elderly population is a major determinant of the overall number of patients receiving dialysis therapy. Session: Moderated Poster Session: Epidemiology, Outcomes and Health Services Research in Dialysis Date/Time: Sunday, April 23, 2017 - 12:00 pm Room: Hall A (Exhibition)
Periode23 apr 2017
EvenementstitelISN World Congress Nephrology
LocatieMexico City, Mexico