International comparison of patient survival after start of renal replacement therapy in 12 countries in Europe

Principal investigator: 
Kitty Jager

What is already known about this topic and why is it important?

Recent studies comparing survival of adult patients starting RRT (renal replacement therapy, that is dialysis or kidney transplantation) on a country-level in Europe are scarce. Though several renal registries publish data on survival on RRT, these publications cannot be used to compare survival in different countries due to different methodology. In addition it is not possible to investigate the effect of different patient characteristics on the international differences in survival on RRT.

The few recent studies comparing European countries only studied survival of patients who started with dialysis. In addition these studies were based on aggregated unadjusted survival probabilities or were not population based. Large European differences in transplantation rates likely influence survival of patients on RRT as kidney transplantation offers better survival than dialysis.

Our aim is to compare short- and long term survival of patients starting RRT across European countries. In addition, we would like to study to what extent patient characteristics and transplant rates contribute to the observed differences in survival probabilities.

How will you carry out your study?

The ERA-EDTA Registry dataset will be used to investigate the survival of patients on RRT per country. The two-, five- and ten-year survival will be calculated. We will also adjust for differences in patient characteristics (such as age, sex, primary kidney disease and year of start on RRT).

How will you decide which patients are included in your study?
We will include adult patients starting RRT between 1/1/2003 and 31/12/2015 in different European countries that provided individual patient data from 2003 onwards. Patients who indicated that their data should not be used for research will be excluded. 

How many patients do you anticipate including?

We anticipate to include about 450.000 patients starting renal replacement therapy between 2003 and 2015 from the participating countries in Europe.

For how long will you follow up these patients?

Patients will be followed from start of renal replacement therapy till recovery of renal function, death, loss to follow-up or the end of the study period (31 December 2017).

What new information will your study generate and how will this benefit patients?

This study will generate an overview of differences in patient survival after start of RRT between European countries. This information can be used to increase awareness regarding health care inequalities within Europe among policy makers and in the nephrology community. Secondly these results may be used in future studies to investigate differences in clinical practice that may explain any differences in survival. With this new information we can assist nephrologists to exchange best practice for patients in need of RRT.

Rianne de Jong, Vianda S. Stel, Anneke Kramer, Rianne Boenink,


NICE accredited clinical practice guidelines 

Available here

23rd Annual Report

Analyses about the care provided to patients at UK renal centres.

Read the report


A report on the nationwide collection of AKI warning test scores. 

Read the report