Kidney replacement therapy trajectories of patients with kidney failure: an ERA Registry study

BACKGROUND: Trajectories of patients receiving kidney replacement therapy (KRT), including transitions between hemodialysis (HD), peritoneal dialysis (PD), and kidney transplantation (KTx), may vary across patient sub-groups and have not yet been investigated in Europe. This study aimed to: (1) describe the number of shifts across KRT modalities; and (2) characterize the most frequent patient trajectories, including the direction of shifts across KRT modalities, the duration spent on each modality, and patient events, including death.

METHODS: Data of adult patients (≥20 years) who initiated KRT between 2004-2013 were extracted from the European Renal Association (ERA) Registry database and patients were followed for 10 years from the moment of KRT initiation. Results were stratified by age, sex, primary renal disease (PRD), country, and initial KRT modality.

RESULTS: Among 289,323 patients, more than two-thirds (69.6%) remained on their initial KRT modality until death or the end of 10 years follow-up, but younger patients and patients who initiated with PD had more shifts across KRT modalities than others. Overall, the most frequent patient trajectories were HD followed by death (53.4%), HD to KTx (10.2%), remaining on HD for 10 years (5.6%), PD followed by death (4.4%), and PD to KTx (2.9%). The most frequent patient trajectories differed between age and PRD groups, and across European countries, but not between women and men.

CONCLUSION: The number and direction of shifts across KRT modalities varied by age, PRD, country, and initial KRT modality, but not by sex. Future research should further investigate trajectories of patient sub-groups that stood out, including young HD patients who died on their initial KRT modality and those who remained on HD for 10 years without undergoing KTx.