Spanish Registry of Dialysis and Transplantation: 2023 Report and evolutive analysis

INTRODUCTION: Chronic kidney disease (CKD) will be the second leading cause of death worldwide by 2100. The Spanish Dialysis and Transplantation Registry (REDYT) records the incidence, prevalence and mortality of all patients requiring kidney replacement therapy (KRT) in Spain. This article focuses on the 2023 report. METHODS: Data are provided by Spanish autonomous regions and cities and the Organización Nacional de Trasplantes. Incidence and prevalence rates of KRT have been calculated (considering the Spanish population according to annual data from the Instituto Nacional de Estadística), as well as mortality of patients on KRT in our country during the period 2014-2023. RESULTS: The incidence rate of KRT has increased by 15% over the last decade, reaching 153.7 persons per million people (pmp) in 2023, with 76.6% corresponding to hemodialysis (HD), 16.9% to peritoneal dialysis (PD), and 6.5% to kidney transplantation. Diabetes is the leading cause of CKD requiring KRT (25.2%). The incidence rate of KRT was more than twice as high in men as in women, with large differences among autonomous communities. The prevalence rate of KRT in 2023 was 1404.8 pmp, showing a progressive increase over the last decade, mainly due to a rise in the kidney-transplanted population (55.8%). There was an over 2-fold difference between communities in the transplant/dialysis prevalence ratio (1.93 to 0.77, state average 1.26). In 2023, Spain performed 3690 kidney transplants (76.8 pmp), maintaining the country's position as a global leader. Donation came mainly from brain death donors (47.9%), followed by donation after circulatory death donors (40.3%) and living donors (11.8%). There was a 10-fold difference between communities in the living donor/deceased donor ratio (0.21 to 0.02, state average 0.13). The overall annual mortality of patients on KRT returned to pre-pandemic levels at 7.4% (13.3% in HD, 8.5% in PD and 2.6% in transplantation). CONCLUSIONS: The incidence and prevalence of patients on KRT continues to increase in Spain, albeit with significant variation between autonomous communities. Annual mortality returned to pre-pandemic levels after 3 years. Nevertheless, public health measures are required to slow CKD progression and promote equity in Spain.