TOPLINE:

Among 67 national‐level factors examined for their impact on the incidence of kidney replacement therapy (KRT) across 38 European countries, only three — median age at therapy initiation, the prevalence of physical inactivity, and population density — showed a positive correlation with higher KRT incidence rates.

METHODOLOGY:

• Researchers analysed incidence rates of KRT from European Renal Association Registry annual reports and studies to identify factors linked to higher treatment rates.
• They included 38 European countries and categorised them as low (0-100 per million population), middle (100-200 per million population), or high (> 200 per million population) KRT incidence countries.
• The incidence of KRT was defined as the number of patients initiating therapy in a year per million population; by this definition, 12 countries were classified as low, 21 were classified as middle, and five were classified as high KRT incidence countries.
• After expert review and removal of incomplete or overlapping data, 67 factors were identified as related to the incidence of KRT across European countries and grouped into three categories: geographical, socioeconomic, sociocultural, and health- related factors; chronic kidney disease (CKD)-related factors; and factors related to national capacity for CKD prevention.

TAKEAWAY:

• Among the evaluated factors, the prevalence of physical inactivity (correlation coefficient [R], 0.569; P < .001), median age at KRT initiation (R, 0.549; P = .001), population density (R, 0.508; P = .001), CKD-attributed deaths (R, 0.418; P = .038), disability-adjusted life-years attributed to CKD (R, 0.420; P = .010), and the number of practicing physicians per 1000 inhabitants (R, 0.374; P = .023) were significantly correlated with the higher incidence of KRT.
• After correction for multiple testing, only median age at KRT initiation, the prevalence of physical inactivity, and population density maintained a significant correlation with the incidence of KRT.
• Among wealthier countries (GDP per capita > $40,000), only median age at KRT initiation remained significantly correlated with the incidence of KRT; however, among less affluent countries, all correlations remained significant.

IN PRACTICE:

"The results of this study could be used by policy makers, stakeholders and nephrologists to optimize healthcare (planning) regarding KRT initiation and in turn reduce disparities in KRT incidence," the authors wrote.

SOURCE:

This study was led by Eva Pella, Nephrocare Hemodialysis Unit, Thessaloniki, Greece. It was published online on August 28, 2025, in Nephrology Dialysis Transplantation.

LIMITATIONS:

Online databases used for data collection had limitations, including the reliance on statistical models to address data gaps. This study used national-level data and did not examine variability within countries or distinguish between different KRT modalities. Additionally, some potentially important factors like the estimated glomerular filtration rate at KRT initiation and the availability of newer nephroprotective agents could not be included due to incomplete data across countries.

DISCLOSURES:

Some authors reported receiving support from the European Renal Association, Comunidad de Madrid en Biomedicina, and other sources. One author reported receiving grants and consultancy or speaker fees and holding other ties with various pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.