The need for renal replacement therapy (RRT) — dialysis or kidney transplantation — is highly variable across different European countries and this variance can only be partially explained by differences in the availability of national resources to address RRT needs, according to a new report. 

Out of nearly 700 million people enrolled in national or regional renal registries in 37 countries, 88,453 individuals began RRT in 2017, reveals the latest annual report from the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA). 

This works out to over 127 individuals per million people (pmp). 

However, the need for RRT is highly variable, ranging from a high adjusted incidence rate of 429 individuals per pmp in Kosovo to a low of 68 individuals per pmp in Estonia, with adjusted incidence rates of 223 individuals per pmp in Greece, 174  individuals per pmp in France, and 99 individuals per pmp in Switzerland. 

Overall, the report notes 85% of patients with end-stage renal disease (ESRD) who required RRT in 2017 started with hemodialysis and 11% started on peritoneal dialysis. 

In contrast, only 4% of all patients who required RRT in 2017 received a kidney transplant right from the start and could thereby avoid dialysis altogether. 

"This is sad," Ron Gansevoort, MD, professor of internal medicine, University of Groningen, the Netherlands and press officer of the ERA-EDTA, said in a statement. 

"Kidney transplantation is the best renal replacement therapy we have from a medical point of view — transplanted patients suffer from [fewer] comorbidities than dialysis patients and have better outcomes," he added. 

Moreover, patients who receive a transplant in general have a higher quality of life with fewer complications and do not have to endure what many patients on dialysis call "doing time" three times a week for 4 hours a session, Gansevoort noted. 

Main Explanation for Growing Need for RRT Is Aging Population 

As is true in North America, the key reason why so few patients in Europe receive a transplant when they first develop ESRD is the scarcity of donor organs. 

This shortage is apparently "dramatic" in many European countries, Gansevoort says — a situation the ERA-EDTA is trying to rectify. 

However, the minuscule number of patients with ESRD who receive a donor organ right away is not the only alarming finding revealed by the ERA-EDTA registry data. 

The incidence of patients requiring RRT is also rising, as Gansevoort indicated. For example, in 2016, 121 individuals per pmp started RRT. By 2017, this number had risen to 127 individuals per pmp. 

Of course, the main explanation for the growing need for RRT across Europe is the fact that the general population is aging and kidney diseases are more likely to occur in the elderly. 

Europe has not seen an end to the demographic shift towards an increasingly elderly population, at least for the foreseeable future, Gansevoort pointed out. 

"What we see here is not an abnormal development per se, but it is nevertheless a challenge we have to cope with," he noted. 

This means that the number of patients in Europe requiring RRT will rise accordingly — posing a major challenge to European healthcare systems. 

Preventive Kidney Care Varies Greatly Across European Nations 

It is noteworthy that the annual cost to treat each hemodialysis patient ranges from $59,000 per year in Germany to $71,000 per year in France and $84,000 per year in Belgium (US dollars). 

Also, a large part of the enormous variability in the need for RRT between different European countries can be attributed to differences in the general health of their resident populations and the availability of preventive measures in different nations, the report concludes. 

Thus, strengthening strategies for the prevention of kidney disease is not only in the interest of patients but also policymakers, Gansevoort stressed. 

"It is high time that the focus is put on the rising incidence of ESRD," he added. 

For European patients who required RRT between 2011 and 2015, the chances of them being alive at 2 years following initiation of RRT were highest for those who received a deceased donor organ, at 96.8%, or living donor organ, at 98.4%. 

In contrast, 75.6% of patients who started dialysis during the same study interval were still alive at 2 years, while 78% of all patients on RRT were still alive at 2 years following treatment initiation.