Treatment modality choices for end-stage kidney disease in Europe

In this thesis, the frequency of dialysis, kidney transplantation and comprehensive conservative management for end-stage kidney disease (ESKD) and factors influencing treatment modality choice by patients and nephrologists in Europe were investigated under the umbrella of the European EDITH project. For the first aim, we combined data from the European Renal Association – European Dialysis and Transplant Association Registry with information from other registries, insurance data, personal communication and scientific articles. We demonstrated a large international variation in the incidence and prevalence of kidney replacement therapy (KRT) in general and a variable frequency of specific treatments. For the second aim, we surveyed European patients receiving KRT and nephrologists treating these patients about factors influencing modality choice. Patients from low-Gross Domestic Product (GDP) countries experienced poorer information provision and lower patients’ satisfaction than those from middle- or high-GDP countries. Quality of life, survival and safety were the most important factors influencing modality choice for patients, but they also reported many other reasons including costs, fears, and work or study. Enthusiasm of nephrologists for other treatments than in-centre haemodialysis was greater in middle- and high-GDP countries, while barriers to offer these treatments were more often experienced by nephrologists from low-GDP countries. Our findings suggest large international differences in the frequency of KRT and limited access to preferable treatments for many European patients with ESKD. Moreover, factors influencing treatment modality choice differ across Europe. Therefore, a single European policy may not be feasible and measures to improve access to treatments for ESKD should target clusters of comparable countries.