An overview of international differences and time trends in the epidemiology and outcomes of dialysis and kidney transplantation in Europe

This thesis includes epidemiological studies on patients with end-stage kidney disease (ESKD) who are treated with kidney replacement therapy (KRT; dialysis or kidney transplantation) using data from the European Renal Association (ERA) Registry. The first part of this thesis reports the incidence and survival of KRT patients. In Europe in 2019, the overall incidence rate of KRT was 132 per million population (pmp) with large variation across countries from 40 pmp in Ukraine to 284 pmp in Cyprus. Of the patients who started KRT, 84% started hemodialysis, 11% peritoneal dialysis and 5% received a kidney transplant. The life expectancy of patients on dialysis was about 70% shorter than in the general population. For kidney transplant recipients, life expectancy was approximately 40% shorter than that of the general population.
The second part of this thesis focuses on kidney transplantation (KT). KT, especially with a kidney from a living donor, is seen as the best treatment option for most patients with ESKD. We found that in most countries a variety of measures have been taken aiming to increase the KT rate such as the presence of transplantation coordinators and the use of standard protocols. Countries with low KT rates (predominantly Eastern European countries) more often perceived barriers such as patients’ lack of knowledge. For all European countries combined we observed an increase in both deceased and living donor KT rates in the last decade, with more older patients receiving a KT. The results reported in this thesis may guide the medical community and policy makers where to focus new strategies to improve the outcomes of KRT patients.