BACKGROUND AND HYPOTHESIS Kidney replacement therapy (KRT) practices in Europe are heterogeneous, with apparent differences between Western and Central/Eastern Europe. However, time trends in KRT incidence and prevalence in Central and Eastern Europe are not previously reported. Therefore, we aimed to describe trends in incidence and prevalence of KRT in Central and Eastern Europe from 2010 to 2021. METHODS Data on incident and prevalent KRT patients from 19 Central and Eastern European countries between the years 2010 and 2021 were derived from the European Renal Association (ERA) Registry. Time trends were calculated using JoinPoint regression. RESULTS Overall, KRT incidence increased with 1.5% (95% confidence interval (CI): +0.7 to + 2.6%) per year from 106.3 per million population (pmp) in 2010 to 119.6 pmp in 2019. However, trends differed within the region. While in Bosnia and Herzegovina KRT incidence significantly decreased from 2010 to 2019, it remained stable in nine and increased in eight countries. The overall KRT prevalence increased with 5.1% (95% CI: +4.5 to + 5.7%) per year from 426.2 pmp in 2010 to 651.2 pmp in 2019. KRT prevalence increased in all countries, except for Belarus where it remained stable, and was mainly attributable to increases in the prevalence of kidney transplantation. The COVID-19 pandemic did not have a major impact on KRT incidence and prevalence in the region, as most trends remained until 2021. CONCLUSIONS Although we found an overall increase in KRT incidence and prevalence in the region, large country variations remain, much larger than observed in Western Europe. The results of this study can help to define country-specific priorities for the optimization of KRT care in Central and Eastern Europe.

BACKGROUND This paper compares the incidence and prevalence of kidney replacement therapy (KRT), kidney transplantation rates, and mortality on KRT between Europe and the United States (US), including sex comparisons. METHODS Data were derived for 2022 from the population-based European Renal Association (ERA) Registry and the United States Renal Data System (USRDS). RESULTS In 2022, the KRT incidence in the US (388.7 per million population (pmp)) was 2.7-fold higher than in Europe (146.2 pmp), with a greater difference for women (3.2-fold) than for men (2.4-fold). The proportion of women initiating KRT was lower in Europe (35%) than in the US (41%). Between 2013 and 2022, the KRT incidence in Europe was stable in women (+0.1% annually), but increased in men (+1.1%). In the US, the KRT incidence increased similarly in women (+0.2%) and men (+0.3%). On 31 December 2022, the KRT prevalence was 2-fold (women: 2.2-fold, men: 1.9-fold) higher in the US (2444.2 pmp) than in Europe (1218.6 pmp). The proportion of women was lower in Europe (38%) than in the US (41%). The kidney transplantation rate was 1.7-fold higher in the US (79.1 pmp) than in Europe (45.4 pmp), 1.9-fold for women and 1.7-fold for men, with women accounting for 37% of the recipients versus 39% in the US. The KRT mortality rate was 1.5 times higher in the US (145.0 per 1000 patient years (/1000py)) compared to Europe (100.5/1000py): 1.6-fold for women and 1.4-fold for men. In Europe, mortality was lower for women receiving KRT (93.7/1000py) than for men (104.6/1000py), whereas in the US the reverse was (women: 148.9/1000py, men: 142.2/1000py). CONCLUSION The US had a notably higher KRT incidence, prevalence, kidney transplantation rate and mortality compared to Europe. Differences between Europe and the US were larger for women than for men.

AIM Lung ultrasound (LUS) can be used for an assessment of volume overload in patients with end-stage kidney disease (ESKD) and those undergoing dialysis. The aim of this study was to analyse whether the initial use of LUS in evaluating volume status could benefit patients by optimizing haemodialysis treatment and improving their clinical status. METHODS The study included 50 haemodialysis patients in stage V of ESKD with the diagnosis of ischaemic heart failure with reduced (HFrEF) or midrange ejection fraction (HFmrEF). The assessment of volume status was verified solely by LUS (along with the analysis of B lines as measures of volume status). The specified laboratory parameters were performed initially, after three, and after six months. RESULTS The number of B-lines on LUS were decreased during the six-month follow-up compared to baseline, indicating a reduction in volume overload due to the LUS-guided protocol. Statistically significant differences were observed in the average creatinine (p=0.001) and parathormone (PTH) (p=0.003) levels over the six-month monitoring period. Significant differences were also noted in triglyceride (p=0.000) and potassium (p=0.02) levels. No significant differences were found in the values of other monitored parameters. CONCLUSION In haemodialysis patients diagnosed with heart failure, LUS can aid the achievement of a more efficient volume reduction by decreasing B-lines, which are indicative of congestion. Our study also demonstrated beneficial effects of LUS on potassium and parathormone levels.

The shortage of applications for fellowships in nephrology is a worldwide challenge. This is the first survey to explore in Europe the reasons physicians choose (and do not choose) a career in nephrology. An anonymous questionnaire was sent to the presidents of societies that are members of the European Renal Association (ERA), who invited trainees and nephrologists to respond. Statistical analysis was performed using SPSS v.26. (SPSS Inc., Chicago, IL, USA). Continuous variables were compared by Student's t-test or by one-way ANOVA. Responders included 516 (49%) females and 542 (51%) males. They comprised 278 (26%) trainees, and 780 (74%) nephrologists. The majority (64%) believe that students have an unfavourable perception of nephrology. For trainees, nephrology is not considered an attractive option due to ‘chronically ill patients’ (35%), ‘lack of contact during undergraduate training’ (37%), ‘nephrology is too challenging’ (38%), ‘poor remuneration’ (22%), ‘negative role models’ (15%), and ‘long working hours’ (14%). The factors with the greatest impact on choosing a career include a positive role model (46%), practical experience during medical school and early postgraduate training (42%). Trainees emphasize that work–life balance is very important for the younger generation. A strong mentorship along with early engagement is associated with a higher likelihood of pursuing a career in nephrology. It is crucial to create a strategy that will provide a positive experience, renew the interest in nephrology careers and ensure enough nephrologists to treat the growing number of patients with kidney disease.

ABSTRACT Background Inherited kidney diseases (IKDs) and congenital anomalies of the kidney and urinary tract (CAKUT) are causes of kidney failure requiring kidney replacement therapy (KRT) that major renal registries usually amalgamate into the primary renal disease(PRD) category ‘miscellaneous’ or in the glomerulonephritis or pyelonephritis categories. This makes IKDs invisible (except for polycystic kidney disease) and may negatively influence the use of genetic testing, which may identify a cause for IKDs and some CAKUT. Methods We re-examined the aetiology of KRT by composing a separate IKD and CAKUT PRD group using data from the European Renal Association (ERA) Registry. Results In 2019, IKD-CAKUT was the fourth most common cause of kidney failure among incident KRT patients, accounting for 8.9% of cases [IKD 7.4% (including 5.0% autosomal dominant polycystic kidney disease), CAKUT 1.5%], behind diabetes (23.0%), hypertension (14.4%) and glomerulonephritis (10.6%). IKD-CAKUT was the most common cause of kidney failure among patients <20 years of age (41.0% of cases), but their incidence rate was highest among those ages 45–74 years (22.5 per million age-related population). Among prevalent KRT patients, IKD-CAKUT (18.5%) and glomerulonephritis (18.7%) were the two most common causes of kidney failure overall, while IKD-CAKUT was the most common cause in women (21.6%) and in patients <45 years of age (29.1%). Conclusion IKD and CAKUT are common causes of kidney failure among KRT patients. Distinct categorization of IKD and CAKUT better characterizes the epidemiology of the causes of chronic kidney disease (CKD) and highlights the importance of genetic testing in the diagnostic workup of CKD.

ABSTRACT Background In 2020, the coronavirus disease 2019 (COVID-19) pandemic caused disruptions in kidney replacement therapy (KRT) services worldwide. The aim of this study was to assess the effect of the COVID-19 pandemic in 2020 on the incidence of KRT, kidney transplantation activity, mortality and prevalence of KRT across Europe. Methods Patients receiving KRT were included from 17 countries providing data to the European Renal Association Registry. The epidemiology of KRT in 2020 was compared with average data from the period 2017–2019. Changes occurring during the first and second waves of the pandemic were also explored. Results The incidence of KRT was 6.2% lower in 2020 compared with 2017–2019, with the lowest point (−22.7%) during the first wave in April. The decrease varied across countries, was smaller in males (−5.2%) than in females (−8.2%) and was moderate for peritoneal dialysis (−3.7%) and haemodialysis (−5.4%) but substantial for pre-emptive kidney transplantation (−23.6%). The kidney transplantation rate decreased by 22.5%, reaching a nadir of −80.1% during the first wave, and was greatest for living donor kidney transplants (−30.5%). While in most countries the kidney transplantation rate decreased, in the Nordic/Baltic countries and Greece there was no clear decrease. In dialysis patients, mortality increased by 11.4% and was highest in those 65–74 years of age (16.1%), in those with diabetes as the primary renal disease (15.1%) and in those on haemodialysis (12.4%). In transplant recipients, the mortality was 25.8% higher, but there were no subgroups that stood out. In contrast to the rising prevalence of KRT observed over the past decades across Europe, the prevalence at the end of 2020 (N = 317 787) resembled that of 2019 (N = 317 077). Conclusion The COVID-19 pandemic has had a substantial impact on the incidence of KRT, kidney transplant activity, mortality of KRT and prevalence of KRT in Europe with variations across countries.

ABSTRACT Background This paper compares the most recent data on the incidence and prevalence of kidney replacement therapy (KRT), kidney transplantation rates, and mortality on KRT from Europe to those from the United States (US), including comparisons of treatment modalities (haemodialysis (HD), peritoneal dialysis (PD), and kidney transplantation (KTx)). Methods Data were derived from the annual reports of the European Renal Association (ERA) Registry and the United States Renal Data System (USRDS). The European data include information from national and regional renal registries providing the ERA Registry with individual patient data. Additional analyses were performed to present results for all participating European countries together. Results In 2021, the KRT incidence in the US (409.7 per million population (pmp)) was almost 3-fold higher than in Europe (144.4 pmp). Despite the substantial difference in KRT incidence, approximately the same proportion of patients initiated HD (Europe: 82%, US: 84%), PD (14%; 13%, respectively), or underwent pre-emptive KTx (4%; 3%, respectively). The KRT prevalence in the US (2436.1 pmp) was 2-fold higher than in Europe (1187.8 pmp). Within Europe, approximately half of all prevalent patients were living with a functioning graft (47%), while in the US, this was one third (32%). The number of kidney transplantations performed was almost twice as high in the US (77.0 pmp) compared to Europe (41.6 pmp). The mortality of patients receiving KRT was 1.6-fold higher in the US (157.3 per 1000 patient years) compared to Europe (98.7 per 1000 patient years). Conclusions The US had a much higher KRT incidence, prevalence, and mortality compared to Europe, and despite a higher kidney transplantation rate, a lower proportion of prevalent patients with a functioning graft.

ABSTRACT Background Primary glomerular disease (PGD) is a major cause of end-stage kidney disease (ESKD) leading to kidney replacement therapy (KRT). We aimed to describe incidence (trends) in individuals starting KRT for ESKD due to PGD and to examine their survival and causes of death. Methods We used data from the European Renal Association (ERA) Registry on 69 854 patients who started KRT for ESKD due to PGD between 2000 and 2019. ERA primary renal disease codes were used to define six PGD subgroups. We examined age and sex standardized incidence, trend of the incidence and survival. Results The standardized incidence of KRT for ESKD due to PGD was 16.6 per million population (pmp), ranging from 8.6 pmp in Serbia to 20.0 pmp in France. Immunoglobulin A nephropathy (IgAN) and focal segmental glomerulosclerosis (FSGS) had the highest incidences, of 4.6 pmp and 2.6 pmp, respectively. Histologically non-examined PGDs represented over 50% of cases in Serbia, Bosnia and Herzegovina, and Romania and were also common in Greece, Estonia, Belgium and Sweden. The incidence declined from 18.6 pmp in 2000 to 14.5 pmp in 2013, after which it stabilized. All PGD subgroups had 5-year survival probabilities above 50%, with crescentic glomerulonephritis having the highest risk of death [adjusted hazard ratio 1.8 (95% confidence interval 1.6–1.9)] compared with IgAN. Cardiovascular disease was the most common cause of death (33.9%). Conclusion The incidence of KRT for ESKD due to PGD showed large differences between countries and was highest and increasing for IgAN and FSGS. Lack of kidney biopsy facilities in some countries may have affected accurate assignment of the cause of ESKD. The recognition of the incidence and outcomes of KRT among different PGD subgroups may contribute to a more individualized patient care approach.