Inherited kidney diseases (IKD) 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. We have re-examined the etiology of KRT by composing a separate IKD and CAKUT PRD group using data from the European Renal Association (ERA) Registry. 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% ADPKD], 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 younger than 20 years (41.0% of cases), but their incidence rate was highest among those aged 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 younger than 45 years (29.1%). 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, and highlights the importance of genetic testing in the diagnostic workup of CKD.

BACKGROUND In 2020, the 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. Also changes occurring during the first and second wave of the pandemic were 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 most 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 decline. In dialysis patients, mortality increased by 11.4%, and was highest in those aged 65-74 years (16.1%), in those with diabetes as 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=317787) resembled that of 2019 (N=317077). 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.

ABSTRACT Background The European Renal Association (ERA) Registry collects data on kidney replacement therapy (KRT) in patients with end-stage kidney disease (ESKD). This paper is a summary of the ERA Registry Annual Report 2021, including a comparison across treatment modalities. Methods Data was collected from 54 national and regional registries from 36 countries, of which 35 registries from 18 countries contributed individual patient data and 19 registries from 19 countries contributed aggregated data. Using this data, incidence and prevalence of KRT, kidney transplantation rates, survival probabilities and expected remaining lifetimes were calculated. Result In 2021, 533.2 million people in the general population were covered by the ERA Registry. The incidence of KRT was 145 per million population (pmp). In incident patients, 55% were 65 years or older, 64% were male, and the most common primary renal disease (PRD) was diabetes (22%). The prevalence of KRT was 1040 pmp. In prevalent patients, 47% were 65 years or older, 62% were male, and the most common PRDs were diabetes and glomerulonephritis/sclerosis (both 16%). On 31 December 2021, 56% of patients received haemodialysis, 5% received peritoneal dialysis, and 39% were living with a functioning graft. The kidney transplantation rate in 2021 was 37 pmp, a majority coming from deceased donors (66%). For patients initiating KRT between 2012–2016, 5-year survival probability was 52%. Compared to the general population, life expectancy was 65% and 68% shorter for males and females receiving dialysis, and 40% and 43% shorter for males and females living with a functioning graft.

Dear Colleagues, We are delighted to share another issue (September 2023, Volume 29, Issue 3) of the European Journal of Therapeutics (Eur J Ther). We believe this issue’s valuable and exciting works will be read with interest. As you will notice at first glance, you will see that this issue contains many editorials and letters to the editor, unlike the previous issues. As the new editorial team, we aim to publish current developments, interesting notes, or important historical anecdotes in medicine as Editorials, Special Editorials, or Letters to the Editor. We would like to inform you that you can submit all of your articles that meet these criteria to our journal. In this editorial, we would like to share the developments that we think are important for Eur J Ther, since our previous editorial [1]. First, we would like to share that the Eur J Ther is approved for inclusion in ERIH PLUS [2]. Moreover, the Eur J Ther now also appears in the Journal Section of the ResearchGate [3]. In this way, it will be possible to follow the Eur J Ther through ResearchGate. We wish to inform you that our editorial team is diligently striving to deliver enhanced advancements in the forthcoming editions. Another significant development is that an application to the Index Copernicus was submitted for the Eur J Ther on July 31, 2023 [4]. In the previous issue, it was reported that some of the cited references made to the previous articles published in the Eur J Ther were not reflected in the Web of Science, and applications via “data changes form” were made to correct them [1]. Most of these applications have been completed, updated in the Web of Science database, and corrected missing references. With these corrections and new citations in the last three to four months, the average per-item value (total number of citations for all articles divided by the number of articles) of the Eur J Ther has increased from 0.52 to 0.78 [5]. In addition, the journal’s H-Index has risen from 8 to 10. The current metrics of Eur J Ther in the Web of Science are as follows, as of August 16, 2023 [5]. Total number of publications: 800 (between 2007 to 2023) Citing Articles (total): 593 Citing Articles (without self-citations): 558 Times Cited (total): 620 Times Cited (without self-citations): 570 Average per item: 0.78 (620/800) H-Index: 10 Although these metrics may be insufficient for Eur J Ther, which has been published for over thirty years, we, the New Editorial Team, anticipate that we can achieve better levels in the long run with our updated policies. Another significant development is that the Journal Impact Factor value of the Eur J Ther was calculated for the first time, and this value was 0.3. As is known, the Web of Science calculated Journal Impact Factors for the first time for journals in the E-SCI index as of 2023 [6]. Although a Journal Impact Factor of 0.3 is not satisfactory, it is not bad for a journal whose Journal Impact Factor is calculated for the first time. On the other hand, we believe that this value will increase in the coming years, as essential and valuable studies will be published in our journal. The previous issue reported that there are significant changes in the Editorial Board of Eur J Ther [1, 7]. We are pleased to inform you that we continue to expand our editorial team in this issue. Information about our esteemed editors, who have recently joined our team, is below. Ricardo Grillo, DDS, MBA, MSc, is a new Editorial Board Member of the Eur J Ther for Oral and Maxillofacial Surgery. Dr Grillo is the Head of the Department of Oral and Maxillofacial Surgery at IPESP (Brasília). He has more than 20 years of experience in Orthognathic Surgery, Oral Surgery and Maxillofacial Aesthetics. He is also a court expert in the topic. His special interest is related to new technologies including algorithms, virtual surgical planning, CAD and biotechnology. Figen Govsa (Gokmen), MD, finished her higher education at the Faculty of Medicine at Dokuz Eylul University in Izmir between 1982 and 1988. In 1989, she worked as a general practitioner at the Cal Health Center in Denizli Province. From 1990 to 1992, she served as an assistant at the Department of Anatomy at Ege University’s Faculty of Medicine. She worked as an associate professor at the Department of Anatomy between 1996 and 2001, and since 2001, she has been a professor. She has served in various faculty and upper management positions in Ege University’s institutional structure, continuing her education-focused administrative roles in several councils and committees at the Faculty of Medicine. She has contributed to undergraduate and postgraduate education across Ege University’s faculties, mentoring master’s, doctoral, and specialist students, helping them become academics in the field of anatomy. Her research interests include clinical anatomy (surgical anatomy, head and neck surgery, vascular surgery, reconstructive surgery), radio-anatomy, anatomy teaching, and personalized treatment algorithms. She is the founder of the Digital Imaging and Three-Dimensional Modeling Laboratory- Ege 3D Lab (www.ege3dlab.com), where personalized surgical plans have increased surgical success in complex cases involving orthopedics, general surgery, neurosurgery, eye surgery, radiation oncology, and thoracic surgery. With 150 SCI-expanded indexed academic journal articles, she has served as editor and chapter author for several scientific books published by national and international publishers. She has been an executor and researcher on numerous national projects in collaboration with national and international scientists. She is the Education and Terminology theme editor of the Surgical Radiological Anatomy journal and serves as an editor and reviewer for many foreign journals. She was the only anatomist from Turkey to be included in Stanford University's list of the World's Most Influential Scientists. Her joint publication with Prof. Dr. Yelda Pınar, titled "Anatomy of the superficial temporal artery and its branches: its importance for surgery", was ranked among the top 50 most-cited articles in the face rejuvenation theme by Mayo Clinic's Department of Plastic Surgery since 1950. It's the only study from Turkey in the "Landmarks in Facial Rejuvenation Surgery: The Top 50 Most Cited Articles. Aesthet Surg J, 2020." From 2010 to 2012, Govsa contributed as a member of the TÜBA Turkish Medical Terminology Dictionary Working Group and was invited to rejoin the TÜBA working group starting in 2021. Since its establishment, she has been a member of the Turkish Anatomy and Clinical Anatomy Association, serving on its Qualification Board and Ethical Committee. She is also a member of the European Clinical Anatomy Association (EACA). Özgür Kasapçopur, MD, is a Professor in Pediatrics at Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Pediatrics, and is currently Head of Pediatric Rheumatology. He serves as the Chairman of the Institutional Review Board and Clinical Research Ethical Committee of Cerrahpasa Medical Faculty. Professor Kasapçopur received his undergraduate education in Medicine at Istanbul University, Cerrahpasa Medical Faculty and also completed here both his residency and fellowship in the Department of Pediatrics. Professor Kasapçopur is a member of the Pediatric Rheumatology European Society (PReS), the Pediatric Rheumatology International Trials Organization (PRINTO), the Turkish Pediatric Association and the Turkish National Society of Pediatric Rheumatology. Professor Kasapçopur’s research interests include vaccine response, cytokine pathway, and medical ethics, with clinical emphases on juvenile idiopathic arthritis, familial Mediterranean fever, autoinflammatory disease and juvenile systemic lupus erythematosus, dermatomyositis and scleroderma. Professor Kasapçopur has published 83 book chapters in Turkish medical textbooks, and more than 315 original peer-reviewed articles (and case reports) in medical journals. The h-index of Professor Kasapçopur is 55 in Google Scholar and 43 in Web of Science. He had more than 8800 citations in the Web of Science. Professor Kasapcopur is Editor-in-Chief of Turkish Archives Pediatrics. Additionally, Professor Kasapcopur is the Associate Editor of Archives of Rheumatology, Frontiers in Pediatrics, and Case Report in Pediatrics. He is also on the editorial board of many scientific national and international journals. Harry Pantazopoulos, PhD is a faculty member in the Department of Psychiatry and Human Behavior at the University of Mississippi Medical Center. Dr Pantazopoulos received his A.L.M. degree from Harvard University and his doctoral degree in Neurobiology from Northeastern University in Boston. He trained as a postdoctoral fellow and a Junior Faculty at Mclean Hospital, Harvard Medical School before joining the University of Mississippi. The research of the Pantazopoulos lab is focused on identifying the neuropathological correlates of psychiatric disorders with an emphasis on the role of the extracellular matrix and circadian rhythms. He pursues these questions using a combination of human postmortem and animal model approaches. His long-term research goal is to develop a foundation of changes in neurocircuitry in several diseases, including Autism Spectrum Disorders, Schizophrenia, Bipolar Disorder, Major Depression and Substance Use Disorders, that he can leverage to develop more effective treatments. In addition, he aims to identify basic biological mechanisms that will provide insight into how the circadian system and the extracellular matrix regulate neural functions in a brain region-specific manner, linked to specific behaviors. Ghada Shahrour, PhD, PMHCNS, RN is a faculty member at the Faculty of Nursing in Jordan University of Science and Technology. She is an associate professor in the field of psychiatric nursing and currently is the Chairman of the Community and Mental Health N

Dear Colleagues, In the previous editorial paper published by Balat et al. [1] as an Early View Article a few months ago, it was reported that there were changes in the Editorial Team of the European Journal of Therapeutics (Eur J Ther). During these few months, while the preparations for the new issue (June 2023, volume 29, Issue 2) continued, the editorial board also was revised. We would like to inform you that the Editorial Board has been strengthened by academics who are competent in their fields from many countries of the world and will continue to be strengthened in the future. As it is known, Eur J Ther started broadcasting in 1990 as a Journal of the Faculty of Medicine University of Gaziantep (In Turkish: Gaziantep Üniversitesi Tıp Fakültesi Dergisi). In the first paper titled “While Starting” (In Turkish: Başlarken) of the first issue, Prof. Sabri Güngör, who was the first Editor-in-Chief, stated that the aim of the journal is to have an influential place in the field of science [2]. Over the past three decades, the journal has continued to advance. At the present time, it is inevitable to reorganise the editorial board of the journal and enrich it with leading international editors in order to move the journal to better places. This editorial will explain essential developments in the journal in the last few months, and the new Editorial Board Members of the Eur J Ther will be introduced. Changes are inevitable, and we are delighted to announce that this issue marks several significant improvements. Specifically, we bolstered our editorial team with esteemed international academics and expanded our pool of referees. Consequently, the evaluation period for the submitted articles was significantly reduced. In the last two months, the journal metrics are as follows: Acceptance rate: %29 Average time until the final decision: 24.4 days Average time to publish as Accepted/Early View Article, after acceptance: 4.8 days. Thanks to these improvements, as you will notice, there are 25 articles in this issue. In this way, this issue has been the issue in which most articles have been published so far. In addition, applications were made to DOAJ (Directory of Open Access Journals) and BASE (Bielefeld Academic Search Engine), among the most essential open-access databases in the world, in May 2023. Moreover, cited references to the previous and/or alternative names of the journal (Gaziantep Medical Journal, Gaziantep Med J, Gaziantep Tıp Dergisi and Gaziantep Üniversitesi Tıp Fakültesi Dergisi) in Web of Science that were not reflected in the journal metrics were identified and reported to the Web of Science. Some of these correction requests have been finalized and corrected, and thus the total number of citations and the H-index of the journal increased [3]. After all these data are updated, it will be seen that the citation values of the Eur J Ther will increase even more. We will also update the guidelines for the authors and reviewers with respect to the ICMJE [4] and EQUATOR Network [5], which will enhance the quality of research in the medical fraternity. Additionally, the use of DOI for articles published in the journal started in 2011 (2011, volume 17, Issue 2). In order to facilitate the recognition and access of the articles, DOIs have also been defined for all articles published in previous issues.   Editors Ayşe Balat, MD, became the new Editor-in-Chief of Eur J Ther for the second time, the first between 2007-2010. She is a Professor in Pediatrics and a specialist in Pediatric Nephrology and Rheumatology. She has been working as Vice President of Gaziantep University since October 2020. She was the Dean of Gaziantep University Medical Faculty (2007-2010), President of the Mediterranean Kidney Society (MKS) between 2015 to 2018, and Secretary beginning in 2018. She is also President of the International Association for the History of Nephrology (IAHN) since 2022. In Gaziantep, she first established Pediatric Nephrology and Pediatric Rheumatology Units, and the first peritoneal dialysis was performed by her. She has several studies published in international and national peer-reviewed scientific journals (H-Index: 26, i10-index: 59 and approximately 2500 citations). She was the Guest Editor of the International Journal of Nephrology in 2012 (special issue titled “Devil’s Triangle in Kidney Diseases: Oxidative Stress, Mediators, and Inflammation”). She is a member of many national and international associations related to her field, including membership in the Turkish Pediatric Nephrology Association board in the past. She has several scientific presentation awards at national and international congresses. She has been joined as an “invited speaker” at 20 International Meetings.           As of 2007, she organizes World Kidney Day activities within the scope of the “Survival is not Enough” program (in the first rank among European pediatric nephrologists as an organizer of those activities). Recently, she was elected as a “lifelong member of the Academy of Medicine and Surgical Sciences” of the University of Naples, which is one of the four important academies in Naples.   Şevki Hakan Eren, MD, is the new Deputy Editor-in-Chief of the Eur J Ther. Dr Eren graduated from the Medical School, University of Gaziantep, Turkey and completed Emergency training at Cumhuriyet University. He has been working as a Professor at Gaziantep University, Department of Emergency Medicine, Gaziantep, Turkey. He is interested in traumatology, and toxicology.   Mehmet Sait Menzilcioğlu, MD, is the new Deputy Editor-in-Chief of the Eur J Ther. Dr. Menzilcioğlu graduated from the Medical School, University of Gaziantep, Turkey and completed Radiology training at the same University. He has been working as an Associate Professor at Gaziantep University, Department of Radiology, Gaziantep, Turkey. He is interested in neuroradiology, ultrasonography, doppler Ultrasonography, Computerized Tomography, Magnetic Resonance Imaging, interventional radiology, and obstetric sonography.   İlhan Bahşi, MD, PhD, is the new Deputy Editor-in-Chief of the Eur J Ther. Dr Bahşi is also on the Editorial Board of the Journal of Craniofacial Surgery, Frontiers in Neuroanatomy, and Mersin University School of Medicine Lokman Hekim Journal of History of Medicine and Folk Medicine. In addition, he has published more than 80 articles (H-index: 12 and i10-index: 15) and has been a referee for more than 600 academic papers in many internationally indexed journals. Dr Bahşi, who has been working in the Department of Anatomy at the Gaziantep University Faculty of Medicine since 2012, completed his doctorate education in 2017 and obtained the title of PhD. Besides anatomy, he is particularly interested in the history of medicine, medical ethics, and education.   İlkay Doğan, PhD, is the new Editorial Board member of the Eur J Ther for Statistics and Methodology. He is in the Department of Biostatistics at the Gaziantep University Faculty of Medicine. His professional focus lies in research about Structural Equation Modeling, Multivariate Analysis. With a wealth of experience spanning over 15 years across multiple disciplines, including veterinary, nursing, sport and medicine, Dr Doğan has held various notable articles. He is a member of the Turkish Biostatistics Association.   Ahmet Acıduman, MD, PhD, graduated from Ege University Faculty of Medicine in 1987 and later specialized in Neurosurgery in 1997. Dr Acıduman further expanded his academic credentials by completing a PhD in the History of Medicine and Ethics in 2005. Currently, he is a Professor in the Department of History of Medicine and Ethics at Ankara University Faculty of Medicine. With a notable record of over 200 academic publications, Dr Acıduman’s contributions to the field continue.   Bilal Çiğ, PhD, is a new Editorial board member of the Eur J Ther. Associate Prof Bilal Çiğ is a Postdoctoral researcher at King's College London Wolfson Card. He has been investigating the roles of ion channels in neurological diseases using the patch clamp technique for nearly 15 years. For the past few years, he has focused on the interactions of TRPA1 and Kir 4.1 channels in demyelination. He has 40 SCI-E and international publications, with about 1300 citations.   Tsvetoslav Georgiev, MD, PhD, holds an esteemed position as an associate professor at the First Department of Internal Medicine in Varna, Bulgaria, while also working as a clinician at the University Hospital St. Marina. He has successfully defended his doctoral dissertation in 2018 at the Medical University in Sofia. Having obtained a specialization in rheumatology that same year, Dr Georgiev has extensive expertise in this intricate field of medicine. He further expanded his knowledge and skills by attending comprehensive courses on imaging diagnostics and musculoskeletal ultrasound in rheumatology held in various locations. Dr Georgiev has been involved in formulating the Bulgarian consensus on osteoarthritis and EULAR recommendations for the non-pharmacological core management of osteoarthritis. Notably, Dr Georgiev has received recognition for his outstanding contributions as a reviewer, earning awards in 2019 and 2021 from the Korean Academy of Medical Sciences.   Davut Sinan Kaplan, PhD, is a new Editorial Board Member of the Eur J Ther. Dr Kaplan is an Associate Professor in the Department of Physiology at Gaziantep University Faculty of Medicine. He is also the Graduate School of Health Sciences’ Director. He has taken involved in a wide variety of research with animal models. His research generally focuses on Endocrinology, Metabolism, Physical Activity, and Breast Milk. He has mentored a large group of master’s and PhD students. He has served for many years as a member of the local animal experiments ethics committee.   Mehmet Karadağ, MD, is a new Editorial Board Member of the Eur J Ther for Psychiatry. Dr. Karadag is an Assoc

ABSTRACT Background Large international differences exist in kidney transplantation (KT) rates. We aimed to investigate which factors may explain the total, deceased donor and living donor KT rates over the last decade. Methods KT experts from 39 European countries completed the Kidney Transplantation Rate Survey on measures and barriers and their potential effect on the KT rate in their country. In the analyses, countries were divided into low, middle and high KT rate countries based on the KT rate at the start of study period in 2010. Results Experts from low KT rate countries reported more frequently that they had taken measures regarding staff, equipment and facilities to increase the total KT rate compared with middle and high KT rate countries. For donor type–specific KT, the largest international differences in measures taken were reported for deceased donor KT, with middle and high KT rate countries taking more measures, such as the use of expanded criteria donor kidneys, the presence of transplantation coordinators and (inter)national exchange of donor kidneys. Once a measure was taken, experts’ opinion on its success was similar across the low, middle and high KT rate countries. Experts from low KT rate countries more often reported potential barriers, such as patients’ lack of knowledge and distrust in the healthcare system. Conclusions Particularly in low KT rate countries, the KT rate might be stimulated by optimizing staff, equipment and facilities. In addition, all countries may benefit from measures specific to deceased and living donors.