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.

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.

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.

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