# 67 national-level factors potentially related to the incidence of kidney replacement therapy across Europe

## TL;DR

This study explores factors related to kidney replacement therapy rates across European countries to help reduce disparities in treatment.

## Contribution

Identifies 67 national-level factors and their correlations with kidney replacement therapy incidence across Europe.

## Key findings

- Median age at KRT initiation, physical inactivity, and population density are strongly correlated with KRT incidence.
- Findings are consistent in less affluent countries, but only median age at KRT initiation matters in wealthy countries.
- After correction, three factors remain significantly correlated with KRT incidence.

## Abstract

Kidney replacement therapy (KRT) incidence varies considerably across European countries. We aimed to provide an overview of factors potentially related to KRT incidence for all individual European countries and across low, middle and high KRT incidence countries and to describe the relationship between these factors and KRT incidence.

We obtained unadjusted KRT incidence rates from the European Renal Association (ERA) Registry annual reports and studies. Countries were divided into low [0–100 per million population (pmp)], middle (100–200 pmp) and high (>200 pmp) KRT incidence countries. Online sources were searched for information on factors potentially related to KRT incidence including geographic, socioeconomic, sociocultural and health-related factors, and factors related to chronic kidney disease (CKD) and national capacity for CKD prevention. Univariate linear or polynomial regression were used to examine whether factors and KRT incidence were related, with the R coefficient as metric of correlation strength. Significant factors were also evaluated separately in less affluent and wealthy countries.

Thirty-eight European countries were included, and divided into 12 low, 21 middle and 5 high KRT incidence countries. Among 67 factors evaluated, the number of practicing physicians (R = 0.374, P = .023), the population density (R = 0.508, P = .001), the median age at KRT initiation (R = 0.549, P = .001), the percentages of CKD-attributed deaths (R = 0.418, P = .038) and disability-adjusted life years (R = 0.420, P = .010), and the physical inactivity prevalence (R = 0.569, P < .001) were significantly positively correlated with KRT incidence. These findings were consistent among less affluent countries, while median age at KRT initiation was the only significant factor among wealthy countries (R = 0.889, P < .001). After multiple testing correction, median age at KRT initiation, physical inactivity prevalence and population density remained correlated with KRT incidence.

These findings may be a first step for policy makers, stakeholders and nephrologists to optimize healthcare (planning) regarding KRT initiation and reduce KRT incidence disparities.

Graphical Abstract