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

Abstract Background 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. Methods 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. Results 38 European countries were included, and divided into 12 low, 21 middle, 5 high KRT incidence countries. Among 67 factors evaluated, the number of practicing physicians (R = 0.374, p = 0.023), the population density (R = 0.508, p = 0.001), the median age at KRT initiation (R = 0.549, p = 0.001), the percentages of CKD-attributed deaths (R = 0.418, p = 0.038) and disability-adjusted-life-years (R = 0.420, p = 0.010) and the physical inactivity prevalence (R = 0.569, p < 0.001) 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 < 0.001). After multiple testing correction, median age at KRT initiation, physical inactivity prevalence and population density remained correlated with KRT incidence. Conclusions 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.