Management of kidney failure in Western Europe: structure, organisation and services

A recent paper to which Prof. Raymond Vanholder, EKHA President, contributed, looked into structures, organisation, and services for the management of kidney failure across the Western European region.

There has been a steady increase in kidney failure in Western Europe. This rise in burden is mainly attributable to ageing populations and increasing rates of diabetes and obesity – which are risk factors for chronic kidney disease (CKD), and thus for kidney failure. The increasing rates of CKD and kidney failure lead to an increase in the frequency of kidney replacement therapy (KRT; dialysis and kidney transplantation) in the region. The International Society of Nephrology (ISN) conducted numerous surveys to assess the global capacity for KRT, which were published in the ISN Global Kidney Health Atlas. The present study used this data to describe the current picture of KRT in 21 countries of the Western European Region.

Western Europe is an affluent region in comparison to other regions, and benefits from an operational health care system, guidelines for noncommunicable diseases, available health professionals, access to essential medicines, and universal health coverage. The functioning public health infrastructure has allowed the region to reduce premature deaths from major noncommunicable diseases.

According to the results, the prevalence of kidney failure varies greatly between countries in the region. Similarly, there are important disparities in the prevalence of treated kidney failure. In terms of initial treatment, haemodialysis is most commonly used across the Western European region, followed by peritoneal dialysis and pre-emptive kidney transplant in third place. The results showed significant variations in the rate of kidney transplantation across countries. All surveyed countries had the capacity to provide long-term haemodialysis. Although peritoneal dialysis was not available in all countries, exchange systems for peritoneal dialysis were efficient and well-organised. Transplantation services were offered in most countries, alongside information to patients, and preventive therapy to control infections and provide appropriate immunosuppression treatment after transplantation. Conservative care (nondialytic management of kidney failure) was available in the majority of countries when medically advised or chosen by the patient. 

Nonetheless, challenges in kidney failure care subsist in the region. Workforce shortages of nephrologists and other essential nephrology staff are reported across the region, with some countries suffering a significant scarcity of specialists. Only half of the countries addressed CKD in national public health strategies. Most often, CKD prevention and care were included within strategies for non communicable diseases, rather than in CKD-specific national strategies.

Although the Western European region is performing better in all aspects of kidney care, compared to other regions worldwide, some aspects could be improved. For example, it would be beneficial to increase CKD prevention, expand the workforce, implement more multi-disciplinary teams, and augment the access to telemedicine. Finally, more policies and public health strategies should target kidney failure prevention, treatment, and long-term care.

Read the article here.