International Society of Nephrology Global Kidney Health Atlas: structures, organization, and services for the management of kidney failure in Western Europe

  • Dearbhla M. Kelly
    Affiliations
    Wolfson Centre for the Prevention of Stroke and Dementia, University of Oxford, John Radcliffe Hospital, Oxford, UK

    Department of Nephrology, Beaumont Hospital, Dublin, Ireland
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  • Hans-Joachim Anders
    Affiliations
    Division of Nephrology, Department of Internal Medicine IV, University Hospital of the Ludwig Maximilians University Munich, Munich, Germany
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  • Author Footnotes
    40 AKB and DWJ are co-chairs for International Society of Nephrology Global Kidney Health Atlas Project.
    Aminu K. Bello
    Footnotes
    40 AKB and DWJ are co-chairs for International Society of Nephrology Global Kidney Health Atlas Project.
    Affiliations
    Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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  • Gabriel Choukroun
    Affiliations
    Nephrology Dialysis Transplantation Department, CHU Amiens, MP3CV Research Unit, Amiens University, Amiens, France
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  • Rosanna Coppo
    Affiliations
    Fondazione Ricerca Molinette, Regina Margherita Hospital, Turin, Italy
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  • Gavin Dreyer
    Affiliations
    Department of Nephrology, Barts Health National Health Service Trust, London, UK
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  • Kai-Uwe Eckardt
    Affiliations
    Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany
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  • Author Footnotes
    40 AKB and DWJ are co-chairs for International Society of Nephrology Global Kidney Health Atlas Project.
    David W. Johnson
    Footnotes
    40 AKB and DWJ are co-chairs for International Society of Nephrology Global Kidney Health Atlas Project.
    Affiliations
    Department of Nephrology, Metro South and Ipswich Nephrology and Transplant Services (MINTS), Princess Alexandra Hospital, Brisbane, Queensland, Australia

    Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia

    Translation Research Institute, Brisbane, Queensland, Australia
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  • Vivekanand Jha
    Affiliations
    George Institute for Global Health, University of New South Wales (UNSW), New Delhi, India

    School of Public Health, Imperial College, London, UK

    Manipal Academy of Higher Education, Manipal, India
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  • David C.H. Harris
    Affiliations
    Centre for Transplantation and Renal Research, The Westmead Institute for Medical Research, University of Sydney, Westmead, New South Wales, Australia
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  • Adeera Levin
    Affiliations
    Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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  • Meaghan Lunney
    Affiliations
    Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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  • Valerie Luyckx
    Affiliations
    Nephrology, Cantonal Hospital Graubunden, Chur, Switzerland

    Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA

    Department of Child Health and Paediatrics, University of Cape Town, Cape Town, South Africa
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  • Hans-Peter Marti
    Affiliations
    Department of Clinical Medicine, University of Bergen, Bergen, Norway

    Division of Nephrology, Department of Medicine, Haukeland University Hospital, Bergen, Norway
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  • Piergiorgio Messa
    Affiliations
    Nephrology, Dialysis and Renal Transplant Unit, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Milan, Italy

    Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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  • Thomas F. Mueller
    Affiliations
    Nephrology Clinic, University Hospital Zurich, Zürich, Switzerland
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  • Syed Saad
    Affiliations
    Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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  • Benedicte Stengel
    Affiliations
    Center for Research in Epidemiology and Population Health (CESP), National Institute of Health and Medical Research (INSERM), Villejuif, France

    University Paris Saclay, Villejuif, France
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  • Raymond C. Vanholder
    Affiliations
    Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, Ghent, Belgium

    European Kidney Health Alliance, Brussels, Belgium
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  • Talia Weinstein
    Affiliations
    Department of Nephrology, Tel Aviv Medical Center, Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
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  • Maryam Khan
    Affiliations
    Faculty of Science, University of Alberta, Edmonton, Alberta, Canada
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  • Deenaz Zaidi
    Affiliations
    Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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  • Mohamed A. Osman
    Affiliations
    Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
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  • Feng Ye
    Affiliations
    Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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  • Marcello Tonelli
    Affiliations
    Department of Medicine, University of Calgary, Calgary, Alberta, Canada

    Pan-American Health Organization/World Health Organization’s Collaborating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, Alberta, Canada
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  • Ikechi G. Okpechi
    Affiliations
    Department of Medicine, University of Alberta, Edmonton, Alberta, Canada

    Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa

    Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
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  • Eric Rondeau
    Correspondence
    Correspondence: Eric Rondeau, Intensive Care Nephrology and Transplantation Department, Hopital Tenon, Assistance Publique-Hopitaux de Paris, 4 rue de la chine, Paris, 75651, France, and Sorbonne Université, Paris, France.
    Affiliations
    Intensive Care Nephrology and Transplantation Department, Hopital Tenon, Assistance Publique-Hopitaux de Paris, Paris, France

    Sorbonne Université, Paris, France
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  • on behalf of theISN Western Europe Regional Board
  • Author Footnotes
    40 AKB and DWJ are co-chairs for International Society of Nephrology Global Kidney Health Atlas Project.
      Populations in the high-income countries of Western Europe are aging due to increased life expectancy. As the prevalence of diabetes and obesity has increased, so has the burden of kidney failure. To determine the global capacity for kidney replacement therapy and conservative kidney management, the International Society of Nephrology conducted multinational, cross-sectional surveys and published the findings in the International Society of Nephrology Global Kidney Health Atlas. In the second iteration of the International Society of Nephrology Global Kidney Health Atlas, we aimed to describe the availability, accessibility, quality, and affordability of kidney failure care in Western Europe. Among the 29 countries in Western Europe, 21 (72.4%) responded, representing 99% of the region’s population. The burden of kidney failure prevalence varied widely, ranging from 760 per million population (pmp) in Iceland to 1612 pmp in Portugal. Coverage of kidney replacement therapy from public funding was nearly universal, with the exceptions of Germany and Liechtenstein where part of the costs was covered by mandatory insurance. Fourteen (67%) of 21 countries charged no fees at the point of care delivery, but in 5 countries (24%), patients do pay some out-of-pocket costs. Long-term dialysis services (both hemodialysis and peritoneal dialysis) were available in all countries in the region, and kidney transplantation services were available in 19 (90%) countries. The incidence of kidney transplantation varied widely between countries from 12 pmp in Luxembourg to 70.45 pmp in Spain. Conservative kidney care was available in 18 (90%) of 21 countries. The median number of nephrologists was 22.9 pmp (range: 9.47–55.75 pmp). These data highlight the uniform capacity of Western Europe to provide kidney failure care, but also the scope for improvement in disease prevention and management, as exemplified by the variability in disease burden and transplantation rates.

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