NEW data from the European Renal Association (ERA) Registry reveal a sustained rise in kidney replacement therapy (KRT) incidence and prevalence across Central and Eastern Europe, alongside marked differences between individual countries. The findings provide the first comprehensive overview of long-term KRT trends in this region from 2010 to 2021.
Marked National Variation in Kidney Replacement Therapy Use
Analysing registry data from 19 Central and Eastern European countries, researchers found that overall KRT incidence (new cases) increased by an average of 1.5% per year between 2010 and 2019. This translated into a rise from 106.3 per million population (pmp) in 2010 to 119.6 pmp in 2019. However, this regional trend masked substantial national variation. While KRT incidence declined significantly in Bosnia and Herzegovina, it remained stable in nine countries and increased in eight, underlining persistent inequalities in access to and delivery of renal care.
The growth in KRT prevalence was even more pronounced. Across the region, prevalence rose by 5.1% annually, increasing from 426.2 pmp in 2010 to 651.2 pmp in 2019. Nearly all countries demonstrated rising prevalence, with Belarus the only exception, where rates remained stable. Importantly, the authors noted that this increase was largely driven by growth in kidney transplant prevalence, suggesting improvements in long-term survival and transplant activity rather than dialysis expansion alone.
Contrary to concerns raised elsewhere in Europe, the COVID-19 pandemic did not appear to significantly disrupt KRT trends in Central and Eastern Europe. Most incidence and prevalence patterns observed before 2020 continued through to 2021, indicating a degree of resilience within renal services during the pandemic period.
The authors emphasised that the variation observed between countries was considerably greater than that reported in Western Europe. These disparities may reflect differences in healthcare infrastructure, funding, organ donation systems, and access to transplantation programmes.
Optimising Kidney Replacement Therapy Care in Eastern Europe
By highlighting both regional progress and persistent national gaps, the study offers valuable insights for clinicians, policymakers, and healthcare planners. The authors concluded that these data could support the development of country-specific strategies aimed at optimising KRT provision and reducing inequalities in renal care across Central and Eastern Europe.
As the burden of end-stage kidney disease continues to rise globally, understanding such regional trends is essential to inform sustainable and equitable nephrology services.
Reference
Bonthuis M et al. Incidence and prevalence of kidney replacement therapy in central and eastern europe –trends from the ERA registry. Nephrol Dial Transplant. 2026;doi: 10.1093/ndt/gfaf268
