A comparison of the epidemiology of kidney replacement therapy between Europe and the United States: 2021 data of the ERA Registry and the USRDS

Vianda S. Stel, Rianne Boenink, Megan E. Astley, Brittany A. Boerstra, Danilo Radunovic, Rannveig Skrunes, Juan Carlos Ruiz San Millán, Maria F. Slon Roblero, Samira Bell, Pablo Ucio Mingo, Marc A. G. J. Ten Dam, Patrice M. Ambühl, Halima Resić, Olga Lucía Rodríguez Arévalo, Nuria Aresté-Fosalba, Jaume Tort i Bardolet, Mathilde Lassalle, Sara Trujillo-alemán, Ólafur S Indriðason, Marta ArtamendiPatrik Finne, Marta Rodríguez Camblor, Dorothea Nitsch, Kristine Hommel, George Moustakas, Julia Kerschbaum, Mirjana Lausevic, Kitty J. Jager, Alberto Ortiz, Anneke Kramer (Lead / Corresponding author)

Research output: Contribution to journalArticlepeer-review


BACKGROUND AND HYPOTHESIS: This paper compares the most recent data on the incidence and prevalence of kidney replacement therapy (KRT), kidney transplantation rates, and mortality on KRT from Europe to those from the United States (US), including comparisons of treatment modalities (haemodialysis (HD), peritoneal dialysis (PD), and kidney transplantation (KTx)).

METHODS: Data were derived from the annual reports of the European Renal Association (ERA) Registry and the United States Renal Data System (USRDS). The European data include information from national and regional renal registries providing the ERA Registry with individual patient data. Additional analyses were performed to present results for all participating European countries together.

RESULTS: In 2021, the KRT incidence in the US (409.7 per million population (pmp)) was almost 3-fold higher than in Europe (144.4 pmp). Despite the substantial difference in KRT incidence, approximately the same proportion of patients initiated HD (Europe: 82%, US: 84%), PD (14%; 13% respectively), or underwent pre-emptive KTx (4%; 3% respectively). The KRT prevalence in the US (2436.1 pmp) was 2-fold higher than in Europe (1187.8 pmp). Within Europe, approximately half of all prevalent patients were living with a functioning graft (47%), while in the US, this was one third (32%). The number of kidney transplantations performed was almost twice as high in the US (77.0 pmp) compared to Europe (41.6 pmp). The mortality of patients receiving KRT was 1.6-fold higher in the US (157.3 per 1000 patient years) compared to Europe (98.7 per 1000 patient years).

CONCLUSIONS: The US had a much higher KRT incidence, prevalence, and mortality compared to Europe, and despite a higher kidney transplantation rate, a lower proportion of prevalent patients with a functioning graft.
Original languageEnglish
Article numbergfae040
JournalNephrology Dialysis Transplantation
Early online date4 Mar 2024
Publication statusE-pub ahead of print - 4 Mar 2024


  • epidemiology
  • kidney replacement therapy
  • incidence
  • prevalence
  • mortality


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