What Is Driving Europe's Renal Replacement Therapy Surge?
In 2022, 567,440 patients with end-stage renal disease in Europe received renal replacement therapy (RRT), with an unadjusted prevalence of 1074 per million population. In France, the rate was 1383 per million population among 93,486 patients (mean age, 63.5 years; 62% men). These data were obtained from the European Renal Association Registry, which collects information on RRT in patients with end-stage kidney disease. The RRT data were obtained from 53 registries in 35 countries, covering approximately 530 million individuals. After adjusting for age and sex, France's prevalence was among the highest in Europe (1440 per million population vs 1192 per million population overall). Across the cohort, 56% underwent haemodialysis, 39% had a renal transplant, and 5% received peritoneal dialysis.
In 2022, there were 80,389 incident RRT cases in Europe — an unadjusted incidence of 152 per million population, up from 145 per million population in 2021. France reported 163 cases per million people. The age- and sex-adjusted incidence rates were 163 and 168 per million population in Europe and France, respectively. On average, 54% of new cases were aged 65 years or older, and 64% were men. Haemodialysis use increased by 83% with patient age, while peritoneal dialysis and renal transplantation declined by 12% and 5%, respectively. No differences were observed between the sexes.
In 2022, 21,261 patients underwent renal transplantation, including 3352 in France. Across Europe, 66% of grafts were from deceased donors compared with 15% in France. Among patients who began RRT between 2013 and 2017, the unadjusted 5-year survival probabilities were 51.5%, 41.3% for those on dialysis, 85.1% for recipients of deceased donor grafts, and 94.2% for recipients of living donor grafts. Dialysis patients aged 20-24 years have an estimated remaining life expectancy of 20 years for men and 21 years for women, which is 39 and 44 years shorter, respectively, than their age-matched peers in the general population.
Women account for 24%-46% of RRT cohorts across Europe, from 24% in Iceland to 46% in Estonia, with France at 33%. The initial RRT modality did not differ according to sex.
The French National Authority for Health has announced a forthcoming set of best-practice recommendations for live kidney donation, which are expected to be released in the third quarter of 2025. These guidelines aim to enhance both donor and recipient safety, harmonise practices, and improve overall outcomes in live kidney donation procedures, and address recent studies, despite methodological limitations that raised concerns about potential morbidity risks for the recipient.
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