Survival of children receiving dialysis varies widely across Europe

All European Union Member States have made commitments towards reducing inequalities in access to health care and in health outcomes. But substantial differences in mortality rates persist in the paediatric renal replacement therapy population across Europe. This is the sad result of a brand new study published in The Lancet this week.

The authors extracted and carefully analyzed patient data from the European Society for Paediatric Nephrology/European Renal Association-European Dialysis and Transplant Association (ESPN/ERA-EDTA) Registry for 32 European countries. In summary, the analysis showed that public health expenditure was inversely associated with mortality risk and explained 67% of the variation in renal replacement therapy mortality rates between countries. Moreover, differences between countries in their ability to treat the youngest patients, who are typically the most complex and costly to treat, were an important driver for poor outcomes.

"We hope that this study is a huge wake-up call for policy makers in Europe", explains Professor Kitty J. Jager, Managing Director of the ERA-EDTA Registry. Throughout Europe there are vast inequalities in access to renal care. Especially Eastern European countries remain burdened by stringent austerity measures and limited health-care budgets, which results in higher mortality rates. "In some countries children are still dying, because renal care does not meet the European standards. This is something we are not willing to accept any longer. Measures for improvement have to be taken!"

But what measures would be promising? The study observed a positive trend between the number of paediatric nephrologists in a country and the time patients spent in nephrological care before starting renal replacement therapy. "This makes an early referral a key factor for a better survival of pediatric dialysis patients und underlines the value of specialist care as it has already been shown for adult patients", comments Professor Dr Andrzej Więcek, president of the ERA-EDTA. "Nephrology is a key subspecialty of internal medicine which has to be strengthened within the healthcare systems, if we want to decrease patient mortality."

Article: Mortality risk disparities in children receiving chronic renal replacement therapy for the treatment of end-stage renal disease across Europe: an ESPN-ERA/EDTA registry analysis, Prof Kitty J Jager et al., The Lancet, doi: 10.1016/S0140-6736(17)30063-6, published 20 March 2017.