#872 An overview of 67 national-level factors potentially related to the incidence of kidney replacement therapy across European countries

Abstract Background and Aims Kidney replacement therapy (KRT) incidence varies considerably across European countries. We aimed to provide a comprehensive and up-to-date overview of national-level factors potentially related to KRT incidence for all individual European countries and across low, middle and high KRT incidence countries. Secondly, we aimed to describe the relationship between these factors and KRT incidence. Method We obtained unadjusted KRT incidence rates from the European Renal Association (ERA) Registry annual reports and studies. Countries were divided into low [0–100 per million population (pmp)], middle (100–200 pmp) and high (>200 pmp) KRT incidence countries. Online sources were searched for information on factors potentially related to KRT incidence, including geographic, socioeconomic, sociocultural and health-related factors and factors related to chronic kidney disease (CKD) and national capacity for CKD prevention. Linear or polynomial regression was used to model linear or curvilinear univariate relationships using data from all individual countries, with the R coefficient as metric of correlation strength. As secondary analysis, we evaluated the univariate relationship between each significant factor from the main analysis and the KRT incidence separately for the wealthy (gross domestic product (GDP) per capita >$40,000) and less affluent (GDP per capita <$40,000) countries. Results 38 European countries were included in this study, and divided into 12 low, 21 middle, and 5 high KRT incidence countries. Among the 67 factors evaluated, the number of practicing physicians (R = 0.374, P = 0.023), the population density (R = 0.508, P = 0.001), the median age at KRT initiation (R = 0.549, P = 0.001), the percentages of CKD-attributed deaths (R = 0.418, P = 0.038) and disability-adjusted-life-years (R = 0.420, P = 0.010) and the physical inactivity prevalence (R = 0.569, P < 0.001) were statistically significantly positively correlated with KRT incidence. According to our secondary analysis these findings were consistent among less affluent countries, while only the median age at KRT initiation remained significant among wealthy countries. After multiple test correction, median age at KRT initiation, physical inactivity prevalence and population density remained statistically significantly positively correlated with KRT incidence (Fig. 1). Conclusion We visualized the distribution of 67 national-level factors potentially related to KRT incidence across 38 European countries. We did not aim to prove causality and inevitably some of the factors studied may be both the cause and the consequence of differences in the KRT incidence. We found that the median age at KRT initiation, physical inactivity prevalence and population density were the most important factors significantly correlated with KRT incidence. These findings may be a first important step for policy makers, stakeholders and nephrologists to optimize healthcare (planning) regarding KRT initiation and minimize disparities in KRT incidence.