European East–West divide in kidney disease: the need to understand the drivers of chronic kidney disease outcomes

In this issue of ckj, Sever et al. (A roadmap for optimizing chronic kidney disease patient care and patient-oriented research in the Eastern European nephrology community. Clin Kidney J, this issue) present a roadmap for optimizing chronic kidney disease (CKD) patient care and patient-oriented research in Eastern Europe. The document clearly identifies current unmet needs and proposes corrective actions. Focusing on CKD epidemiology and outcomes, it collects evidence pointing to an East–West gradient for some key risk factors for CKD development. Thus, the prevalence of diabetes, raised blood pressure, obesity and tobacco use is higher in Eastern than in Western Europe. These risk factors may contribute to the higher CKD prevalence in Eastern Europe, which for the Eastern-most countries may be more than 2-fold higher than in Western Europe. The problem is compounded by the lower prevalence of dialysis and transplantation in Eastern Europe, especially in lower income countries. The combination of higher prevalence of CKD with lower prevalence of renal replacement therapy would be expected to result in higher CKD-associated mortality, but this is not the case. CKD-associated mortality may even be lower in the Eastern-most European countries than in Western Europe. The reasons for this discrepancy should be studied, since it may reveal serious additional healthcare issues, potentially related to high mortality from other non-communicable diseases (NCDs). If this is the case and the high mortality from other NCD is successfully addressed, pressure will further mount on renal replacement capacity needs in Eastern Europe.