title: Time trend in access to the waiting list and renal transplantation: a comparison of four European countries.
abstract: BACKGROUND
  To examine the time trend and international differences in access to the waiting list and renal transplantation of patients with end-stage kidney disease.
  
  
  METHODS
  We included all patients (n = 30 961) from Austria, Norway, the Netherlands and Scotland who started renal replacement therapy (RRT) between 1995 and 2003 with their kidney transplant waiting list data (until 31 December 2005) and follow-up data on RRT and mortality (until 31 December 2007). The outcome measure was access to the waiting list within 2 years and to a first renal transplant within 4 years from the start of RRT, expressed as incidence per million age-related population (p.m.a.r.p.) per year. To estimate trends over time, mean percentage annual change (MPAC) and 95% confidence interval (CI) were calculated.
  
  
  RESULTS
  In each country, the number of patients starting RRT > 65 years increased significantly over time, whereas the number of renal transplants did not increase to the same extent. Only in Norway were almost all patients on the waiting list transplanted within 4 years of RRT start if they were < 65 years. In patients who started RRT > 65 years, the access to renal transplantation was high in Norway (49 p.m.a.r.p.) and low in Austria ( < 26 p.m.a.r.p.), the Netherlands and Scotland (both < 10 p.m.a.r.p.) but increased significantly in Austria (MPAC = 9.8%; 95% CI = 3.9-16.9) and the Netherlands (MPAC = 9.0%; 95% CI = 3.2-15.0).
  
  
  CONCLUSIONS
  Only in Norway, virtually all patients on the waiting list < 65 years received a transplant within 4 years after the start of RRT and, remarkably, also most of those > 65 years of age.
authors.affiliation: ERA–EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. v.s.stel@amc.uva.nl
authors.forename: Vianda S
authors.initials: VS
authors.lastname: Stel
authors.forename: Reinhard
authors.initials: R
authors.lastname: Kramar
authors.forename: Torbjorn
authors.initials: T
authors.lastname: Leivestad
authors.forename: Andries J
authors.initials: AJ
authors.lastname: Hoitsma
authors.forename: Wendy
authors.initials: W
authors.lastname: Metcalfe
authors.forename: Jacqueline M
authors.initials: JM
authors.lastname: Smits
authors.forename: Pietro
authors.initials: P
authors.lastname: Ravani
authors.forename: Kitty J
authors.initials: KJ
authors.lastname: Jager
mesh_terms: D000367:Age Factors; D000368:Aged; D001317:Austria / Q000453:epidemiology; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D009664:Norway / Q000453:epidemiology; D011379:Prognosis; D017582:Renal Replacement Therapy; D012307:Risk Factors; D012606:Scotland / Q000453:epidemiology; D015996:Survival Rate; D013997:Time Factors; D014850:Waiting Lists