Country profiles

Belgium has implemented clinical guidelines and quality indicators for CKD management. Its two registries are important sources of data, but the absence of CKD from the most recent national health survey means there is a gap in epidemiological data and reflects a lack of policy focus on CKD as a key chronic disease.

Germany's disease management plans reflect CKD only as a co-morbidity of other chronic diseases, but it has well-established national adaptations of international guidelines to inform CKD management. Its one registry is based on voluntary data entry, so although promising, its utility is limited.

Greece has no national policy on CKD, and it has been noticeably absent in all of the last decade’s national health plans. Adopting national guidelines would provide consistency in how practitioners identify and test patients at risk for CKD, enabling more timely intervention.

Portugal lacks policy and clinical guidelines for CKD. Its national registry covers only renal replacement therapy, expanding its remit could contribute to understanding of the numbers of people affected in Portugal and support its prioritisation in chronic disease policy. The Portuguese Society of Nephrology has implemented training for primary care physicians to raise awareness of CKD.

Spain has adapted international evidence based guidelines, including a clear referral pathway. Currently Spain's national institute of statistics does not list CKD as a leading cause of death. Linking the datasets in its regional and national registries to give comprehensive national data on CKD burden could support its prioritisation in chronic disease policy.

France has a long history of publishing evidence-based guidelines and care pathways, but there remain gaps between recommendations and the care received. Innovations in telemonitoring for CKD are being trialled currently.

Italy has strong policies on integrated care for CKD and emphasises early detection and timely access to care. Its National Health Plan looks to use digital health models and tools to better manage chronic diseases, which could be beneficial in the diagnosis and management of CKD.

The Netherlands has interdisciplinary clinical guidelines in place for the management of CKD, but there remain issues with implementation. Digital health and e-health tools are being used to improve data collection, delivery of services and care coordination.

Poland has well developed national policies and clinical guidelines for chronic conditions, but these do not include CKD. Awareness of CKD is low among the public, recent inditiatives have aimed to raise awareness among GPs. Poland's three registries cover only later stages of the disease and are not fully integrated, limiting their potential use.

The addition of CKD to Romania's National Healthcare Strategy 2023-2030 has enabled great progress in introducing screening for people at risk of CKD and reimbursement of CKD related health checks. Whilst Romania's EHR system has been greatly expanded, a lack of linkage between systems still holds back data analysis and usage.