Prevalence and incidence of renal disease in disadvantaged communities in Europe.

Despite well-established, publicly-funded national health systems, kidney disease inequalities exist in Europe. There are differences between countries in rates of treated end-stage renal disease, at least some of which appears explained by organizational and economic factors. Pooling of chronic kidney disease (CKD) prevalence data is allowing new like-for-like comparisons between countries, which suggest that there are also differences in underlying rates of kidney disease. The few studies that exist suggest a paradoxically lower rate of earlier stages of kidney disease in ethnic minority groups, which have long been known to have higher rates of end-stage disease. Once on renal replacement therapy, children of South Asian and Black origin are now being reported to have lower rates of survival and lower chances of receiving a kidney transplant. New challenges are reportedly being faced by renal services with immigrants arriving in Europe requiring immediate dialysis with limited ability to communicate with clinical staff and increased infection risk. And data are at last emerging on the risk of chronic kidney disease in Europe's biggest minority, disadvantaged population, the Roma. A public health approach to address these issues requires, as a first step, the extent of the problem to be measured.