Report from the European Kidney Forum 2017

On 11 April, EKHA (European Kidney Health Alliance) and the MEP Group for Kidney Health hosted the European Kidney Forum 2017.

The main aim of this collaboration is to bring together experts from the kidney community (physicians, patients, researchers, health economists, nurses and allied professionals) and European policymakers to discuss key topics and activities related to kidney health. In 2015, EKHA launched its Recommendations for Sustainable Kidney Care for policy makers in order to influence kidney health policy at EU level.  This year’s Forum focused on the second cluster of recommendations – patient choice of treatment.

The main outcome:

• MEP Hilde Vautmans (BE) in her opening speech stressed that more attention should be given to kidney health at EU level, including better treatments for patients and more affordable self- or home care, issues related to transplantation such as organ harvesting.
• EKHA  presented the results of its multi-country survey to build a Snapshot of Renal Patient Choice in Europe to explore the issue in the context of sustainability of kidney care, economic impact on health systems, and outcomes impact on the patient and quality of life. The background and findings are:
  • Health inequalities in kidney care in Europe: inability to continue work or study due to dialysis dependence; time lost at dialysis (travelling to and from, waiting); inability to be mobile/travel; health implications; personal cost implications and implications for family.
  • Factors taken into account re RRT (Renal Replacement Therapy) pointed out by several studies:
    • The highest survival and quality of life is offered by transplantation followed by home dialysis strategies – PD (Peritoneal Dialysis) and home HD (Home Hemodialysis)
    • Amongst dialysis strategies, patients preference goes towards home strategies, irrespective of whatever they ate treated in center or not
    • TP (Post-Dialysis based on the physiologically-appropriate patient clearance time) and home strategies are more cost-effective to societies
  • Survey methodology: 7 counties (UK, France, Netherlands, Slovenia, Lithuania, Spain, Greece) – in total – 662 patients and 460 healthcare professionals; 1 survey for patients and 1 survey for health professionals; conducted online and deployed via EKHA’s member networks (patients, nurses and physicians organisations). The conclusions are:
    • Amongst transplantation options, living donation is often discriminated
    • Low patient awareness of possible options due to the lack of patients information
    • Free choice is hampered by financial drivers and lack of trained staff
    • The options of the patients and their families are often neglected
  • Recommendations to improve patients’ access to choice of treatment:
    • EKHA maintains that all therapies should be accessible to all patients throughout Europe and in order to safe-guard this right a better distribution of healthcare spending and cost savings is required.
    • Key tasks: patients-centred decision-making in RRT;  fair access and distribution of care modalities across regions; social impact should be considered in the search for technological innovation; option for conservative care if appropriate.
• Health economic factors: the QUALY (quality-adjusted life years) concept was presented that states that crucial is to strike the balance between healthcare money and health effects. The review concluded that providing drug insurance to people with chronic diseases who have no drug insurance appears to increase appropriate use of and adherence to drugs. The shift of financial responsibility to patients may lead to underuse of potentially important medications in people with chronic conditions. In order to improve the current situation and help ensure patient access to care, it has been suggested to shift towards value-based insurance scheme that varies cost sharing depending on whether the drug, procedure or treatment is considered high or low value for money. The speaker concluded by saying prevention that acts on persons indirectly, by altering their physical or social environment is most cost-effective and innovations should be available for all.
• The EC (European Commission) referred to the main findings of its recently published report Health at a Glance: Europe that shows in average 10{cabf78295431282ca1bec49ffbe2c87b89a1285ae102b2d0687184fc21af24ba} of GDP countries spend on health, only 3{cabf78295431282ca1bec49ffbe2c87b89a1285ae102b2d0687184fc21af24ba} healthcare funding is on prevention (4.1{cabf78295431282ca1bec49ffbe2c87b89a1285ae102b2d0687184fc21af24ba} in the UK) whereas the employment rate of people with chronic diseases is much lower than for those who do not have any. The speaker referred to recently published ‘Social rank: a risk factor whose time has come?’ report that includes evidence-based strategies to minimise the impact of social hierarchy on health. He added that the EC is launching its Joint Action on Health Inequalities (€2,5m) included in the EC Work Programme 2017 and adopted in January. EU member states have now the deadline on 11 May to expressed their interests to join. The objective is to develop a policy framework with a list of actions and recommendations for local take up and implementation at national and regional level in order to fight health inequalities and to support health systems dealing with challenges related to integrating vulnerable groups. It includes those inequalities related to high influxes of migrants and the need of integrating these particular populations in the regular health systems. The work will build on the existing evidence, including the conclusions of theMarmot report and the recommendations of the WHO (World Health Organisation) Commission on Social Determinants of Health.

It has been also a reference to the statement of MEP Karin Kadenbach (AT), Chair of the MEP Group for Kidney Health on chronic kidney disease.

In addition, a three year pilot project EDITH was launched in February. It will assess the different treatment modalities for chronic kidney diseases currently used in the EU and the factors influencing the treatment choices by patients and doctors. It aims to further develop and establish registries to follow-up living donors as well as transplant recipients, to gather information to increase the quality and safety of living donors and all transplant recipients. The project will run until 31 December 2019 and will be structured around 6 WPs (Work Packages):

• WP 1 Coordination
• WP 2 Dissemination
• WP 3 Evaluation
• WP 4 Assessment of different treatment modalities for CKD (Chronic Kidney Disease)
• WP 5 Establishment of registries to follow-up living donors
• WP 6 Establishment of follow-up registers for transplant recipients