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Introduction After decades of increasing dialysis incidence, we observed a decreasing trend in the Netherlands in the last decade. We compared this trend with trends in other European countries. Materials and Methods Aggregated data for calendar years 2001–2019 from the Dutch registries of kidney replacement therapy patients and the European Renal Association Registry were used. Dialysis incidence in the Netherlands was compared with that in 11 other European countries/regions using three age groups: 20–64, 65–74, and ≥75 years, taking into account pre-emptive kidney transplantation (PKT) incidence. Time trends were assessed as annual percentage change (APC) with 95% confidence intervals (CI) using joinpoint regression analysis. Results Between 2001 and 2019 the Dutch dialysis incidence decreased slightly among patients aged 20–64 years (APC −0.9, 95% CI −1.4; −0.5). For patients 65–74 and ≥75 years old, a peak was seen in 2004 and 2009, respectively. Afterwards, the decrease was most marked in patients aged ≥75 years: APC −3.2 (−4.1; −2.3) versus APC −1.8 (−2.2; −1.3) for patients 65–74 years old. PKT incidence increased significantly during the study period but remained limited compared to the observed decrease in dialysis incidence, especially among older patients. Large differences in dialysis incidence were observed among European countries/regions. A decreasing dialysis incidence among older patients was also seen in Austria, Denmark, England/Wales, Finland, Scotland, and Sweden. Conclusions The Dutch dialysis incidence decreased most profoundly among older patients. This was also observed in several other European countries/regions. Although PKT incidence increased, it can only explain a minor part of the decrease in dialysis incidence.

BACKGROUND AND AIMS Acute kidney injury (AKI) affects up to one in five hospitalized patients and is independently associated with high morbidity and mortality. Additionally, patients have an increased risk for developing chronic kidney disease (CKD) after AKI. The combined impact of short- and long-term consequences and the high incidence of AKI results in a significant financial burden. Adequate intervention and follow-up might reduce the clinical impact of AKI, however the evidence for this remains inconclusive. The aim of this prospective cohort study was to evaluate whether nephrology consultation had an impact on patient follow-up and clinical outcome after AKI. METHOD All patients, admitted to VU medical centre in Amsterdam between October 2018 and April 2019, were screened for AKI by an automatic warning system integrated into the hospital's electronic patient record. This warning system sent a signal if serum creatinine would rise >27 µmol/L in 48 h or increased by a factor of at least 1.5 within 7 days (KDIGO criteria for AKI). The nephrology or internal medicine resident would then assess eligibility. Exclusion criteria were: a rise in serum creatinine that did not represent an actual AKI, admittance to the intensive care unit at the time of the signal, admission for kidney transplantation and patients that died before consultation was possible. After identification, nephrology consultation was provided. For the least severe AKI cases (KDIGO stage 1), this was done by telephone after review of the patient record, and for severe AKI cases (KDIGO stage 2 and 3) by full clinical review. Patients were grouped according to adherence (consult or no consult) to this protocol. Adequate follow-up was defined as a specific post-AKI referral to a nephrologist or general practitioner after hospital discharge. Recovery of serum creatinine and 6-month mortality were used as primary measures of clinical outcome. RESULTS A total of 371 cases of possible AKI were identified by the warning system. Of those case, 218 cases were eligible for inclusion. In 160 cases, nephrology consultation was performed (consult group). In 58 cases, there was no consult (no-consult group). The average age was 67.4 years. The consult and no-consult groups were similar at baseline (mean age, male/female, incidence of hypertension and diabetes), besides a higher incidence of CKD in the consult group (79% versus 64%; P = 0.034). The consult group had a significantly larger percentage of severe AKI cases (stage 2 or 3 in 29.4% of cases versus 12.1%; P = 0.021). Treatment was initiated in 93.1% of consult cases and in 70.6% of no-consult cases (P CONCLUSION When compared with cases of generally less severe AKI in which nephrology consultation was not performed, cases with nephrology consultation were associated with higher rates of treatment of AKI, faster recovery of kidney function and similar mortality. The data are in line with earlier non-randomized research which concluded that nephrology consultation can be linked to improved outcome in AKI. Before any definitive conclusions can be drawn, these associations should be found replicable in a randomized multi-centre setting and cost-effectiveness and feasibility should be analysed.