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Aim. This study investigates the difference in the incidence of renal replacement therapy (RRT) between Flanders and the Netherlands and possible explanations for this difference. Methods. End-stage renal disease incidence data were obtained from the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA). Additional sources were the National Institute of Statistics (NIS), the Central Bureau of Statistics (CBS), the Organisation for Economic Cooperation and Development (OECD) health data and the WHO Health For All database (WHO-HFA). Results. There is remarkable difference in incidence rate of RRT between Flanders and the Netherlands, with a higher rate in Flanders. This difference is already present in patients aged 45–64 years and increases with age, being >2-fold higher in subjects of ≥75 years. With respect to the renal diagnoses leading to need for RRT, a higher share of especially diabetes mellitus type 2 and renovascular disease was observed in Flanders. Remarkably, the difference in incidence rate of RRT is not associated with a difference in survival on RRT, not even in the elderly, arguing against a restricted access to RRT in the Netherlands. In the general population, the expected number of healthy life years at birth is lower in Belgium than in the Netherlands, and in Belgium, the hospital discharge rates for diabetes, acute myocardial infarction and cerebrovascular accident and the number of coronary bypass procedures and percutaneous coronary interventions per capitum is higher, as is the prevalence of obesity. Conclusion. Our data do not support the assumption that the differences in RRT incidence in the elderly between Flanders and the Netherlands are due to a more restricted access to RRT in the Netherlands but may be due to differences in underlying comorbidity and life style between the two populations. [ABSTRACT FROM AUTHOR]

Background. The incidence of renal replacement therapy (RRT) among patients aged ≥65 years is much higher in Flanders, the Dutch speaking region of Belgium, than in the Netherlands. We studied whether differences in referral policy to nephrologists by primary care physicians (PCPs) and specialists between Flanders and the Netherlands may play a role. Methods. A vignette study was performed among 329 PCPs and 96 specialists in Flanders and compared to the vignette study that was conducted among 209 PCPs and 162 specialists in the Netherlands. Physicians were offered six vignettes concerning case reports of patients with chronic kidney disease and varying co-morbidities or social circumstances. Each vignette was presented for a 65- and an 80-year-old patient. Physicians were asked about the likelihood of referral of the patients in the given circumstances. Univariate and logistic regression analyses were performed to identify whether country affected the likelihood of referral. Results. Univariate analyses showed that the percentage of PCPs who would probably or definitely refer a 65- or an 80-year-old patient with less severe co-morbidity was significantly (P ≤ 0.001) higher in the Netherlands than in Flanders. However, the likelihood of referral of PCPs-concerning patients with more severe co-morbidity did not differ significantly. Specialists in Flanders did not differ in the likelihood to refer patients from that of specialists in the Netherlands. Logistic regression analysis showed that country (higher referral in the Netherlands) was an important predictor for the referral of PCPs, and this was especially the case for patients with less severe co-morbidity. These patterns persisted, even after controlling for other possible predictors as physicians’ age, gender, religion and years in practice. Conclusions. This study suggests that the lower RRT incidence in the Netherlands cannot be explained by a more restrictive referral policy among physicians in the Netherlands. The data suggested that the latter group had a similar or even more liberal attitude to the referral of older patients than physicians in Flanders. [ABSTRACT FROM PUBLISHER]