5.7.6. Future developments

There is a need for an integrated strategy of community management of CKD, including self-care and long-term conditions. New models and new technologies (e.g. telemedicine) may be very helpful in this respect. The RenalPatientView, which is being rolled out in a number or renal units in the UK offers a web-based system to provide support to kidney patients.

Monitoring and evaluation are essential in the prevention of ESRD and in the improvement of survival and quality of life of those patients for whom ESRD cannot be prevented. Under the umbrella of the ERA-EDTA registry, most of the national and regional renal registries in EU Member States have started to collaborate within the QUEST initiative (Jager and Zoccali, 2007). This initiative includes not only European collaborative studies on different aspects on the quality of ESRD care, but also projects to stimulate the future EU wide availability of comparable data on clinical performance indicators in RRT. The availability of these data would facilitate (inter)national benchmarking and the collection of new epidemiological knowledge. In addition, such data will assist policy makers and other stakeholders in guiding their decisions. The NephroQUEST project that has recently been funded under the Public Health Programme of the European Commission, will help making these data available through the standardization of clinical performance indicators, the development of techniques to automatically extract clinical data from electronic medical records and by bringing renal registries in development up to high quality standards.

As already summarized in the paragraph on policies a growing number of Member States have developed national health policies regarding RRT for ESRD. In contrast, only very few countries have developed this kind of policies for CKD. The development of these policies, however, including full recognition of CKD as a preventable disease and the development of meaningful screening strategies and prevention programs is vital. As stated in the introduction, these policies for CKD will need to be harmonized with policies for other chronic diseases.

In Europe there is still no document on pan-European or national health plans of the calibre of Healthy People 2010 (http://www.healthypeople.gov/), i.e. a document that challenges individuals, communities, and professionals to take specific steps to ensure that good health, as well as long life, are enjoyed by all. In Healthy People 2010 specific goals have been fixed for curbing ESRD in the American population. Indicators on these goals are currently being monitored (http://www.ep.niddk.nih.gov/Divisions/kuh/kidneyHP2010.htm).

In most Member States, dialysis multinational companies have taken over or set up haemodialysis centres. Over the next few years the number of these private centres is expected to grow.

In Europe the availability of cadaver kidneys for renal transplantation is far below the demand. As patient survival and quality of life are higher in transplant recipients compared to dialysis patients, whereas costs of treatment are lower, it is important to increase organ donation rates. Some countries (Spain, Scandinavian countries, Austria) have successfully implemented policies that ensure superior donation rates. Legislation and the development and promulgation of specific policies at European level may be of help for improving organ donation rates ( see also the Chapter 9.2. on Transplants).